Anxiety, depression, traumatic stress and COVID-19-related anxiety in the UK general population during the COVID-19 pandemic

COVID-19 trauma-related stress in young people: do sensory-processing sensitivity, resilience, and life satisfaction play a role?

Although COVID-19 was experienced as a traumatic event with long-lasting effects, there is limited data on its traumatic impact in relation to factors that can promote or threaten young people's mental wellbeing. This study investigated the association between sensory-processing sensitivity (SPS), resilience, and life satisfaction with COVID-19 trauma-related stress and whether resilience mediates the relationship between SPS and COVID-19 traumatic stress in a young sample. A total of 441 individuals aged between 16 and 25 years (Mage = 19.26, SD = 1.65) participated in an online survey in the UK between November 2021 and April 2022. We found that SPS was positively correlated, and resilience was negatively correlated with COVID-19 trauma-related stress. Life satisfaction was not significantly related to COVID-19 trauma-related stress. A mediation analysis showed that the relationship between SPS and COVID-19 trauma-related stress was mediated by resilience. Our findings suggest that resilience can be a protective factor against the traumatic effect of COVID-19 in young people, but other factors should also be considered. Our study makes implications about the potential benefits of including resilience in interventions which target young people's mental wellbeing.

Predictors of COVID-Related stress in a community sample in Turkey: a cross-sectional study

The distinctive mental health features associated with COVID-19 have gained importance as the psychological effects of the pandemic on the community become more visible. This study aims to assess the COVID-related stress status and associated factors in the community sample of Turkey. The sample of this cross-sectional study is composed of 2.065 people between the ages of 18-90. Data were collected through an online survey prepared by Google.docs between October-December, 2020. Mild to moderate stress was found in the community with the most common symptoms of the fear of contamination and danger. Some variables, such as being female and the severity of COVID-19 illness, were associated with higher COVID-related stress. Vulnerable groups associated with high stress should be monitored during the pandemic. The findings of this study will guide the practices of professionals working in the field of public health, healthcare, or mental health in possible future pandemics.

Understanding the Relationships Between Fear of COVID-19, Depression, Loneliness, and Life Satisfaction in Türkiye: Testing Mediation and Moderation Effects

AIM

This study examined the mediating roles of depression and various dimensions of loneliness (family, social, and romantic) in the associations between COVID-19 fear and satisfaction with life. Additionally, the research investigated how the economic impact of COVID-19, family income, gender, and marital status may moderate these associations.

DESIGN

A cross-sectional descriptive design.

METHODS

An online survey was conducted in Türkiye. 1702 participants completed self-report measures assessing COVID-19 fear, depression, social, emotional, and romantic loneliness, and satisfaction with life.

RESULTS

The findings revealed positive associations between COVID-19 fear and depression, along with negative relationships between COVID-19 fear and family, social, and romantic loneliness. Depression was identified as a mediator in the relationship between COVID-19 fear and the different components of loneliness. These loneliness components, in turn, influenced life satisfaction. Furthermore, the study found significant moderation effects related to the economic impact of COVID-19 restrictions, family income, marital status, and gender.

CONCLUSIONS

This study provides evidence about the psychological mechanisms linking COVID-19 fear to life satisfaction. It highlights the mediating role of depression and the moderating effects of demographic and economic factors. The findings emphasise the need for targeted mental health interventions, particularly addressing the varied impact of COVID-19 fear across different social and economic groups. This evidence can inform strategies aimed at improving life satisfaction during periods of social and economic disruption.

PATIENT OR PUBLIC CONTRIBUTION

This study has no direct patient involvement in its design, conduct, or reporting. However, it contributes to public health by providing evidence about the psychological impacts of COVID-19, which may inform future interventions and mental health support strategies.

Psychometric evaluation and community norms of the GAD-7, based on a representative German sample

Introduction

The Generalized Anxiety Disorder-7 (GAD-7) scale is widely used to assess generalized anxiety symptoms in both clinical and general populations. However, updated psychometric evaluations and population norms for the German adult population are lacking. This study aims to examine the psychometric properties of the GAD-7 and provide representative population norms.

Methods

A representative sample of the adult population in Germany (N = 2,519) was assessed. Item characteristics (means, standard deviations, inter-item correlations) were examined. Construct validity was evaluated through correlations with the PHQ-9 and BSI-18. Internal consistency was assessed using coefficient omega. Confirmatory factor analysis (CFA) was conducted to test the one-factor model, and measurement invariance across gender and age was examined using multi-group CFA.

Results

The GAD-7 demonstrated strong internal consistency and construct validity. CFA supported the assumed one-factor model. Measurement invariance analyses indicated that the GAD-7 provides comparable measurements across gender and age groups. Updated population-based norms were established for the total sample and specific age groups.

Discussion

Findings confirm the GAD-7 as a psychometrically sound measure for generalized anxiety in the general population. The updated norms enhance its applicability in clinical and epidemiological research, supporting its use for screening and assessment across diverse demographic groups.

Symptomatic Pathways of Comorbid Depression, Anxiety, and Stress Among Adolescents Exposed to Childhood Trauma-Insights from the Network Approach

Background

Childhood trauma can have a long-lasting influence on individuals and contribute to mental disorders, including depression and anxiety. Depression, anxiety, and stress are highly comorbid among adolescents with the trauma experience. Yet, the evolution of comorbidity remains unclear. To fill this gap, the current study aimed to explore the symptomatic and changing patterns of depression, anxiety, and stress among adolescents exposed to childhood trauma.

Methods

A total of 1548 college students (females = 782 (50.98%), Meanage = 19.59, SDage = 1.14) in China completed the Childhood Trauma Questionnaire (CTQ) and the Depression, Anxiety, and Stress Scales (DASS-21), and 942 students (Females = 516 (54.78%), Meanage = 19.57, SDage = 1.16) met the selection standard based on the cut-off scores of the CTQ. The symptomatic network and directed acyclic graph (DAG) network approaches were used.

Results

The results revealed that males reported experiencing significantly more physical abuse, physical neglect, emotional neglect, and sexual abuse compared to females. However, females scored significantly higher than males on "Worried" (DASS9), "Agitated" (DASS11), "Panic" (DASS15), and "Scared" (DASS20). No significant difference between genders was observed in the network structure and global strength. Meanwhile, among all participants, "Down-hearted" and "Agitated" appeared to be the most interconnected symptoms, the bridge symptoms in the symptom network, as well as the most vital symptoms in the directed acyclic graph network. Apart from that, "Panic" also served as the most prominent symptom in the directed acyclic graph network.

Conclusion

The results suggested that intervention targeted at assisting adolescents in developing more adaptive coping strategies with stress and regulating emotion could benefit the alleviation of comorbid depression, anxiety, and stress.

The Role of Religious Involvement as a Moderator of Perceived Health and Somatic Anxiety Among Hispanic Seventh-Day Adventists During COVID-19

This study investigated whether the relationship between perceived health and somatic anxiety is moderated by religious involvement among a sample of Hispanic Seventh-day Adventists (n = 365) during the COVID-19 pandemic. Using PROCESS moderation analysis, we examined the interaction between perceived health and religious involvement on somatic anxiety. Results indicated a significant interaction effect, suggesting that the inverse relationship between perceived health and somatic anxiety was stronger when religious involvement was present.

Coronavirus anxiety and its relationship to mood and cognition in post-acute sequelae of COVID-19

Background: Subjective and objective cognitive dysfunction may be observed in patients with post-acute sequelae of COVID-19 (PASC), and are associated with depression and general anxiety. Coronavirus anxiety (CA) is associated with subjective cognition, depression, and general anxiety in community samples. We determined the base rate of CA in patients with PASC and its relation to mood, subjective and objective cognition. Design and Methods: Participants were 79 patients with PASC referred for clinical neuropsychological evaluation, who completed the Coronavirus Anxiety Scale (CAS), BDI-II, BAI, BRIEF-A, and cognitive tests. Results: Base rate of clinically elevated CAS was low (5.1%), whereas BDI-II (78.6%), BAI (80%), and BRIEF-A Global Executive Composite (GEC; 60.3%) were high. Objective dysfunction was most common for Color-Word Interference (20.8%) and Trail Making Test (TMT) Part-B (23.1%). Greater CA was associated with worse depression, general anxiety, BRIEF-A GEC, and TMT Part-A. Higher GAI accounted for the CAS and BRIEF-A GEC association. Longer time since pandemic onset was only associated with decreasing CA. Exploratory factor analysis supported a unidimensional structure for the CAS. Conclusions: Clinically elevated CA is rare in patients with PASC seen for neuropsychological evaluation. Higher CA is associated with worse mood and subjective executive dysfunction, though the latter was accounted for by general anxiety. Patients with PASC who endorse a high level of CA would likely benefit from interventions to reduce emotional distress.

German college students' mental health state and their willingness to use mental health prevention: An online survey during the COVID-19 pandemic

The number of college students suffering from mental illnesses has been rising for several years. The COVID-19 pandemic has disproportionately affected young adults. Mental health prevention is essential in order to effectively reduce the incidence of mental disorders and may help to counteract chronic mental disorders in the long term. Data were derived from a German online survey of 1334 college students (M AGE = 24.75, SD AGE = 3.32, [19-42] years) conducted in autumn 2021. Besides validated questionnaires (PHQ-2, ASI-3, CD-RISC-10) to assess their mental health status, we asked specific questions on students' general interest in mental health prevention, whether students knew where to get help, and how many activities they engaged in to maintain their mental health. Students' overall interest in mental health prevention was high. Participants with clinically relevant scores were significantly more interested in prevention offers compared to those with clinically normal scores. Females engaged in significantly more activities to strengthen their mental health during the pandemic, and showed significantly higher anxiety scores and significantly lower resilience scores compared to their male counterparts. According to our results, students show decreasing mental health and resilience in times of crisis. Overall, motivation to seek professional support is high but knowledge about where to find such support is low. Based on these results, we conclude that easily accessible and low-threshold mental health prevention offers should be integrated into university curricula.

Digital mental health service engagement changes during Covid-19 in children and young people across the UK: Presenting concerns, service activity, and access by gender, ethnicity, and deprivation

The adoption of digital health technologies accelerated during Covid-19, with concerns over the equity of access due to digital exclusion. The aim of this study was to assess whether service access and presenting concerns differed before and during the pandemic. Sociodemographic characteristics (gender, ethnicity, and deprivation level) were examined to identify disparities in service use. To do this we utilised routinely collected service data from a text-based online mental health service for children and young people. A total of 61221 service users consented to sharing their data which represented half of the service population. We used interrupted time-series models to assess whether there was a change in the level and rate of service use during the Covid-19 pandemic (April 2020-April 2021) compared to pre-pandemic trends (June 2019-March 2020) and whether this varied by sociodemographic characteristics. The majority of users identified as female (74%) and White (80%), with an age range between 13 and 20 years of age. There was evidence of a sudden increase (13%) in service access at the start of the pandemic (RR 1.13 95% CI 1.02, 1.25), followed by a reduced rate (from 25% to 21%) of engagement during the pandemic compared to pre-pandemic trends (RR 0.97 95% CI 0.95,0.98). There was a sudden increase in almost all presenting issues apart from physical complaints. There was evidence of a step increase in the number of contacts for Black/African/Caribbean/Black British (38% increase; 95% CI: 1%-90%) and White ethnic groups (14% increase; 95% CI: 2%-27%), sudden increase in service use at the start of the pandemic for the most (58% increase; 95% CI: 1%-247%) and least (47% increase; 95% CI: 6%-204%) deprived areas. During the pandemic, contact rates decreased, and referral sources changed at the start. Findings on access and service activity align with other studies observing reduced service utilization. The lack of differences in deprivation levels and ethnicity at lockdown suggests exploring equity of access to the anonymous service. The study provides unique insights into changes in digital mental health use during Covid-19 in the UK.

Are thoughts and behaviours of individuals with schizophrenia more susceptible to being influenced during pandemic situations? A glimpse provided by the COVID-19 pandemic

Individuals with psychotic disorders such as schizophrenia may be more vulnerable during pandemics, but research on this topic is limited. This study examined COVID-19 impact on a population affected by schizophrenia during the COVID-19 pandemic. Levels of psychological distress and COVID-19-related behaviours, from the COVID-related Thoughts and Behavioral Symptoms (Cov-Tabs) Scale, were compared between 107 patients with schizophrenia and 70 control participants. Participants with schizophrenia had significantly higher Cov-Tabs scores than non-clinical participants. These results suggest a higher vulnerability in this population, emphasising the need for targeted support and further assessment.

Romantic attachment security buffers the effect of stress on anxiety in college students during the COVID-19 pandemic

Background and objectives: The stressors of the COVID-19 pandemic spurred alarming levels of stress and anxiety in college students. It is important to identify factors that attenuate the negative effect of stress on anxiety. Framed by the attachment diathesis-stress process perspective, this study examined how the two dimensions of insecurity in romantic attachment-attachment anxiety and attachment avoidance-buffered the effect of stress on anxiety in a population of college students during the first year of the COVID-19 pandemic. Design and methods: The study employed cross-sectional and correlation designs and used an online survey to gather self-report data from a sample of 453 college students. Data were collected from March 15, 2020, to February 16, 2021. Results: Anxiety, stress, and the two insecurity dimensions were all mutually correlated with one another. Multiple regression analysis revealed that as the level of attachment anxiety increased, the association of stress and anxiety turned stronger. Conclusions: The findings suggest that targeting attachment insecurity may prove to be fruitful when helping college students effectively regulate stress to lessen levels of anxiety.

How Does the Normalization Process After the COVID-19 Pandemic Affect Patients With Obsessive-Compulsive Disorder? A Longitudinal Study

ABSTRACT

This study aims to investigate the effect of the normalization process after the pandemic on obsessive-compulsive disorder (OCD) patients. During the pandemic period, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Padua Inventory-Washington State University Revision, the Fear of COVID-19 Scale (FCV-19S), and an interview form inquiring sociodemographic characteristics were applied to the participant patients with OCD. During the normalization process, the patients were reevaluated after about 1 year. A significant decrease was found in the patients' FCV-19S and PE-WSUR total scores along with all subscale scores as well as the Y-BOCS scores. The FCV-19S was associated with OCD symptoms both during the pandemic and the normalization period. The final FCV-19S scores of patients with a Y-BOCS score of 12 and under were found to be statistically significantly lower than the others. This study shows that OCD symptom severity and fear of COVID-19 decreased with the normalization process. A decrease in pandemic-related stress and fear of COVID-19 with the normalization process may have positively affected OCD patients.

Differential Effects of Pandemic-Related Stressors on Mental Health by Age and Sex

OBJECTIVE

There have been consistent concerns about a greater impact of COVID-19 on the mental health of younger people and females. We aimed to explore the potential synergistic effect of various pandemic-related stressors with age and sex on the mental health of the general Canadian household population during the COVID-19 pandemic.

METHODS

Using cross-sectional data from the Statistics Canada 2022 Mental Health and Access to Care Survey (MHACS), frequencies for major depressive episode (MDE), generalized anxiety disorder (GAD), general psychological distress, and various pandemic-related and demographic factors were estimated. Odds ratios were estimated using binary logistic regression models. These estimates used a replicate bootstrapping procedure recommended by Statistics Canada. Finally, Relative Excess Risk due to Interaction (RERI) models were used for each outcome to evaluate the interactions of each pandemic-related stressor with age and sex on an additive scale.

RESULTS

Past-12-month MDE and GAD, psychological distress, and the various COVID-19 stressors were more prevalent in young people and females. Overall, the stressors were confirmed to be associated with these outcomes. There were greater-than-additive interactions between age and difficulty accessing healthcare, loneliness, physical health problems, household relationship challenges, and work stress; and between sex and severe illness of a loved one, loneliness, work stress, LGBTQ2+ status, marital status, difficulty accessing healthcare, physical health problems, job/income loss, and financial difficulties. Generally, evidence of synergy was found between age and pandemic-related stressors and sex and pandemic-related stressors.

CONCLUSIONS

Greater-than-additive interactions of pandemic-related stressors with age and sex may indicate synergistic vulnerabilities within females and young people. Future pandemics, via corresponding stressors, may be associated with increased mental health vulnerability in females, youth, and especially young females.

'Let the System Do Its Job and Families Handle the Rest'? Protective and Risk Factors Contributing to Pandemic Crisis Parental Burnout

Background: The work main purposes were to identify the sources of problems and demands causing parental burnout and to specify the resources/support factors during the COVID-19 pandemic. The study was based on the Balance Theory of Risk and Support/Resource Factors (BR2 Model) by Mikolajczak and Roskam. Methods: The study explored the predictive value of socio-economic variables, religiosity, the meaning of life, positivity, perceived social support, family functionality, and balance between risks and resources in parental burnout using the structural equation modelling method on a sample of 337 parents. Results: The presence of children's learning difficulties and behavioural problems are the most important risk factors and aggravate parental burnout, and the presence of a meaning of life, support coming from the family, family affection, and relationship lengths are the main protective resources, allowing parental burnout to decrease during the pandemic crisis. Conclusions: The findings are instructive for both theory and practice. The study successfully operationalised the BR2 model-the model obtained from the path analysis fits well, confirms the structure of parental burnout theory, and demonstrates the appropriateness of the application of BR2 theory in crisis conditions. The most effective way to help parents in a crisis situation is (in addition to psychological support) the effective provision of specialist help for children, resulting in a reduced risk of an unfavourable balance between demands and family resources. The family- or parent-oriented interventions that address professional help in problems with children can be the most effective at reducing the negative consequences of a pandemic on children and their parents. The COVID-19 pandemic has shown the importance of investing in healthcare infrastructures.

Socio-demographic variation in diagnosis of and prescribing for common mental illnesses among children and young people during the COVID-19 pandemic: time series analysis of primary care electronic health records

BACKGROUND

The impact of the COVID-19 pandemic on the mental health of children and young people (CYP) has been widely reported. Primary care electronic health records were utilised to examine trends in the diagnosing, recording and treating of these common mental disorders by ethnicity and social deprivation in Greater Manchester, England.

METHODS

Time-series analyses conducted using Greater Manchester Care Record (GMCR) data examined all diagnosed episodes of anxiety disorders and depression and prescribing of anxiolytics and antidepressants among patients aged 6-24 years. The 41-month observation period was split into three epochs: Pre-pandemic (1/2019-2/2020); Pandemic Phase 1 (3/2020-6/2021); Pandemic Phase 2 (7/2021-5/2022). Rate ratios for all CYP specific to sex, age, ethnicity, and neighbourhood-level Indices of Multiple Deprivation (IMD) quintile were modelled using negative binomial regression.

RESULTS

Depression and anxiety disorder rates were highest in females, CYP aged 19-24, and White and 'Other' ethnic groups. During Pandemic Phase 1, rates for these diagnoses fell in all demographic subgroups and then rose to similar levels as those recorded pre-pandemic. In Pandemic Phase 2, rates in Black and Mixed-ethnicity females rose to a significantly greater degree (by 54% and 62%, respectively) than those in White females. Prescribing rates increased throughout the study period, with significantly greater rises observed in non-White females and males. The temporal trends were mostly homogeneous across deprivation quintiles.

CONCLUSION

The observed fluctuations in frequency of recorded common mental illness diagnoses likely reflect service accessibility and patients' differential propensities to consult as well as changing levels of distress and psychopathology in the population. However, psychotropic medication prescribing increased throughout the observation period, possibly indicating a sustained decline in mental health among CYP, and also clinicians' responses to problems presented. The comparatively greater increases in frequencies of diagnosis recording and medication prescribing among ethnic minority groups warrants further investigation.

Prevalence of posttraumatic stress disorder (PTSD) in Canada during the COVID-19 pandemic: results from the Survey on COVID-19 and Mental Health

INTRODUCTION

This study provides a descriptive overview of the prevalence of posttraumatic stress disorder (PTSD) in Canada, across sociodemographic characteristics, mental health-related variables and negative impacts of the COVID-19 pandemic.

METHODS

Data were obtained from cycles 1 and 2 of the Survey on COVID-19 and Mental Health (SCMH), collected in fall 2020 (N = 14 689) and spring 2021 (N = 8032). The prevalence of PTSD was measured using the PTSD Checklist for DSM-5 (PCL-5) Cross-sectional associations were quantified using logistic regression, while controlling for sociodemographic characteristics.

RESULTS

The overall prevalence of PTSD was 6.9%. Factors associated with higher PTSD prevalence were female gender; younger age; lower income (females only); living in an urban area; frontline worker status or not being at work in the past week (males only); fair or poor mental health; a weak sense of community belonging; symptoms of generalized anxiety disorder and major depressive disorder; suicidal ideation; heavy alcohol use; daily cannabis use; increased alcohol and cannabis use since the start of the pandemic; decreased alcohol consumption since the start of the pandemic (males only); concerns about violence in the home; and negative impacts of the pandemic.

CONCLUSION

PTSD prevalence in Canada varies significantly across sociodemographic groups and is more common among those with indicators of lower mental health and well-being, as well as those more adversely affected by the COVID-19 pandemic. Ongoing and enhanced surveillance of PTSD in Canada is important to better understand and address the burden and impacts of this condition.

The pandemic within a pandemic: mental health and wellbeing of racially Minoritised women experiencing domestic abuse during the COVID-19 pandemic in the UK

BACKGROUND

The prevalence of domestic abuse is greater in times of humanitarian crisis, and the COVID-19 pandemic has been no different. Considerable evidence indicates that domestic abuse disproportionately impacts the mental health and wellbeing of racially Minoritised women. The present study aimed to explore racially Minoritised women's experiences of domestic abuse and mental health in the COVID-19 pandemic in the UK.

METHOD

An online cross-sectional survey was used with racially Minoritised women (n = 1202) in the UK during the third national lockdown.

RESULTS

Results demonstrate complex interplay of psychosocial factors, such as the roles of autonomy, resilience, self-silencing, family functioning, and social support as predictors of mental health and wellbeing during the 'shadow pandemic'.

CONCLUSION

Implications such as incorporating culturally competent mental health support, exploring the complex and multiple underpinnings of mental health in racially Minoritised victim-survivors of domestic abuse for future pandemic preparedness and support provision are discussed.

Energetic activity for depression in young people aged 13-17 years: the READY feasibility RCT

Background

Prevalence of depression is increasing in young people. Behaviour change interventions providing benefits equal to or greater than talking therapies or pharmacological alternatives are needed. Exercise could be beneficial for young people with depression, but we lack robust trials of its effectiveness.

Objective

To test whether an exercise intervention targeting young people with depression is feasible, including recruitment and retention of young people, recruitment and training of exercise professionals and intervention delivery.

Design

Three-arm cluster feasibility randomised controlled trial with embedded process evaluation and health economic data collection.

Setting

Local community venues in Hertfordshire, Bedfordshire and Norfolk.

Participants

Young people aged 13-17 years experiencing mild to moderate low mood or depression (indicated by scoring 17-36 on the Child Depression Inventory version 2) identified by mental health services, schools or self-referral.

Interventions

Participants were randomised to one of three groups: high-intensity exercise, low-intensity exercise or a social activity control. Group sessions ran twice-weekly for 12 weeks delivered by registered exercise professionals, supported by mental health support workers.

Main outcome measures

Referral, recruitment and retention rates; attendance at group sessions; adherence to and ability to reach intensity during exercise sessions; proportions of missing data, and adverse events measured at baseline and at 3 and 6 months; resource use; and reach and representativeness.

Results

Of 321 referrals to the study, 173 were assessed for eligibility, and of the target sample size of 81, 15 were recruited and 14 were randomised (one withdrew). The retention rate was 71.4% and attendance at intervention sessions was > 67%; data completeness was > 80% for baseline assessments. Follow-up completion rate at 14 weeks was > 80% for most outcomes, with 50% for accelerometer data in the low-intensity group. Trial processes and the intervention were acceptable to young people. Barriers to and facilitators of intervention delivery were identified.

Limitations

Findings highlighted challenges around recruitment, delivery of exercise interventions and informed ways of addressing barriers to recruitment for future studies. The study was conducted between October 2020 and August 2022 and consequently the COVID-19 pandemic had a disruptive impact on implementation.

Conclusions

A large randomised trial of the effectiveness of the intervention is not feasible using the current study design, but issues relating to recruitment could be addressed with further work.

Future work

Developing appropriate recruitment strategies via triage services, general practitioner practices, schools and social media and early engagement with the local Clinical Research Network to support recruitment to the study would address the significant shortfalls identified. Young people who are deemed unsuitable for mental health services should be followed up to be offered participation in such interventions. Collaborations between the NHS services and sports delivery partners should consider in-person contact with young people rather than remote consultations. Recruiting through general practitioner practices is effective and relatively inexpensive. The role of community engagement (socialmedia, public health agencies, community groups) needs to be further explored. Strong public and patient involvement and engagement via young people advisory groups is important to ensure that research is relevant to young people.

Funding

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/78/10.

Psychometric evaluation and community norms of the PHQ-9, based on a representative German sample

Background

The Patient Health Questionnaire (PHQ-9) is a popular tool for assessing depressive symptoms in both general and clinical populations. The present study used a large representative sample of the German adult population to confirm desired psychometric functioning and to provide updated population norms.

Methods

The following psychometric properties were assessed: (i) Item characteristics (item means, standard deviations and inter-item correlations), (ii) Construct validity (correlations of the PHQ-9 sum-score with scores obtained from instruments assessing depression, anxiety and somatization (GAD-7, BSI-18), (iii) Internal consistency (coefficient omega), (iv) Factorial validity (via confirmatory factor analysis of the assumed one factorial model) as well as (v) Measurement invariance (via multi-group confirmatory factor analyses across gender, age, income and education).

Results

The study found that the PHQ-9 had sound psychometric properties in terms of internal consistency and construct validity, and that measurements obtained with the tool could be compared across gender and age.

Limitations

Despite using a representative sample, the response rate was only 42.6%. Furthermore, diagnostic efficiency cannot be assessed as there were no clinical interviews conducted. Conclusion: The updated population based norms, which are presented for the total sample as well as separated by gender and various age-groups, provide a useful reference for clinical practice and epidemiological research.

Psychological impact of the COVID-19 pandemic on people with asthma: a co-produced mixed-methods study

OBJECTIVE

When COVID-19 was declared a pandemic there was concern that people living with asthma were at high-risk of poor outcomes. We aimed to explore the psychological impact of living with asthma in the United Kingdom during the pandemic.

METHODS AND MEASURES

Our mixed methods study, co-designed with patient and public involvement colleagues, included an online survey to detect anxiety/depression/post-traumatic stress disorder (PTSD) and health beliefs; and qualitative interviews. We recruited 849 participants for the survey and interviewed 26 between May and June 2020. Audio-recorded interviews were transcribed verbatim, and analysed thematically.

RESULTS

The survey identified that 77% of respondents were experiencing symptoms of anxiety, 77% were experiencing symptoms of depression, and PTSD was of concern for 61%. Two-thirds of respondents felt the pandemic had changed how they managed their asthma (n = 568, 66.9%), and over half felt that they had not been given adequate health information about COVID-19 (n = 495, 58.3%). Qualitative interviews identified five themes (1) health communication, (2) interaction with healthcare, (3) COVID-19-related concerns, (4) impact on mental health, and (5) behaviour change.

CONCLUSION

Psychological distress was prevalent in people with asthma during the early stage of the pandemic. Understanding this may be useful to inform future healthcare/policy planning.

Psychosocial predictors of distress in East and West Germans during the COVID-19 pandemic

BACKGROUND

Psychological (meaning in life, science attitude, internal locus of control, religiosity), and social factors (social support, cohesion) can counteract stressor-related distress. We investigated these factors' links with peri-pandemic distress (depression, anxiety, intrusions) and whether they weakened the impact of being affected by the COVID-19 pandemic. We compared prior East and West Germans on predictors and distress to investigate if their different backgrounds created lasting differences.

METHODS

A population-representative German sample aged 45 to 70 (N = 380) in terms of age, sex, and school education completed online questionnaires in May-July 2020 and June-July 2021. We examined the predictive relations with correlation, forward inclusion regression, and moderation analyses.

RESULTS

Social support predicted lower distress, also prospectively. Meaning in life predicted lower distress cross-sectionally. Religiosity predicted greater distress. Life meaning and social support partly weakened the link between being affected by the pandemic and distress, religiosity and science attitude strengthened this link. The only significant East/West difference was in religiosity, which was higher in the West.

CONCLUSION

Social resources appeared particularly important in adjusting to the pandemic. The identified predictors may inform interventions. East and West Germans' similarity might indicate that their post-war separation did not create lasting differences in the investigated factors.

Housing Environmental Enrichment, Lifestyles, and Public Health Indicators of Neurogenesis in Humans: A Pilot Study

BACKGROUND

In response to the rising mental health concerns and cognitive decline associated with the human brain's neurogenesis, which continues until the tenth decade of life but declines with age and is suppressed by poor environments, this pilot study investigates how physical environments may influence public health proxy measures of neurogenesis in humans. This pilot study focuses on the residential environment where people spend most of their time and age in place, exploring the dependency of depression, anxiety, and cognitive impairment variations on spatial and lifestyle variables.

METHODS

A total of 142 healthy adults in England completed a survey consisting of PHQ-8, GAD-7, and CFI questionnaires and other questions developed to capture the variance in spatial and lifestyle factors such as time spent at home, house type layout complexity, spaciousness, physical activity, routine and spatial novelty, and perceived loneliness.

RESULTS

Extensive time spent at home has adverse effects on all measures, while multi-storey houses perform better than single-story houses with positive correlations with physical activity and spatial novelty. Separate regression models on the variance in depression, as the most salient dependent variable and reliably associated with neurogenesis, reveal that getting out of the house explains 20.5% of the variance in depression symptoms. At the scale of the house, multi-storey houses explain 16.5% of the variance. Both percentages are closer to the effect of loneliness, which we found to explain 26.6% of the variance in depression.

CONCLUSIONS

The built environment appears to be significantly associated with changes in cognitive function and mental health symptoms associated with neurogenesis. This pilot study shows the equally important effect of physical and social enrichment, offering critically needed insights for neuroarchitecture and brain health research that is interested in public health.

Sleep and diet patterns of college students during the COVID-19 pandemic lockdowns

Introduction: College students experience high levels of depression, anxiety, and stress during the academic year as they juggle the competing demands of young adulthood and their studies. The COVID-19 pandemic heightened this experience. Healthful diets and sleep patterns are associated with improved physical and mental well-being. Purpose: The goal of this study was to identify if there was a relationship between changes in sleep and diet during the COVID-19 pandemic. Methods: A group of college students was surveyed online using Qualtrics software during the first two months of lockdown restrictions at a large, midwestern university in the United States. Results: More participants reported no changes in diet and increased hours of sleep than reported declines or improvements in diet, or reductions or retained sleep patterns. Participants who maintained their diet were likely to maintain their current sleep pattern. Conclusion: College students demonstrated resilience in healthful behaviors during the first two months of COVID-19 lockdown.

Intolerance of uncertainty as a predictor of anxiety severity and trajectory during the COVID-19 pandemic

BACKGROUND

Efforts to identify risk and resilience factors for anxiety severity and course during the COVID-19 pandemic have focused primarily on demographic rather than psychological variables. Intolerance of uncertainty (IU), a transdiagnostic risk factor for anxiety, may be a particularly relevant vulnerability factor.

METHOD

N = 641 adults with pre-pandemic anxiety data reported their anxiety, IU, and other pandemic and mental health-related variables at least once and up to four times during the COVID-19 pandemic, with assessments beginning in May 2020 through March 2021.

RESULTS

In preregistered analyses using latent growth models, higher IU at the first pandemic timepoint predicted more severe anxiety, but also a sharper decline in anxiety, across timepoints. This finding was robust to the addition of pre-pandemic anxiety and demographic predictors as covariates (in the full sample) as well as pre-pandemic depression severity (in participants for whom pre-pandemic depression data were available). Younger age, lower self/parent education, and self-reported history of COVID-19 illness at the first pandemic timepoint predicted more severe anxiety across timepoints with strong model fit, but did not predict anxiety trajectory.

CONCLUSIONS

IU prospectively predicted more severe anxiety but a sharper decrease in anxiety over time during the pandemic, including after adjustment for covariates. IU therefore appears to have unique and specific predictive utility with respect to anxiety in the context of the COVID-19 pandemic.

Young, Muslim and poor: The persistent impacts of the pandemic on mental health in the UK

Muslims in the UK experienced a much larger decline in mental health than the rest of the population during the pandemic and this decline persisted even as mental health in the rest of the population bounced back to pre-pandemic levels. We use panel data from the UK Household Longitudinal Study (UKHLS) to decompose the mental health gap between Muslims and non-Muslims into those attributable to differences between the characteristics of the two groups and find that these differences - particularly Muslims being younger and being substantially overrepresented at the bottom of the income distribution - explain a substantial proportion of this gap. However, over a third of the Muslim-non-Muslim mental health gap remains unexplained by these factors and is driven by the experiences of Muslims who are neither young nor poor suggesting that this may be a result of discrimination experienced by the community. We conclude that being Muslim, being young, and being poor all independently contributed to experiencing a mental health gap and to the persistence of this gap.

Prevalence and Co-Occurrence of Psychiatric Conditions Among Bereaved Adults

Importance

Rates of grief-related psychiatric conditions, such as prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD), among bereaved adults in the US are largely unknown due to limited studies that leverage national samples.

Objective

To assess risk factors for and prevalence rates and co-occurrence of PGD, PTSD, and MDD among bereaved adults in the US.

Design, Setting, and Participants

Data for this survey study were collected from a large US panel sample between October 10 and 28, 2022, using a web-based survey. Participants were aged 18 years or older and were proficient in English. Data analysis was conducted between March and June 2023.

Main Outcomes and Measures

Probable psychiatric conditions were assessed with validated measures that used conservative cutoff scores, duration, and impairment criteria. These measures included the revised Prolonged Grief Disorder scale for PGD, the PTSD Checklist for DSM-5 for PTSD, and the Patient Health Questionnaire-9 for MDD. Data were analyzed using basic descriptives and logistic regression.

Results

A total of 2034 adults (n = 1529 and 505 in the bereaved and comparison groups, respectively) completed the study. Respondents had a mean (SD) age of 40.7 (15.9) years; the majority were women (1314 [64.6%]) and had at least some college experience (1394 [68.5%]). With regard to race and ethnicity, 392 respondents (19.3%) were Black, 138 (6.8%) were Hispanic, and 1357 (66.7%) were White. Among bereaved adults, 312 (20.4%), 518 (33.9%), and 461 (30.2%) met criteria for a presumptive diagnosis of PGD, PTSD, and MDD, respectively. Comorbidities were common, with 441 participants (28.8%) meeting criteria for at least 2 co-occurring disorders. Comorbid PGD, PTSD, and MDD were more common than any 2 co-occurring or isolated disorders; the presence of co-occurring conditions was more likely among respondents who reported a traumatic loss. Age and educational attainment were associated with the risk of psychiatric conditions; less time since the index death, loss of a psychologically close other, and a traumatic loss experience were associated with increased risk of PGD, PTSD, and MDD or their co-occurrence.

Conclusions and Relevance

In this study, the majority of bereaved adults did not meet presumptive criteria for PGD, PTSD, or MDD. Nevertheless, PGD, PTSD, and MDD were highly prevalent and comorbid, particularly among those who experienced traumatic loss. These findings underscore the need for integrated psychological care that leverages transdiagnostic mechanisms of evidence-based practice.

Signs of front-line healthcare professionals' information anxiety during the COVID-19 pandemic: Grounded theory study in a Wuhan hospital

AIM

Being front-line healthcare professionals is associated with possible severe information anxiety during the COVID-19 pandemic. Investigating signs of information anxiety is the first and key step of its targeted medical intervention. This study aims to explore the signs of front-line healthcare professionals' information anxiety during the COVID-19 pandemic.

DESIGN

This study is qualitative research. Grounded theory was used to classify information anxiety signs of front-line healthcare professionals.

METHODS

Twenty-four front-line healthcare professionals from a general hospital with over 5000 beds in Wuhan were recruited to participate in semi-structured interviews. According to the frequency and frequency variation of signs appearing in interviews, the trends of signs during the virus encounter, lockdown, flattening and second wave were compared. Based on the interviews, those signs that were conceptually related to each other were extracted to construct a conceptual model.

RESULTS

Psychological signs (emotion, worry, doubt, caution, hope), physical signs (insomnia, inattention, memory loss, appetite decreased) and behavioural signs (panic buying of goods, be at a loss, pay attention to relevant information, change habits) could be generalized from 13 subcategories of information anxiety signs. Psychological signs were the most in every period of the pandemic. Furthermore, psychological signs decreased significantly during lockdown, while behavioural and physical signs increased. Finally, severe psychological and behavioural signs were associated with physical signs.

The psychological implications of COVID-19 over the eighteen-month time span following the virus breakout in Italy

Background

In a short time, the COVID-19 pandemic has exerted a huge impact on many aspects of people's lives with a number of consequences, an increase in the risks of psychological diseases being one of them. The aim of this experimental study, based on an eighteen-month follow-up survey, is to assess the psychological effects of the COVID-19 pandemic, in particular, changes in stress, anxiety and depression levels, and the risks of developing Post-Traumatic Stress Disorder (PTSD).

Methods

A follow-up survey was performed on a sample of 184 Italian individuals to collect relevant information about the psychological impact of COVID-19. Predictors of the components of the psychological impact were calculated based on the ANCOVA model.

Results

The analysis of the online questionnaires led to the conclusion that a high percentage of the participants suffer from levels of stress, anxiety and depression higher than normal as well as an increased risk of PTSD. The severity of such disorders significantly depends on gender, the loss of family members or acquaintances due to the pandemic, the amount of time spent searching for COVID-19 related information, the type of information sources and, in part, on the level of education and income. The time factor had a more severe effect on the low-income population.

Conclusion

COVID-19 has entailed a very strong psychological impact on the Italian population also depending on the coping strategies adopted, the level of mindful awareness, socio-demographic variables, people's habits and the way individuals use the available means of communication and information.

The relation between economic stressors and higher education students' mental health during the initial outbreak of the COVID-19 pandemic

AIMS

The COVID-19 pandemic has had a large impact on the financial situation of higher education students, disproportionately affecting students with a low socioeconomic status (SES). This raises the question of whether economic stressors related to COVID-19 have aggravated existing socioeconomic inequalities in mental health. This study examined the relationship between economic stressors and students' depressive symptoms, and the role of students' SES and countries' socioeconomic conditions.

METHODS

Data from the COVID-19 International Student Well-being Study was used for multilevel analyses, with depressive symptoms as dependent variable. Three indicators measured SES: educational level of the parents, ability to borrow money from their social network, and struggling with financial resources prior to COVID-19.

RESULTS

Students with a low SES had more depressive symptoms, and those not able to borrow money and with parents without higher education were more exposed to a deterioration in their financial situation. Both economic stressors (reduction in working hours and a deterioration of their financial situation) were positively related to depressive symptoms. In addition, the positive relationship between a decrease in working hours and depressive symptoms was stronger in countries with a higher unemployment rate.

CONCLUSIONS

We observed socioeconomic inequalities in students' mental health, which, in part, can be ascribed to a larger exposure to the economic stressors related to COVID-19 among students' with a low SES. The macroeconomic context also played a role, as the impact of a reduction in working hours on depressive symptoms was stronger in countries with poor economic conditions.

Unique and interactive effects of emotion regulation difficulties and perceived stress on COVID-19 traumatic stress, anxiety, and safety behavior use: A four-year prospective study

Given that emotion regulation difficulties confer risk for poor responses to stress, they may predict who is at risk for adverse psychological reactions to major, chronic stressors such as the COVID-19 pandemic. Specific adverse reactions to the pandemic may include more severe traumatic stress, anxiety, and excessive safety behavior use (i.e., hand washing). While emotion regulation difficulties may be a diathesis for adverse reactions to chronic stressors, the context(s) by which they may confer elevated risk is unclear. Accordingly, the present longitudinal study examined the interaction between pre-pandemic emotion regulation difficulties and early pandemic perceived stress in predicting subsequent COVID-related traumatic stress, anxiety, and safety behavior use over 32 weeks of the pandemic. Community adults (N = 145) who completed a measure of emotion regulation in 2016 as part of a larger study were recontacted at the start of the pandemic (March 2020) and assessed every two weeks for 32 weeks. Consistent with a diathesis-stress model, the interaction between difficulties in emotion regulation and perceived stress was significant in predicting COVID-19 anxiety (p = 0.003, d = 0.52) such that at high, but not low, levels of perceived stress, difficulties in emotion regulation in 2016 significantly predicted higher COVID-19 anxiety in 2020. The interaction between difficulties in emotion regulation in 2016 and perceived stress early in 2020 approached significance in predicting COVID-19 traumatic stress (p = 0.073, d = 0.31) and safety behavior use (p = 0.069, d = 0.31). These findings highlight that current perceived stress is an important context that potentiates the effects of preexisting emotion regulation difficulties on the emergence of anxiety-related symptoms during COVID-19, which has important implications for diathesis-stress models of adverse reactions to chronic stressors.

A systematic review on the relationship between socioeconomic conditions and emotional disorder symptoms during Covid-19: unearthing the potential role of economic concerns and financial strain

BACKGROUND

Covid-19 has disrupted the lives of many and resulted in high prevalence rates of mental disorders. Despite a vast amount of research into the social determinants of mental health during Covid-19, little is known about whether the results are consistent with the social gradient in mental health. Here we report a systematic review of studies that investigated how socioeconomic condition (SEC)-a multifaceted construct that measures a person's socioeconomic standing in society, using indicators such as education and income, predicts emotional health (depression and anxiety) risk during the pandemic. Furthermore, we examined which classes of SEC indicators would best predict symptoms of emotional disorders.

METHODS

Following PRISMA guidelines, we conducted search over six databases, including Scopus, PubMed, etc., between November 4, 2021 and November 11, 2021 for studies that investigated how SEC indicators predict emotional health risks during Covid-19, after obtaining approval from PROSPERO (ID: CRD42021288508). Using Covidence as the platform, 362 articles (324 cross-sectional/repeated cross-sectional and 38 longitudinal) were included in this review according to the eligibility criteria. We categorized SEC indicators into 'actual versus perceived' and 'static versus fluid' classes to explore their differential effects on emotional health.

RESULTS

Out of the 1479 SEC indicators used in these 362 studies, our results showed that 43.68% of the SEC indicators showed 'expected' results (i.e., higher SEC predicting better emotional health outcomes); 51.86% reported non-significant results and 4.46% reported the reverse. Economic concerns (67.16% expected results) and financial strains (64.16%) emerged as the best predictors while education (26.85%) and living conditions (30.14%) were the worst.

CONCLUSIONS

This review summarizes how different SEC indicators influenced emotional health risks across 98 countries, with a total of 5,677,007 participants, ranging from high to low-income countries. Our findings showed that not all SEC indicators were strongly predictive of emotional health risks. In fact, over half of the SEC indicators studied showed a null effect. We found that perceived and fluid SEC indicators, particularly economic concerns and financial strain could best predict depressive and anxiety symptoms. These findings have implications for policymakers to further understand how different SEC classes affect mental health during a pandemic in order to tackle associated social issues effectively.

Self-Control, Openness, Personal Need for Structure and Compensatory Control Change: A Serial Mediation Investigation

In the aftermath of the COVID-19 pandemic, numerous studies have indicated that individuals are confronting a diminished sense of control. Compensatory control theory suggests that individuals strive to mitigate this loss by modifying their behavior. The present study aims to investigate the relationship between self-control and compensatory control change during the COVID-19 pandemic, as well as the mediating effects of openness and the personal need for structure. Participants completed an online questionnaire consisting of Personal Need for Structure Scale, Self-Control Scale, Openness Scale and Compensatory Control Change Scale. The results showed that the compensatory control change increased after the outbreak. Moreover, a serial mediation was found: openness and the personal need for structure partially mediated the relationship between self-control and compensatory control change. The results indicate that the COVID-19 pandemic has led to an increase in compensatory control behaviors, especially among those with pronounced self-control. High self-control individuals are found to exhibit greater openness, reducing their personal need for structure, in effect enhancing their compensatory control change. These findings highlight the critical role of self-control in sustaining a sense of control, which is vital for understanding psychological health management in the context of public health events.

Perceptions of risk and coping strategies during the COVID-19 pandemic among women and older adults

The world's health, economic, and social systems have been adversely impacted by the COVID-19 pandemic. With lockdown measures being a common response strategy in most countries, many individuals were faced with financial and mental health challenges. The current study explored the effect of the COVID-19 pandemic on the psychological well-being, perception of risk factors and coping strategies of two vulnerable groups in Malaysia, namely women and older adults from low-income households (USD592). A purposive sample of 30 women and 30 older adults was interviewed via telephone during Malaysia's Movement Control Order (MCO) regarding the challenges they faced throughout the pandemic. Thematic analysis was subsequently conducted to identify key themes. The themes identified from the thematic analysis indicated a degree of overlap between both groups. For women, seven themes emerged: 1) Psychological challenges due to COVID-19 pandemic, 2) Family violence, 3) Finance and employment related stress and anxiety, 4) Women's inequality and prejudice, 5) Coping strategies, 6) Professional support, and 7) Women's empowerment. Similarly, there were six themes for the older adults: 1) Adverse emotional experiences from COVID-19, 2) Threats to health security, 3) Loss of social connections, 4) Government aid to improve older adults' psychological well-being, 5) Psychological support from family members and pets, and 6) Self-reliance, religion, and spirituality. The findings provide valuable information on the specific burdens faced by these groups, and support psychological interventions and mitigations that would be appropriate to improve well-being during the recovery phase.

Association between household income and mental health among adults during the COVID-19 pandemic in Korea: Insights from a community health survey

People of low socioeconomic status are vulnerable to health problems during disasters such as the COVID-19 pandemic. Using data from the 2019 and 2021 Korea Community Health Survey, this study analyzed the associations between Korean adults' mental health and their national and regional-level household incomes during the pandemic. The prevalence of perceived stress and depression experience for each risk factor category was calculated through univariate analyses. A multivariate logistic regression analysis helped identify the association between two types of income levels (national or regional) and perceived stress and experience of depression. Additionally, we investigated the effect of income levels by subgroup (gender and residential area) on perceived stress and the experience of depression. During the pandemic, the crude prevalence of an experience of depression was higher (6.24% to 7.2%) but that of perceived stress remained unchanged. Regarding regional-income based mental health disparities, even after adjusting for each independent variable, perceived stress (2019 odds ratio (OR): 1.26, 95% confidence interval (CI):1.26-1.27, 2021 OR: 1.32, 95% CI: 1.32-1.32) and experience of depression (2019 OR: 1.56, 95% CI: 1.55-1.56, 2021 OR: 1.63, 95% CI: 1.63-1.64) increased as the income level decreased. The perceived stress based on the two income levels was higher in women than in men. For both income levels, the experience of depression of women was higher than that of men before COVID-19 and vice versa during the COVID-19 period. National income had a more pronounced effect on mental health in urban areas than in rural areas. Contrarily, the effect of regional income level on mental health was not consistent across residential areas (urban and rural areas). Our findings demonstrated that mental health disparities based on income level were more likely to occur during the COVID-19 pandemic and are better reflected through disparities in regional income levels.

The Prevalence of Depression among the Global Public in the Context of the COVID-19 Epidemic: A Systematic Review and Meta-Analysis

Background

We aimed to analyze the prevalence of depression among the global public during COVID-19, identify its influencing factors in order to provide reference, and help safeguard public mental health.

Methods

A comprehensive literature on global public depression in various countries during the COVID-19 pandemic was obtained through electronic searches of PubMed, Web of Science, and other databases, combined with literature tracing from Dec 2019 to Mar 2023. Then a meta-analysis was conducted using the random effects model by Stata 16.0. The heterogeneity was evaluated by I2 . Subgroup analysis, sensitivity analysis, and meta-regression analysis were used to explore the sources of heterogeneity and the factors influencing public depression. Egger's test was used to test publication bias.

Results

Overall, 68 articles with 234,678 samples were included in the study. Analysis revealed that the overall prevalence of depression among the population during COVID-19 was 32.0% (95% CI: 29.0%-35.0%). Of these, marital status (OR=0.65, 95% CI: 0.47-0.87), presence of infected cases (OR=2.45, 95% CI: 1.82-3.30), and fear of being infected by the virus (OR=9.31, 95% CI: 6.03-14.37) were the main factors influencing people's depression and the main source of heterogeneity.

Conclusion

The prevalence of depression among the global public is at a high level during COVID-19. The prevalence of depression among people unmarried, divorced, or widowed, surrounded by infected cases, contact infection cases, and worried about being were higher than others.

Covid-19 psychological pressures, depression and FOMO: the mediating role of online social support and emotional regulation

BACKGROUND

The spread of the coronavirus has led to significant anxiety among university students, resulting in various mental health problems that could potentially impact their academic performance.

METHOD

To examine the mediating role of emotional regulation and online social support in the relationships between COVID-19 psychological pressures, depression, and the fear of missing out (FoMO) among young adult university students, a cross-sectional research design was employed using an online survey. The sample consisted of 521 full-time university students from China, currently enrolled in undergraduate and postgraduate programs.

RESULTS

Findings revealed that more than half (55.09%, n=287) of the university students experienced COVID-19 psychological pressures. These pressures directly contributed to increased levels of depression (β = 0.339, p < .001) and fear of missing out (β = 0.236, p < .001). Moreover, online social support and emotional regulation exhibited partial mediating effects on the association between COVID-19 psychological pressures, depression, and the fear of missing out. The results indicated that COVID-19 psychological pressures were linked to higher levels of depressive symptoms and a greater fear of missing out among university students.

CONCLUSIONS

However, the provision of timely and adequate online social support, as well as the implementation of emotional regulation strategies, mitigated the negative effects of the pandemic on students' social and emotional well-being. Consequently, this led to reduced levels of depression and fear of missing out.

COVID-19-related dysfunctional anxiety and associated factors among adolescents in Southwest Ethiopia: a cross-sectional study

BACKGROUND

COVID-19 pandemic causes serious threats to people's mental health, particularly it has huge negative mental health outcomes for adolescents. However, there is lack of studies examining COVID-19-related anxiety among adolescents in Ethiopia. Hence, this study was aimed to examine COVID-19-related dysfunctional anxiety and its associated factors among adolescents in Mettu town.

METHODS

Community-based cross-sectional study was conducted from September 1 to 30, 2020 among 847 adolescents selected by stratified sampling technique. IBM SPSS Statistics Version 26.0 was used for analysis. Descriptive statistics such as frequency, percentage, mean, and standard deviation were computed. Bivariate and multivariate binary logistic regression analyses were done to identify factors associated with COVID-19-related dysfunctional anxiety. The statistical significance was declared at p ≤ 0.05; and the strength of association was described in terms of adjusted odds ratio.

RESULTS

Out of the total sample, 819 adolescents participated in this study. The mean age of the participants was 14.9 (SD = 2.798) years. The magnitude of COVID-19-related dysfunctional anxiety was found to be 20.9% (95% CI (18.1, 23.9)). The finding indicates that sex [(AOR (95% CI)); (0.724 (0.502, 1.043))], having both parents deceased [(AOR (95% CI)); (2.981 (1.138, 7.814))], living alone [(AOR (95% CI)); (2.363 (1.050, 5.321))], having unemployed mothers [(AOR (95% CI)); (1.943 (1.194, 3.163))], absence of close friend [(AOR (95% CI)); (0.377 (0.225, 0.630))], and medical problem [(AOR (95% CI)); (0.408 (0.278, 0.597))] were significantly associated with COVID-19-related anxiety.

CONCLUSION

The magnitude of COVID-19-related dysfunctional anxiety was found to be high in the study area. The findings have shown that the likelihood of developing COVID-19-related dysfunctional anxiety was linked to several factors. Provision of continued psychological support for adolescents is extremely encouraged.

Prevalence of Depression, Anxiety, Stress, and Insomnia in Iranian Gay Men During the COVID-19 Pandemic

Internationally, gay men have been found to be at a higher risk of mental health problems than heterosexual men. However, there is little information about the mental health situation of Iranian gay men, a population facing serious legal repercussions. Additionally, there is limited international data on the effect of the COVID-19 pandemic on the mental health of gay men. The aim of this study was to evaluate Iranian gay men's mental health during this pandemic. We assessed depression, anxiety, and stress with the DASS and insomnia with the ISI in N = 176 Iranian gay men. We compared their DASS subscores with those of the general male population during the COVID-19 pandemic. 65.9% of Iranian gay men showed mild to extremely severe depression symptoms, 63.6% reported mild to extremely severe anxiety symptoms, 65.3% had mild to extremely severe stress symptoms, and 43.3% had mild to severe insomnia symptoms. Compared to the general Iranian male population, gay men reported significantly more depressive, anxiety, and stress symptoms. Iranian gay men show a high number of depression, anxiety, stress, and insomnia symptoms during the COVID-19 pandemic. Gay men reported significantly more mental health symptoms in the DASS subscores than the general population of Iranian men recruited during the pandemic. They showed descriptively more insomnia symptoms than Iranian adults before the pandemic. The mental health of Iranian gay men should be improved by abolishing punishments for same-sex sexual activities and establishing specialized mental health units for this population.

Variation in symptoms of common mental disorders in the general population during the COVID-19 pandemic: longitudinal cohort study

BACKGROUND

A significant rise in mental health disorders was expected during the COVID-19 pandemic. However, referrals to mental health services dropped for several months before rising to pre-pandemic levels.

AIMS

To identify trajectories of incidence and risk factors for common mental disorders among the general population during 14 months of the COVID-19 pandemic, to inform potential mental health service needs.

METHOD

A cohort of 33 703 adults in England in the University College London COVID-19 Social Study provided data from March 2020 to May 2021. Growth mixture modelling was used to identify trajectories based on the probability of participants reporting symptoms of depression (Patient Health Questionnaire-9) or anxiety (Generalised Anxiety Disorder-7) in the clinical range, for each month. Sociodemographic and personality-related characteristics associated with each trajectory class were explored.

RESULTS

Five trajectory classes were identified for depression and anxiety. Participants in the largest class (62%) were very unlikely to report clinically significant symptom levels. Other trajectories represented participants with a high likelihood of clinically significant symptoms throughout, early clinically significant symptoms that reduced over time, clinically significant symptoms that emerged as the pandemic unfolded and a moderate likelihood of clinically significant symptoms throughout. Females, younger adults, carers, those with existing mental health diagnoses, those that socialised frequently pre-pandemic and those with higher neuroticism scores were more likely to experience depression or anxiety.

CONCLUSIONS

Nearly 40% of participants followed trajectories indicating risk of clinically significant symptoms of depression or anxiety. The identified risk factors could inform public health interventions to target individuals at risk in future health emergencies.

Changes in mental health services in response to the COVID-19 pandemic in high-income countries: a rapid review

BACKGROUND

Severe deterioration in mental health and disrupted care provision during the COVID-19 increased unmet needs for mental health. This review aimed to identify changes in mental health services for patients in response to the pandemic and understand the impact of the changes on patients and providers.

METHODS

Following the Cochrane guidance for rapid reviews, Cochrane CENTRAL, MEDLINE, Embase and PsycInfo were searched for empirical studies that investigated models of care, services, initiatives or programmes developed/evolved for patients receiving mental health care during COVID-19, published in English and undertaken in high-income countries. Thematic analysis was conducted to describe the changes and an effect direction plot was used to show impact on outcomes.

RESULTS

33 of 6969 records identified were included reporting on patients' experiences (n = 24), care providers' experiences (n = 7) and mixed of both (n = 2). Changes reported included technology-based care delivery, accessibility, flexibility, remote diagnostics and evaluation, privacy, safety and operating hours of service provision. These changes had impacts on: (1) care access; (2) satisfaction with telehealth; (3) comparability of telehealth with face-to-face care; (4) treatment effectiveness; (5) continuity of care; (6) relationships between patients and care providers; (7) remote detection and diagnostics in patients; (8) privacy; (9) treatment length and (10) work-life balance.

CONCLUSIONS

A shift to telecommunication technologies had a significant impact on patients and care providers' experiences of mental health care. Improvements to care access, flexibility, remote forms of care delivery and lengths of operating service hours emerged as crucial changes, which supported accessibility to mental health services, increased attendance and reduced dropouts from care. The relationships between patients and care providers were influenced by service changes and were vastly depending on technological literacy and context of patients and availability and care access ranging from regular contact to a loss of in-person contact. The review also identified an increase in care inequality and a feeling of being disconnected among marginalised groups including homeless people, veterans and ethic minority groups. Telehealth in mental care could be a viable alternative to face-to-face service delivery with effective treatment outcomes. Further research is needed to better understand the impact of the changes identified particularly on underserved populations.

Exploring access and engagement with Improving Access to Psychological Therapies (IAPT) services, before, during, and after the COVID-19 lockdown: A service evaluation in the Northwest of England

The purpose of this study was to compare clients' prevalence and explore the characteristics that predicted access and engagement with IAPT treatment before, during, and after Lockdown.

We conducted a retrospective observational service evaluation, using routinely collected IAPT data from n = 13,019 clients who entered treatment between March and September in 2019, 2020, and 2021. Chi-square and multiple logistic regression were used to explore associations and potential predictors of access and engagement with IAPT treatment.

The number of people accessing and engaging with IAPT treatment was significantly higher after lockdown compared to before. Unemployed clients were less likely to access treatment during and after lockdown. Yet, perinatal clients and people from a black ethnic background were more likely to access treatment during lockdown. Being young and being unemployed were predictors of treatment disengagement across all three time points, whereas perinatal clients were less likely to engage only before and during lockdown. Clients who were not prescribed medication and clients with a long-term condition were more likely to engage during lockdown.

The demonstrated changes in access and engagement with IAPT treatment after the introduction of remote therapy urges the services to further consider the individual needs of specific client groups.

The experiences and impact on wellness among international students in the United States during the COVID-19 pandemic

Objective Assessing experiences and impact on wellness among international students during the COVID-19 pandemic. Participants: 405 undergraduate and graduate international students from 65 countries studying at a large public university. Methods: An online, voluntary and anonymous survey consisting of 50 quantitative and qualitative questions was conducted through Qualtrics. Descriptive and frequency analyses were used. Results: 27% of the students had concerns about the changes in student visa status that could seriously disrupt their studies in the U.S. 66.2% of them reported a moderate level, 18.8% reported a high level of stress related to the pandemic. Students identified the highest confidence in getting tested for infection but the lowest confidence in getting treatment if infected. They preferred telehealth for mental health services. Conclusions: Universities can best help international students by assisting with student visa and international travel issues, access to treatment for COVID-19 infection and developing telehealth for mental health services.

Cannabis use in the UK: a quantitative comparison of individual differences in medical and recreational cannabis users

There is a paucity of research, especially in the UK, that investigates individual differences in both medical and recreational cannabis users. A cross-sectional survey study design was used to assess recreational cannabis users and medical cannabis users currently living in the UK. Recreational cannabis users were invited to take part via social media. Medical cannabis users were recruited from Sapphire Medical Clinics, London, UK, which provides treatment with prescribed cannabis-based medicinal products. Demographic data and cannabis use frequency, as well as post-traumatic stress disorder symptoms (PCL-5), depression symptoms (Centre for Epidemiological Studies Depression Scale), trait and state anxiety (State-Trait Anxiety Inventory), and cannabis use motives [Comprehensive Marijuana Motives Questionnaire (CMMQ)] were collected. The Chi-square and independent-sample t-tests were used for the comparison of categorical variables and normally distributed continuous variables. Data were analyzed using analyses of variance (ANOVAs) and t-tests. Statistical significance was considered where the value of p was <0.05. The survey was completed by 161 participants. Medical cannabis users were older, consumed cannabis more often, had a higher "Sleep" motive on the CMMQ, and had a higher prevalence in self-reporting current diagnoses of neurological problems, mood disorders, and anxiety disorders (p < 0.05). Recreational cannabis users had higher scores on several motives for use (e.g., "Enjoyment," "Coping," "Experimentation," "Boredom," and "Celebration") and higher state anxiety scores (p < 0.05). The most common motives for cannabis use in both groups were "Enjoyment," "Low Risk," and "Sleep." There were no differences between groups in gender, "Low-Risk" motive, post-traumatic stress disorder symptoms, depression scores, trait anxiety scores, self-reported prevalence of substance use-related disorders, and past consumption of alcohol, tobacco, or caffeine (p > 0.05). The current study not only demonstrates a difference in age and motivations for cannabis consumption between recreational and medical cannabis users but also shows areas of potential overlap, including mental health outcomes, past substance use, and gender. These UK-specific findings indicate that recreational cannabis users experience higher state anxiety, highlighting the need for further evaluation of potential anxiogenic/anxiolytic properties of cannabis. These findings demonstrate the importance of researching individual differences in cannabis users and hold significant implications for future research, clinical practice, and legislation.

A network approach to understanding social distancing behaviour during the first UK lockdown of the COVID-19 pandemic

OBJECTIVE

Given the highly infectious nature of COVID-19, social distancing practices are key in stemming the spread of the virus. We aimed to assess the complex interplay among psychological factors, socio-demographic characteristics and social distancing behaviours within the framework of the widely used Capability, Opportunity, Motivation-Behaviour (COM-B) model.

DESIGN

The present research employed network psychometrics on data collected during the first UK lockdown in April 2020 as part of the COVID-19 Psychological Research Consortium (C19PRC) Study. Using a network approach, we examined the predictions of psychological and demographic variables onto social distancing practices at two levels of analysis: macro and micro.

RESULTS

Our findings revealed several factors that influenced social distancing behaviour during the first UK lockdown. The COM-B model was successful in predicting particular aspects of social-distancing via the influence of psychological capability and motivation at the macro-and micro-levels, respectively. Notably, demographic variables, such as education, income, and age, were directly and uniquely predictive of certain social distancing behaviours.

CONCLUSION

Our findings reveal psychological factors that are key predictors of social distancing behaviour and also illustrate how demographic variables directly influence such behaviour. Our research has implications for the design of empirically-driven interventions to promote adherence to social distancing practices in this and future pandemics.

Supplemental data for this article is available online at.

COVID Protection Behaviors, Mental Health, Risk Perceptions, and Control Beliefs: A Dynamic Temporal Network Analysis of Daily Diary Data

BACKGROUND

To control infections, behavioral non-pharmaceutical interventions (NPIs) such as social distancing and hygiene measures (masking, hand hygiene) were implemented widely during the COVID-19 pandemic. At the same time, adherence to NPIs has also been implied in an increase in mental health problems. However, the designs of many existing studies are often poorly suited to disentangle complex relationships between NPI adherence, mental health symptoms, and health-related cognitions (risk perceptions, control beliefs).

PURPOSE

To separate between- and temporal within-person associations between mental health, health-related cognitions, and NPI adherence.

METHODS

Six-month ecological momentary assessment (EMA) study with six 4-day assessment bouts in 397 German adults. Daily measurement of adherence, mental health symptoms, and cognitions during bouts. We used dynamic temporal network analysis to estimate between-person, as well as contemporaneous and lagged within-person effects for distancing and hygiene NPIs.

RESULTS

Distinct network clusters of mental health, health cognitions, and adherence emerged. Participants with higher control beliefs and higher susceptibility were also more adherent (between-person perspective). Within-person, similar findings emerged, additionally, distancing and loneliness were associated. Lagged findings suggest that better adherence to NPIs was associated with better mental health on subsequent days, whereas higher loneliness was associated with better subsequent hygiene adherence.

CONCLUSIONS

Findings suggest no negative impact of NPI adherence on mental health or vice versa, but instead suggest that adherence might improve mental health symptoms. Control beliefs and risk perceptions are important covariates of adherence-both on between-person and within-person level.

Mental health status and coping strategies of Chinese university students during the COVID-19 pandemic: A rapid review

Since the coronavirus (COVID-19) outbreak in December 2019, students have been under unparalleled psychological stress worldwide. As part of its prevention and control strategies, the Chinese Ministry of Education proposed online teaching activities for universities. For the first time, teaching and learning shifted completely online, significantly impacting university students used to classroom learning. This research addresses the knowledge gap about the mental health and coping strategies employed by Chinese university students during the COVID-19 pandemic. Electronic databases (PsycINFO, Scopus, Medline, Cochranes and CNKI) were searched systematically from 2019 to 2023, as part of this literature review. From the 349 articles found, 25 met the inclusion criteria for analysis. Thematic analysis was used to identify six sub-themes, organized under two main themes: Mental health issues of Chinese university students and their coping mechanisms. Heightened stress, anxiety, and depression appeared in Chinese university students during the pandemic, which may have been compounded by their isolation and the disruptions to their studies. Although the impact of COVID-19 on Chinese university students is waning, this study emphasizes the potential long-lasting impact on their mental health, which requires further investigation, particularly regarding gender differences. Moreover, positive and negative coping strategies were found in this review. Strategies for seeking social and family support and participating in sports activities had significant alleviating effects, while negative coping strategies such as alcohol-use and smoking did not. This rapid review informs the development of policies and interventions to enhance the mental health of university students during crisis events. The findings serve to inform health policymakers, university psychologists, and educators in improving the well-being of this student population.

Digital technology and mental health during the COVID-19 pandemic: a narrative review with a focus on depression, anxiety, stress, and trauma

The sudden appearance and devastating effects of the COVID-19 pandemic resulted in the need for multiple adaptive changes in societies, business operations and healthcare systems across the world. This review describes the development and increased use of digital technologies such as chat bots, electronic diaries, online questionnaires and even video gameplay to maintain effective treatment standards for individuals with mental health conditions such as depression, anxiety and post-traumatic stress syndrome. We describe how these approaches have been applied to help meet the challenges of the pandemic in delivering mental healthcare solutions. The main focus of this narrative review is on describing how these digital platforms have been used in diagnostics, patient monitoring and as a treatment option for the general public, as well as for frontline medical staff suffering with mental health issues.

The combined impact of social networks and connectedness on anxiety, stress, and depression during COVID-19 quarantine: a retrospective observational study

Introduction

The COVID-19 pandemic and associated quarantine measures have precipitated a surge in mental health disorders, particularly depression and anxiety. Government policies and restrictions on physical activity have contributed to this phenomenon, as well as diminished subjective social connectedness and exacerbated objective social isolation. As two dimensions of social isolation, it is worth noting that subjectively perceived social connectedness serves as a protective factor for mental health, whereas the decline in the size of objectively evaluated social networks poses a significant risk. However, research investigating the combined influence of these two dimensions remains limited.

Methods

This study used an online survey to collect data to investigate the effects of objective social connectedness and objective social networks on anxiety, stress, and depression during COVID-19 quarantine. A total of 485 participants were analyzed using statistical methods, including paired t-test, Pearson correlation analysis, linear regression, cluster analysis, ANOVA, and moderated mediated.

Results

The study found that anxiety and depression scores increased during the quarantine, with age, education, and social connectedness scores associated with the increase. Pre-quarantine anxiety and depression levels were strongly correlated with mental health status during quarantine. Cluster analysis, respectively, revealed three clusters for those without increasing anxiety and depression scores. The study also found that objective social network influences the impact of subjective social connectedness on pre-quarantine mental health, which in turn affects anxiety and depression levels during quarantine.

Conclusion

The study identified that quarantine increased anxiety and depression, with age being protective, and education and subjective social connectedness as risk factors. The study also emphasizes the comprehensive impact of objective and subjective social isolation. Although individuals perceive the same degree of social connectedness, those with smaller social networks are more prone to developing symptoms of anxiety and depression, which are also more likely to worsen during quarantine.

How does COVID-19-related social media usage influence disordered eating? A daily diary study among Chinese adults during lockdown

BACKGROUND

Despite previous studies highlighting the benefits of social media use during the COVID-19 pandemic, particularly under lockdown, limited research has identified the potential detrimental consequences of social media use during lockdown. Therefore, the purpose of this study is to examine the effects of social media on mental health in particular situations and the mechanisms underlying these effects.

METHODS

A daily diary protocol was adopted. A total of 96 adults (Mage = 25.90 ± 8.32 years) were recruited from Xi'an, Shaanxi Province, China. COVID-19-related social media use, psychological distress, COVID-19-related stress and anxiety, and disordered eating were measured each day for a week. Multilevel path analyses for the nested data were conducted.

RESULTS

Daily COVID-19-related social media use was positively related to daily disordered eating (r = .13 p < .001). Furthermore, the multilevel path analysis showed that psychological distress and COVID-19-related stress and anxiety mediated the relationship between COVID-19-related social media use and disordered eating at the within-person level. However, only COVID-19-related-anxiety mediated the relationship at the between-person level.

CONCLUSIONS

Our findings contribute to the understanding of social media's impact during lockdown and provide implications for social media users, social media platform providers, mental health professionals, and governments regarding the correct and sustainable use of social media during the COVID-19 pandemic and in future public health emergencies.

Perceptions and Knowledge of Public Towards Emerging Human Monkeypox in Yemen: A Cross-Sectional Study

Background

The spread of monkeypox (mpox) worldwide poses a severe threat to human life. This virus leads to a disease with symptoms similar to smallpox in humans. To combat this threat, improving public knowledge and perception toward mpox is vital for public health preventive measures.

Methods

A cross-sectional survey was carried out in Yemen from December 2022 to March 2023 to investigate public perception and knowledge of mpox. Individuals were approached through social media platforms using a convenient sampling approach. Linear regression was used to determine the association between participants' knowledge (dependent variable) and explanatory variables.

Results

A total of 853 individuals consented to take part in the study. A significant proportion of respondents had a low knowledge level (N=572, 67.06%). Most participants knew about the nature of the diseases (75%, n=641), transmission mode (78.1%, n=668), hand sanitizer preventive measures, and skin- related symptoms. However, only 20.8% (n= 178) knew that diarrhea is not a symptom, and 25.4% (n= 217) knew antibiotics are unnecessary for mpox management. A proportion of 57.7% (n=492) of the participants feared human mpox, and 47.7% (n= 407) thought it was a conspiracy. Most participants had a good perception of local and international health authorities controlling the disease. Age, education level, having a health-related certificate, and receiving a 2-dose vaccination for COVID-19 had statistically significant associations with mpox knowledge level (P < 0.05). Social media platforms were the most often used information source about mpox (78.3%, n= 668), followed by articles (41.1%, n=351).

Conclusion

The study reveals a low public knowledge about mpox in Yemen, emphasizing the need for targeted educational campaigns, especially via social media, to strengthen public health measures and disease control. Addressing Knowledge gaps and correcting misconceptions is crucial for improving preparedness and response to the disease.