Associations between Mental Health and Ebola-Related Health Behaviors: A Regionally Representative Cross-sectional Survey in Post-conflict Sierra Leone

Engagement communautaire et prise en compte de la détresse psychologique, de la peur et de la stigmatisation dans la surveillance et la gestion des épidémies de la maladie à virus Ebola dans l'approche « Une seule santé » en République démocratique du Congo

INTRODUCTION ET OBJECTIF

Une réponse efficace aux crises sanitaires telle la maladie à virus Ebola (MVE) nécessite l'engagement des communautés. Cette étude explore les enjeux psychosociaux influant sur la réponse des communautés congolaises aux épidémies de MVE, et comment la détresse et la résilience communautaire s'intègrent dans l'approche « Une seule santé » selon les perceptions des communautés.

MÉTHODES

Cette étude de cas qualitative inclut des entretiens individuels (n = 36) avec des informateurs clés et trois groupes de discussion avec des participants (n = 28) issus de diverses associations locales, Cette étude de cas qualitative menée au Nord-Kivu inclut. Le cadre MATCH de l'engagement communautaire, adapté, structure l'analyse thématique.

RÉSULTATS

Les participants ont tous reconnu le vécu douloureux - la peur, le rejet, la stigmatisation - des communautés et des professionnels de santé, et le rôle crucial des communautés dans la réponse aux épidémies. Ils ont souligné l'importance d'impliquer ces communautés dans l'élaboration et la mise en œuvre des stratégies pour éviter l'« Ebola business ». Les perceptions face à la maladie des différentes catégories de participants sont influencées par des croyances, les rôles sociaux et des considérations religieuses. Concernant l'approche « Une seule santé », les participants ont reconnu la nécessité d'impliquer toutes les couches sociales de la communauté.

CONCLUSION

Un modèle innovant de gestion des épidémies et urgences de santé publique intègre les essentiels de l'engagement communautaire dont la détresse psychologique.

Resilience of mental health services amidst Ebola disease outbreaks in Africa

Introduction

Health systems including mental health (MH) systems are resilient if they protect human life and produce better health outcomes for all during disease outbreaks or epidemics like Ebola disease and their aftermaths. We explored the resilience of MH services amidst Ebola disease outbreaks in Africa; specifically, to (i) describe the pre-, during-, and post-Ebola disease outbreak MH systems in African countries that have experienced Ebola disease outbreaks, (ii) determine the prevalence of three high burden MH disorders and how those prevalences interact with Ebola disease outbreaks, and, (iii) describe the resilience of MH systems in the context of these outbreaks.

Methods

This was a scoping review employing an adapted PRISMA statement. We conducted a five-step Boolean strategy with both free text and Medical Subject Headings (MeSH) to search 9 electronic databases and also searched WHO MINDbank and MH Atlas.

Results

The literature search yielded 1,230 publications. Twenty-five studies were included involving 13,449 participants. By 2023, 13 African nations had encountered a total of 35 Ebola outbreak events. None of these countries had a metric recorded in MH Atlas to assess the inclusion of MH in emergency plans. The three highest-burden outbreak-associated MH disorders under the MH and Psychosocial Support (MHPSS) framework were depression, post-traumatic stress disorder (PTSD), and anxiety with prevalence ranges of 1.4-7%, 2-90%, and 1.3-88%, respectively. Furthermore, our analysis revealed a concerning lack of resilience within the MH systems, as evidenced by the absence of pre-existing metrics to gauge MH preparedness in emergency plans. Additionally, none of the studies evaluated the resilience of MH services for individuals with pre-existing needs or examined potential post-outbreak degradation in core MH services.

Discussion

Our findings revealed an insufficiency of resilience, with no evaluation of services for individuals with pre-existing needs or post-outbreak degradation in core MH services. Strengthening MH resilience guided by evidence-based frameworks must be a priority to mitigate the long-term impacts of epidemics on mental well-being.

Mapping the association between mental health and people's perceived and actual ability to practice hygiene-related behaviours in humanitarian and pandemic crises: A scoping review

Humanitarian crises such as disease outbreaks, conflict and displacement and natural disasters affect millions of people primarily in low- and middle-income countries. Here, they often reside in areas with poor environmental health conditions leading to an increased burden of infectious diseases such as gastrointestinal and respiratory infections. Water, sanitation, and hygiene behaviours are critical to prevent such infections and deaths. A scoping review was conducted to map out what is known about the association between three mental health disorders and people's perceived and actual ability to practice hygiene-related behaviours, particularly handwashing, in humanitarian and pandemic crises. Published and grey literature was identified through database searches, humanitarian-relevant portals, and consultations with key stakeholders in the humanitarian sector. 25 publications were included, 21 were peer-reviewed published articles and four were grey literature publications. Most of the studies were conducted in mainland China (n = 12) and most were conducted in an outbreak setting (n = 20). Six studies found a positive correlation between handwashing and anxiety where participants with higher rates of anxiety were more likely to practice handwashing with soap. Four studies found an inverse relationship where those with higher rates of anxiety were less likely to wash their hands with soap. The review found mixed results for the association between handwashing and depression, with four of the seven studies reporting those with higher rates of depression were less likely to wash their hands, while the remaining studies found that higher depression scores resulted in more handwashing. Mixed results were also found between post-traumatic stress disorder (PTSD) and handwashing. Two studies found that lower scores of PTSD were associated with better hygiene practices, including handwashing with soap. The contradictory patterns suggest that researchers and practitioners need to explore this association further, in a wider range of crises, and need to standardize tools to do so.

Prevalence and Factors Related to Post-traumatic Stress Disorder and Depression Symptoms Among Children and Adolescents Survivors and Orphans of Ebola Virus Disease in Democratic Republic of the Congo Eastern Regions During the COVID-19 Pandemic

PURPOSE

Although previous studies have shown a high prevalence of mental health problems among adult Ebola virus disease survivors, no studies have yet been conducted on mental health problems among children and adolescents in affected regions. Consequently, the current study aimed to examine the prevalence and factors associated with depression and post-traumatic stress disorder (PTSD) among children and adolescent survivors and orphans by utilizing a cross-sectional survey following the 2018-2020 epidemic in Eastern Democratic Republic of the Congo.

METHODS

A total of 146 survivors (mean age = 13.62, standard deviation [SD] = 2.50, 49.32% female), 233 orphans (mean age = 13.18, SD = 2.96, 53.32% female), and 34 orphan-survivor participants (mean age = 13.39, SD = 2.87, 44.12% female) were recruited. Participants completed measures assessing depression and PTSD symptoms, traumatic experiences, and stigma related to Ebola and COVID-19.

RESULTS

The prevalence of depression and PTSD symptoms was 87.32% and 44.42%, respectively. Results showed significant differences in depression and PTSD symptoms between orphan-survivors (100% and 97.06%), survivors (90.21% and 75.86%), and orphans (83.48% and 16.52%; χ2(2) = 9.02; p = .011 and χ2(2) = 168.85; p < .001). Experience of traumatic events, Ebola stigmatization, and COVID-19 stigmatization positively predicted depression and PTSD symptoms. The regression models explained 61%-72% of the variance of depression and PTSD.

DISCUSSION

The results reveal that the Ebola virus disease and its associated grief severely jeopardize the mental health of children and adolescents in affected regions. Despite the relative paucity of resources, intervention programs may be helpful to minimize associated stigma and promote psychological support.

Conducting Social Science Research During Epidemics and Pandemics: Lessons Learnt

The COVID-19 pandemic has had a significant impact on how field-based research is being conducted globally. Given the challenges of undertaking fieldwork during epidemics and the need for mixed methods research to address the social, political, and economic issues related to epidemics, there is a small but growing body of evidence in this area. To contribute to the logistical and ethical considerations for conducting research during a pandemic, we draw on the challenges and lessons learnt from adapting methods for two research studies conducted in 2021 during the COVID-19 pandemic in low- and middle-income country (LMIC) settings: (1) in-person research in Uganda and (2) combined remote and in-person research in South and Southeast Asia. Our case studies focus on data collection and demonstrate the feasibility of conducting mixed methods research, even with many logistical and operational constraints. Social science research is often used to identify the context of specific issues, to provide a needs assessment, or inform longer-term planning; however, these case studies have shown the need to integrate social science research from the start of a health emergency and in a systematic way. Social science research during future health emergencies can also inform public health responses during the emergency. It is also crucial to collect social science data after health emergencies to inform future pandemic preparedness. Finally, researchers need to continue research on other public health issues that are ongoing even during a public health emergency.

Quality of life is associated with vaccine reluctance via mental health and fear of covid-19: an exploratory investigation on a Palestinian sample

Quality of life (QoL) has been studied as an antecedent of good mental health in contexts characterized by extreme poverty and acute conflict. The covid-19 crisis exacerbated the risks of health-related consequences in such contexts. Vaccination campaigns have been started worldwide to contain the virus outbreak with high rates of hesitancy and refusal. Our exploratory study sheds light on the relationship between QoL and vaccine reluctance via mental health and fear of covid-19 in a Palestinian population affected by military occupation or socioeconomic marginalization. Who-QolBref, Fcov-19, and Dass were administered to 1122 Palestinian adults living in the occupied territories and Israel. Structural equation modelling was applied to test the relations between variables. Results showed that fear of COVID-19, stress, anxiety and depression mediated the association between QoL and vaccination reluctance with a good model fit (χ2 (5) = 828.37; p = .001; GFI=.93; AGFI=.94; RMSEA=.046; NFI=.94; CFI=.95). QoL and mental health were negatively associated with stress (βX, Y = - .35; p < .001), depression (βX, Y = -.37; p < .001), and anxiety (βX, Y = -.36; p < .001). QoL and fear of COVID- 19 (βX, Y = -.16; p < .001) were inversely correlated. A positive effects was found between stress (βM, Y = .17; p < .001), anxiety (βM, Y = .18; p < .001), and depression (βM, Y = .17; p < .001), fear of COVID-19 and vaccination reluctance (βX, Y = .23; p < .001). According to our findings, Public health measures to ease the social suffering of people with low QoL due to conflict and social marginality might favour the acceptance of the vaccine.

The roles of risk perception, negative emotions and perceived efficacy in the association between COVID-19 infection cues and preventive behaviors: a moderated mediation model

Preventive behaviors during the COVID-19 pandemic are especially critical to the protection of individuals whose family members or acquaintances have been infected. However, limited research has explored the influence of infection cues on preventive behaviors. This study proposed an interaction model of environment-cognitive/affective-behavior to elucidate the mechanism by which infection cues influence preventive behaviors and the roles of risk perception, negative emotions, and perceived efficacy in that influence. To explore the relationships among these factors, we conducted a cross-sectional online survey in 34 provinces in China during the first wave of the COVID-19 pandemic. A total of 26,511 participants responded to the survey, and 20,205 valid responses (76.2%) were obtained for further analysis. The moderated mediation results show that infection cues positively predicted preventive behaviors in a manner mediated by risk perception and negative emotions. Moreover, perceived efficacy moderated the influence of infection cues not only on preventive behaviors but also on risk perception and negative emotions. The higher the perceived efficacy, the stronger these influences were. These findings validated our model, which elucidates the mechanisms underlying the promoting effect of infection cues on preventive behaviors during the initial stage of the COVID-19 pandemic. The implications of these results for the COVID-19 pandemic and beyond are discussed.

Real-Time Mental Health Crisis Response in the United States to COVID-19

Background: Data are scarce on assessing the impact of the COVID-19 pandemic on young people. Aim: To examine changes in crisis text patterns in the United States during the pandemic compared to the prepandemic period. Method: Nonintrusive data from a national digital crisis texting platform were analyzed using an interrupted time series design. Poisson regression with repeated-measures examined help-seeking patterns for stress, anxiety, depression, suicidal thoughts, and other mental health concerns in the pandemic (March 13 to July 20, 2020) compared to the prepandemic period (March 13 to July 20, 2019). Results: An abrupt increase in national crisis response texts occurred during the pandemic for stress and anxiety, substance abuse, bereavement, isolation, and abuse compared to the prepandemic period. Similar trends of excess texts for isolation and abuse were reported among children (relative risk [RR]_abuse: 1.16, CI: 1.03, 1.31; RR_isolation: 1.15, CI: 1.09, 1.21) and adolescents (RR_abuse: 1.17, CI: 1.11, 1.24; RR_isolation: 1.08, CI: 1.05, 1.11), bereavement among Black (RR: 1.31, CI: 1.12, 1.54) and Hispanic (RR: 1.28, CI: 1.10, 1.49) texters, and isolation and bereavement in female (RR_isolation: 1.09, CI: 1.06, 1.11; RR_bereavement: 1.21, CI: 1.13, 1.28) or nonconforming youth (RR_isolation: 1.19, CI: 1.08, 1.32; RR_bereavement: 1.50, CI: 1.08, 2.09) texters. Conversely, the risks of reporting bullying, depression, relationship issues, and suicidal thoughts as reasons for texting were significantly lower during COVID-19. Limitations: Results may underestimate crisis support-seeking in some groups because demographic data were not captured on all texters. Conclusion: Findings illuminated the real-time crisis response of young people across the United States and can inform more responsive interventions to alleviate the mental health consequences brought on by the COVID-19 pandemic.

Factor structure and psychometric proprieties of the COVID-19 prevention behaviours (COV19-PB) scale

We sought to test the COVID19-PB scale's psychometric properties and its dimensionality in a sample composed of 1107 Italian adults aged from 18 to 80 years (M = 39.59; SD = 16.36), 75% (n = 830) females, and 25% (n = 277) males. Exploratory, Confirmatory factor analysis and parallel analysis were used to validate the instrument that resulted from the Ebola Virus protective behaviours scale adaptation. Fear of covid-19 and a 1-item level of adherence to the Covid-19 protection scale were used to test the measure's convergent validity. A four-factor structure emerged from exploratory and confirmatory factor analysis: direct avoidance, avoidance of public spaces, avoidance of social interaction, and talking about the virus as protection. COVID-19 PB was a valuable measure to assess individuals' competencies in assuming correct behaviours during the pandemic.

The Rising of the Shield hero. Development of the Post-Traumatic Symptom Questionnaire (PTSQ) and Assessment of the Protective Effect of self-esteem from trauma-related Anxiety and Depression

Background

Adverse life events such as life-threatening accidents, domestic and/or sexual violence, organic diseases (i.e., cancer), or COVID-19 can have a strong traumatic impact - generating reactions as intrusive thoughts, hyperarousal, and avoidance. Indeed, the traumatic impact of COVID-19 seems to lead individuals to experience anxiety and depression. However, the Anxiety-Buffer Hypothesis suggests that self-esteem could be considered a shield (buffer) against traumatic experiences and their outcomes (i.e., anxiety and depression). The present study has two objectives. First, to develop a measure of the impact of the traumatic event considering the aforementioned reactions. Second, to test the process - triggered by COVID19-related traumatic experience - in which self-esteem buffers the path that leads to anxiety and depression.

Method

In Study 1 (N = 353), the Post-Traumatic Symptom Questionnaire (PTSQ) was developed and a deep investigation of its psychometric properties was conducted. In Study 2 (N = 445), a structural equation model with latent variables was performed to assess the buffering effect of self-esteem.

Results

The PTSQ has excellent fit indices and psychometric properties. According to the ABH, results confirm the buffering effect of self-esteem in the relationships between traumatic symptoms and both anxiety and depression.

Conclusion

On the one hand, the PTSQ is a solid and reliable instrument. On the other hand, that self-esteem is a protective factor against anxiety and depression related to a traumatic experience - such as COVID-19. Targeted psychological interventions should be implemented to minimize the psychological burden of the illness while promoting adaptation and positive aspects of oneself.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-022-00503-z.

Key features of a trauma-informed public health emergency approach: A rapid review

COVID-19 is a major threat to public safety, and emergency public health measures to protect lives (e.g., lockdown, social distancing) have caused widespread disruption. While these measures are necessary to prevent catastrophic trauma and grief, many people are experiencing heightened stress and fear. Public health measures, risks of COVID-19 and stress responses compound existing inequities in our community. First Nations communities are particularly at risk due to historical trauma, ongoing socio-economic deprivation, and lack of trust in government authorities as a result of colonization. The objective of this study was to review evidence for trauma-informed public health emergency responses to inform development of a culturally-responsive trauma-informed public health emergency framework for First Nations communities. We searched relevant databases from 1/1/2000 to 13/11/2020 inclusive, which identified 40 primary studies (and eight associated references) for inclusion in this review. Extracted data were subjected to framework and thematic synthesis. No studies reported evaluations of a trauma-informed public health emergency response. However, included studies highlighted key elements of a "trauma-informed lens," which may help to consider implications, reduce risks and foster a sense of security, wellbeing, self- and collective-efficacy, hope and resilience for First Nations communities during COVID-19. We identified key elements for minimizing the impact of compounding trauma on First Nations communities, including: a commitment to equity and human rights, cultural responsiveness, good communication, and positive leadership. The six principles guiding trauma-informed culturally-responsive public health emergency frameworks included: (i) safety, (ii) empowerment, (iii) holistic support, (iv) connectedness and collaboration, (v) compassion and caring, and (vi) trust and transparency in multi-level responses, well-functioning social systems, and provision of basic services. These findings will be discussed with First Nations public health experts, together with data on the experiences of First Nations families and communities during COVID-19, to develop a trauma-integrated public health emergency response framework or "lens" to minimize compounding trauma for First Nations communities.

Enacted Ebola Stigma and Health-related Quality of Life in Post Ebola Epidemic: A Psychosocial Mediation Framework Through Social Support, Self-Efficacy, and Coping

On-site experiences and reports have shown that the multiple outbreaks of Ebola virus disease (EVD) in the Democratic Republic of the Congo (DRC) resulted in pervasive experience of stigma against many people who have recovered from EVD as well as their families and close relatives. Three evidence-based protective factors which are supposed to mitigate the impact of enacted Ebola stigma on health-related quality of life (HRQoL) of individuals in this epidemic context were identified. We expected that positive religious coping, perceived social support, and general self-efficacy would mediate the relationship between enacted Ebola stigma and HRQoL. These hypotheses were tested through multiple mediation model using the structural equation modeling among a large sample of adult populations (N = 1614; 50% women) in the province of Equateur in the DRC, in the aftermath of the 9th Ebola outbreak. The mediation model yielded adequate fit statistics and the results provided strong evidence that higher levels of enacted Ebola stigma were associated with lower HRQoL. They confirmed the synergetic mediating effects of positive religious coping, perceived social support from family (but not from others sources) and general self-efficacy. Futher exploratory findings revealed that the perceived social support from family buffered the impact of enacted Ebola stigma on HRQoL. If replicated by a longitudinal study, our findings lay a solid foundation for empirical-based community mental health interventions for reducing enacted Ebola stigma and promoting HRQoL during epidemics, especially in the DRC.

Mental health problems among children in Sierra Leone: Assessing cultural concepts of distress

Globally, over 13% of children and adolescents are affected by mental disorders, yet relatively little scholarship addresses how risk factors, symptoms, and nosology vary by culture and context, especially in young children living in post-conflict and low-resource settings. To address this gap, we conducted a qualitative study to identify and describe the most salient mental health problems facing children aged 6 to 10 years in Sierra Leone, as well as the thoughts, feelings, and behaviors related to these problems. Free list interviews (N = 200) and semi-structured interviews (N = 66) were conducted among caregivers, children, and other relevant key informants to explore risk factors and locally meaningful concepts of distress. Our findings indicate that children are faced with a variety of challenges in their social environments that contribute to distress, including hunger, unmet material needs, and excessive work. Our research identifies five contextually defined mental health problems faced by young children: gbos gbos (angry, destructive behavior), poil at (sad, disruptive behavior), diskoraj (sad, withdrawn), wondri (excessive worry), and fred fred (abnormal fear). The manifestations of these distress concepts are described in detail and contextualized according to Sierra Leone's history of war and current backdrop of poverty and insecurity. Implications are discussed for locally relevant diagnosis and treatment as well as for the wider literature on global child mental health.

Cross-sectional study of mental health and sexual behaviours for Ebola Survivors in Beni, Butembo and Katwa health zones of the Democratic Republic of Congo

OBJECTIVES

To understand the prevalence of mental health disorders in Ebola-affected communities and their association with condom use.

DESIGN

Cross-sectional study.

SETTING

Beni, Butembo and Katwa health zones, Democratic Republic of Congo (DRC).

PARTICIPANTS

223 adult Ebola survivors, 102 sexual partners and 74 comparison respondents.

PRIMARY AND SECONDARY OUTCOME MEASURES

Post-traumatic stress disorder (PTSD), depression, anxiety, substance use, suicidal ideation and attempts, stigma, condom use and sexual behaviour.

RESULTS

Most respondents reported to be married, Christian, from the Nande ethnic group, and farmers/herders. Survivors met symptom criteria for depression at higher rates than partners (23.5% (95% CI 18.0 to 29.1) vs 5.7 (1.2 to 10.1); p<0.001). PTSD symptom criteria for survivors (24.1%, 95% CI 18.5% to 29.7%) and partners (16.7%, 95% CI 9.4% to 23.9%) were four times greater than the comparison participants (6.0%, 95% CI 0.6% to 11.4%). Two times as many survivors as partners reported that sexual activity precautions were discussed at discharge (71.5% (95% CI 65.6 to 77.5) vs 36.2% (95% CI 26.9 to 45.5); p<0.001). The majority of survivors (95.0 (95% CI 85.1% to 98.5%) and partners 98.5% (95% CI 89.6% to 99.8%; p=0.26) participated in risky sexual behaviour after the survivor left the Ebola treatment centre. The ability to refuse sex or insist on condom use before Ebola had a threefold increase in the odds of condom use (adjusted OR 3.3, 95% CI 1.7 to 6.1, p<0.001). Up to 36% of the comparison group held discriminatory views of survivors.

CONCLUSIONS

The new outbreaks in both Guinea and DRC show Ebola remains in semen longer than previously known. Understanding and addressing condom non-use and updating condom use guidelines are necessary to protect against future Ebola outbreaks, especially among sexual partners who did not have similar access to health information regarding sexual transmission of Ebola. Mental health treatment and decreasing stigma in Ebola areas is a priority.

Posttraumatic stress disorder symptoms associated with protective and risky behaviors for coronavirus disease 2019

OBJECTIVE

Psychiatric disorders increase risk for contracting coronavirus disease 2019 (COVID-19), but we know little about relationships between psychiatric symptoms and COVID-19 risky and protective behaviors. Posttraumatic stress disorder (PTSD) has been associated with increased propensity to engage in risky behaviors, but may also be associated with increased COVID-19 protective behaviors due to increased threat sensitivity and social isolation.

METHOD

We examined associations of PTSD symptoms with COVID-19-related protective and risky behaviors using data from a cross-sectional online United States study among 845 US adults in August through September 2020. PTSD symptoms (PTSD Checklist-5), sociodemographics, COVID-19-related experiences and vulnerabilities, and past 30-day engagement in 10 protective and eight risky behaviors for COVID-19 were assessed via self-report. We examined associations between PTSD symptoms and COVID-19 protective and risky behaviors with linear regressions, adjusting for covariates.

RESULTS

Probable PTSD and higher PTSD symptom severity were associated with greater engagement in protective behaviors, but also greater engagement in risky behaviors. Associations were only slightly attenuated by adjustment for COVID-19 exposures and perceived likelihood and severity of COVID-19. Associations varied by PTSD clusters: intrusions and arousal were associated with both more protective and more risky behaviors, whereas negative cognitions or mood was associated only with more risky, and avoidance only with more protective, behaviors.

CONCLUSION

Higher PTSD symptoms were associated with engagement in more protective but also more risky behaviors for COVID-19. Mental health should be considered in the design of public health campaigns dedicated to limiting infectious disease spread. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

COVID-19 behavioral health and quality of life

In addition to concern about physical health consequences of COVID-19, many researchers also note the concerning impact on behavioral health and quality of life due to disruption. The purpose of this paper is to explore pathways of COVID-19 behavioral health and quality of life. We found increased anxiety, depression, and alcohol misuse and that the pandemic exacerbated prior problems. Further community indicators also lead to poorer behavioral health and overall decreased quality of life. The nature of COVID-19 and vast reach of the virus suggests that behavioral health concerns should take a primary role in pandemic recovery.

Effects of School Resumption on College Students' Mental Health During the COVID-19 Pandemic

The current study aimed to investigate the effects of school resumption on college students' mental health during the coronavirus disease 2019 (COVID-19) pandemic. We used the Perceived Stress Scale (PSS-10), Patient Health Questionnaire-9 (PHQ-9), and Self-Rating Anxiety Scale (SAS) to assess stress, depression, and anxiety, respectively, between same-age college students returning to school and those not returning to school. Of 1,598 students who completed the baseline survey (S1), 836 students completed a follow-up survey 10 months after school resumption (S2). There were statistically significant differences in stress and mild anxiety between male and female students (p < 0.01). Comparison of PSS-10, PHQ-9, and SAS scores by perceived impact of COVID-19 showed significant differences (Welch test, p < 0.01). The correlation between PHQ-9 and SAS scores in school resumption and non-school resumption groups was relatively strong (adjusted R2 = 0.49 vs. 0.5). Multivariate linear regression showed that only PSS-10 (p < 0.01) and SAS (p < 0.05) scores significantly differed between returning and non-returning students. School resumption was an independent risk factor for PSS-10 and SAS scores. PSS-10, PHQ-9, and SAS scores were significantly higher in S1 than in S2 (p < 0.01). During the COVID-19 pandemic, stress, anxiety, and depression were prevalent among college students; however, stress and anxiety were generally lower among college students returning to school than among non-returning students. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Psychosocial support for providers working high-risk exposure settings during a pandemic: A critical discussion

Psychological first aid is a form of support designed to lessen disaster-related distress. In a pandemic, providers may need such support but with the high risk of exposure, such a program is offered only virtually. The research is scant for traditional post-disaster support and non-existent for virtual; therefore, by using related research this discussion considers the likelihood of providers accessing and benefiting from this program. The virtual platform is heralded as the responsible way to provide support in a pandemic but this standard may be ineffective and is inherently inequitable. As a global event, pandemics require containment strategies applicable on an international level; therefore, psychosocial support should also be developed with an international audience in mind. Online psychosocial support falls short of being such a strategy as it incorrectly assumes global internet access. Many low-income areas such as Sub-Saharan Africa will need support strategies which compliment local frontline staff and fit with community-driven initiatives, whereas wealthier countries may use a combination of onsite and online support. Provider psychosocial support needs in a pandemic, if articulated, are globally similar but how this support is offered requires contextually sensitive considerations not yet found in the literature.

Psychosocial Impact of COVID-19 Pandemic in Elderly Psychiatric Patients: a Longitudinal Study

The study was designed to investigate the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on mental health and perceived psychosocial support for elderly psychiatric patients in a longitudinal design. n = 32 patients with affective or anxiety disorders aged ≥60 years were included. Telephone interviews were conducted in April/May 2020 (T1) and August 2020 (T2). The psychosocial impact (PSI) of the pandemic and psychopathology were measured. Changes between T1 and T2 were examined. Patients' psychosocial support system six months before the pandemic and at T1/T2 was assessed. We found a significant positive correlation between general PSI and depression as well as severity of illness. General PSI differed significantly depending on social contact. Neither general PSI nor psychopathology changed significantly between T1 and T2. At T1, patients' psychosocial support systems were reduced as compared to six months before. Patients reported an increase in psychosocial support between T1 and T2 and high demand for additional support (sports, arts/occupational therapy, physiotherapy, psychotherapy). Elderly psychiatric patients show a negative PSI of the pandemic. They are likely to suffer from an impaired psychosocial situation, emphasizing the importance of developing concepts for sufficient psychosocial support during a pandemic.

The influence and enlightenment of five public health emergencies on public psychology since new century: A systematic review

BACKGROUND

Since the 21st century, humans have experienced five public health emergencies: the severe acute respiratory syndrome (SARS), type A H1N1 influenza (H1N1), Middle East respiratory syndrome (MERS), Ebola virus disease (EVD), and the new coronavirus pneumonia (COVID-19). They caused a large number of casualties and a wider psychological crisis, which might cause severe consequences such as post-traumatic stress disorder and suicide.

AIMS

To reveal the law of formation of public psychological crisis in public health emergencies, and draw lessons from it. To provide ideas for effectively deal with these psychological crisis problems and fundamentally curbing the occurrence of public health emergencies.

METHOD

Through the method of literature research, 'public health incidents', 'psychological crisis', 'mental health', 'psychological intervention', 'SARS', 'H1N1', 'MERS', 'EVD', and 'COVID-19' were used to search literatures in the databases such as PubMed, Springer, and Sciencedirect, and the literatures were summarized, sorted, and studied.

RESULTS

(1) The public health emergencies caused a universal psychological crisis. The main manifestations were depression, compulsion, despair, etc. The people involved mainly include patients, suspected isolated patients, medical staff, and the general public in the epidemic situation. (2) People's psychological state often experienced stress stage, shock stage, acceptance, and reorganization. Only some susceptible individuals couldn't complete effective psychological reconstruction, resulting in serious psychological disorders. Individual susceptibility is related to genetic factors, adversity, and traumatic stimuli experienced in early life.

CONCLUSION

To reduce these psychological crisis problems, we should establish and improve the psychological crisis intervention or rescue system of public health emergencies, it was still necessary to live in harmony with nature, get rid of the inappropriate habit of preying on wild animals, in order to prevent the cross-species transmission of the virus between wild animals and humans, and to fundamentally avoid the occurrence of major infectious diseases.

Ebola virus disease, stigmatization, peritraumatic distress, and posttraumatic stress disorder in the Democratic Republic of the Congo: A moderated mediation model

BACKGROUND

Mechanisms worsening the development of Posttraumatic stress disorder (PTSD) symptoms among individuals affected by high-mortality epidemics are unclear. This study examined the prevalence of PTSD and related risk factors among populations affected by the Ebola virus disease (EVD) outbreak, and investigated whether peritraumatic distress mediates the impact of exposure level to EVD on PTSD symptoms, and the moderation role of stigmatization.

METHODS

The sample included 1614 participants (50% women) affected by EVD in Democratic Republic of the Congo (DRC). Participants completed the PTSD Check-List for DSM-5, Peritraumatic Distress Inventory, and measures evaluating levels of exposure and stigmatization related to EVD. Descriptive analyses and a moderated mediation model were computed.

RESULTS

A total of 58.81% participants (95% CI: 56.41%; 61.21%) met PTSD diagnostic criteria. Participants living in rural areas presented greater risk, while there is no significant difference between men and women. Peritraumatic distress mediated partially the association between exposure to EVD and PTSD symptoms. Moreover, this relationship was moderated by stigmatization related to EVD.

LIMITATIONS

As the design was cross-sectional, this study could not examine the causality of PTSD symptoms among communities affected by EVD.

CONCLUSIONS

This study shows high prevalence rates and important risk factors associated with PTSD in populations affected by EVD. It indicates elements that could help to develop and implement prevention and intervention programs in affected communities.

Mixed-methods assessment of health and mental health characteristics and barriers to healthcare for Ebola survivors in Beni, Butembo and Katwa health zones of the Democratic Republic of Congo

OBJECTIVES

Health and mental health characteristics of all respondents, barriers to accessing health and mental health services and the characteristics and those most at risk for mental health disorders.

SETTING

Beni, Butembo and Katwa health zones in the Democratic Republic of Congo.

PARTICIPANTS

The sample contained 223 Ebola survivors, 102 sexual partners and 74 comparison respondents living in the same areas of the survivors. Survivors were eligible if aged >18 years with confirmed Ebola-free status. The comparison group was neither a survivor nor a partner of a survivor and did not have any household members who contracted Ebola virus disease (EVD).

PRIMARY AND SECONDARY OUTCOME MEASURES

Health and mental health characteristics, barriers to care and the association of association of mental health disorders with study population characteristics.

RESULTS

Funding was a barrier to accessing needed health services among all groups. Nearly one-third (28.4%, 95% CI 18.0% to 38.7%) of comparison households avoided getting injections for their children. Although most pregnant women were attending antenatal care, less than 40% of respondents stated EVD precautions were discussed at those visits. Trouble sleeping and anger were the strongest predictors of post-traumatic stress disorder, major depressive disorder (MDD), anxiety and suicide attempts with 3-fold to 16-fold increases in the odds of these disorders. There was a 71% decrease in the odds of MDD if current substance abuse (aOR 0.29; 95% CI 0.13 to 0.67; p<0.01) was reported.

CONCLUSIONS

Specialised mental health services were limited. Fear of contracting EVD influenced vaccine compliance. Anger and sleep disorders significantly increased the odds of mental health disorders across all groups. Respondents may be using substance abuse as self-medication for MDD. Ebola outbreak areas would benefit from improved screening of mental health disorders and associated conditions like anger and sleep difficulties and improved mental health services that include substance abuse prevention and treatment.

COVID-19 Mental Health Disparities

Communities of color in the United States have been disproportionately impacted by the COVID-19 pandemic. Studies exploring the mental health implications of these disparities have only just begun to emerge. The purpose of this study is to better understand mental health concerns and test whether social determinants of health and COVID-19-related experiences influence these concerns. In April 2020, we launched a community-based survey for adults across the United States. A total of 341 respondents completed the survey, which included questions about demographics, depression, social isolation, work environment, and preexisting mental health conditions. We generated matched controls by adding county data from the Robert Wood Johnson Foundation to our survey. Chi square, Pearson product-moment correlation, point biserial correlation, and logistic regression were estimated. Our analysis revealed that respondents who identified as Latinx, Latin@, or Hispanic were 10 times more likely to meet the threshold score for depression. Similarly, individuals with prior mental health conditions and those who expressed feelings of social isolation due to COVID-19 were 3 times more likely to meet the threshold score for depression. These results confirm our hypothesis that communities of color will likely experience disproportionate mental health impacts of COVID-19-specifically, the mental health sequela that emerge from exposure, cumulative burden, and social isolation. We discuss the implications for expanding access and quality of health and mental health services to address current inequities.

[Psychiatric consequences of Covid 19 pandemic in the pediatric population]

The objective of this article is to present a literature review concerning the psychiatric consequences associated with the Covid 19 pandemic, in the pediatric population. This review is realized with Pubmed Database, using Covid 19, Coronavirus, child, children, adolescent, mental health, psychiatric or psychological consequences as keywords. We propose to present an inventory of current research based on three factors: fear linked to the pandemic, the consequences of the stay-at-home confinement, and the risks of cumulative trauma. We will present three clinical vignettes of children who were followed during the health crisis following the development of symptoms related to the health situation. We will end with some perspectives on the management of the health crisis by child and adolescent psychiatry services.

Global health disparities in vulnerable populations of psychiatric patients during the COVID-19 pandemic

The coronavirus disease 2019 pandemic affects psychiatric patients disproportionately compared to the general population. In this narrative review, we examine the impact of the pandemic on significant global health disparities affecting vulnerable populations of psychiatric patients: People of diverse ethnic background and color, children with disabilities, sexual and gender minorities, pregnant women, mature adults, and those patients living in urban and rural communities. The identified disparities cause worsened mental health outcomes placing psychiatric patients at higher risk for depression, anxiety and posttraumatic stress disorder symptoms. Those psychiatric patients who are ethnic minorities display barriers to care, including collective trauma and structural racism. Sexual and gender minorities with mental illness face discrimination and limited access to treatment. Pregnant women with psychiatric diagnoses show higher exposure to domestic violence. Children with disabilities face a higher risk of worsening behavior. Mature adults with psychiatric problems show depression due to social isolation. Psychiatric patients who live in urban communities face pollutants and overcrowding compared to those living in rural communities, which face limited access to telehealth services. We suggest that social programs that decrease discrimination, enhance communal resilience, and help overcome systemic barriers of care should be developed to decrease global health disparities in vulnerable population.

Child witchcraft confessions as an idiom of distress in Sierra Leone; results of a rapid qualitative inquiry and recommendations for mental health interventions

BACKGROUND

Reports about child witchcraft are not uncommon in sub-Saharan Africa. In this study we approach child witchcraft as an idiom of distress. In an environment that may prohibit children from openly expressing distress, the shared imagery of witchcraft can provide a cultural idiom to communicate about psychosocial suffering. We used an ecological approach to study how some children in distressing circumstances come to a witchcraft confession, with the aim to set out pathways for mental health interventions.

METHODS

We employed rapid qualitative inquiry methodology, with an inductive and iterative approach, combining emic and etic perspectives. We conducted 37 interviews and 12 focus group discussions with a total of 127 participants in Freetown, Sierra Leone. Inductive analysis was used to identify risk and protective factors related to witchcraft accusations and confessions.

RESULTS

We identified risk and protective factors related to the individual child, the family, peer relations, teachers and other professionals in a child's life, traditional healers, pastors and the wider society. We found that in the context of a macrosystem that supports witchcraft, suspicions of witchcraft are formed at the mesosystem level, where actors from the microsystem interact with each other and the child. The involvement of a traditional healer or pastor often forms a tipping point that leads to a confession of witchcraft.

CONCLUSIONS

Child witchcraft is an idiom of distress, not so much owned by the individual child as well as by the systems around the child. Mental health interventions should be systemic and multi-sectoral, to prevent accusations and confessions, and address the suffering of both the child and the systems surrounding the child. Interventions should be contextually relevant and service providers should be helped to address conscious and subconscious fears related to witchcraft. Beyond mental health interventions, advocacy, peacebuilding and legislation is needed to address the deeper systemic issues of poverty, conflict and abuse.

Change in Health-Related Socioeconomic Risk Factors and Mental Health During the Early Phase of the COVID-19 Pandemic: A National Survey of U.S. Women

Background: During a pandemic, women may be especially vulnerable to secondary health problems driven by its social and economic effects. We examined the relationship between changes in health-related socioeconomic risks (HRSRs) and mental health. Materials and Methods: A cross-sectional survey of 3,200 women aged 18-90 years was conducted in April 2020 using a quota-based sample from a national panel (88% cooperation rate). Patterns of change in HRSRs (food insecurity, housing instability, interpersonal violence, and difficulties with utilities and transportation) were described. Weighted, multivariate logistic regression was used to model the odds of depression, anxiety, and traumatic stress symptoms among those with and without incident or worsening HRSRs. Results: More than 40% of women had one or more prepandemic HRSRs. In the early pandemic phase, 49% of all women, including 29% with no prepandemic HRSRs, had experienced incident or worsening HRSRs. By April 2020, the rates of depression and anxiety were twice that of prepandemic benchmarks (29%); 17% of women had symptoms of traumatic stress. The odds of depression, anxiety, and posttraumatic stress symptoms were two to three times higher among women who reported at least one incident or worsening HRSR; this finding was similar for women with and without prepandemic HRSRs. Conclusions: Increased health-related socioeconomic vulnerability among U.S. women early in the coronavirus disease 2019 (COVID-19) pandemic was prevalent and associated with alarmingly high rates of mental health problems. Pandemic-related mental health needs are likely to be much greater than currently available resources, especially for vulnerable women.

The Role of Personality in Shaping Pandemic Response: Systemic Sociopolitical Factors Drive Country Differences

The current study utilizes the current COVID-19 pandemic to highlight the importance of accounting for the influence of external political and economic factors in personality public health research. We investigated the extent to which systemic factors modify the relationship between personality and pandemic response. Results shed doubt on the cross-cultural generalizability of common Big Five factor models. Individual differences only predicted government compliance in autocratic countries and in countries with income inequality. Personality was only predictive of mental health outcomes under conditions of state fragility. Our ability to use individual differences to understand policy-relevant outcomes changes based on environmental factors and must be assessed on a trait-by-trait basis, thus supporting the inclusion of systemic political and economic factors in individual differences models.

Psychological Adjustment in Spain during the COVID-19 Pandemic: Positive and Negative Mental Health Outcomes in the General Population

In the midst of the COVID-19 epidemic, Spain was one of the countries with the highest number of infections and a high mortality rate. The threat of the virus and consequences of the pandemic have a discernible impact on the mental health of citizens. This study aims to (a) evaluate the levels of anxiety, depression and well-being in a large Spanish sample during the confinement, (b) identify potential predictor variables associated to experiencing both clinical levels of distress and well-being in a sample of 2,122 Spanish people. By using descriptive analyses and logistic regression results revealed high rates of depression, anxiety and well-being. Specifically, our findings revealed that high levels of anxiety about COVID-19, increased substance use and loneliness as the strongest predictors of distress, while gross annual incomes and loneliness were strongest predictors of well-being. Finding of the present study provide a better insight about psychological adjustment to a pandemic and allows us to identify which population groups are at risk of experiencing higher levels of distress and which factors contribute to greater well-being, which could help in the treatments and prevention in similar stressful and traumatic situations.

Social Behaviors Associated With a Positive COVID-19 Test Result

Objective

To compare the social behaviors of individuals who were tested positive for COVID-19 relative to non-infected individuals.

 

Methods

We sent COVID positive cases and age/gender-matched controls a survey regarding their social behaviors via MyChart (online patient portal). We called cases if they did not complete the electronic survey within two days. Data were collected from May to June 2020. Survey responses for cases without close contact and controls were compared using Pearson chi-square or Fisher’s exact tests as appropriate.

 

Results

A total of 339 participants completed the survey (113 cases, 226 controls); 45 (40%) cases had known contact with COVID-19. Cases were more likely to have recently traveled (4% vs. 0%, p = 0.01) or to work outside the home (40% vs. 25%, p = 0.02). There was no difference in the rates of attending private or public gatherings, mask/glove use, hand-washing, cleaning surfaces, and cleaning mail/groceries between cases and controls.

 

Conclusions

Sixty percent of cases had no known contact with COVID-19, indicating ongoing community transmission and underlining the importance of contact tracing. The greater percentage of cases who work outside the home provides further evidence for social distancing and remote telework when possible.

The prevalence of PTSS under the influence of public health emergencies in last two decades: A systematic review and meta-analysis

BACKGROUND

Since the beginning of 21st century, several major public health emergencies (PHEs) have threatened the health of people globally. Posttraumatic stress symptoms (PTSS) was one of the most concerned mental health problems. The objective of this study is to systematically estimate the prevalence of PTSS under the influence of PHEs.

METHOD

We searched both English and Chinese databases. This meta-analysis used a random-effects model to estimate the prevalence of PTSS. Subgroup analyses were conducted to analyze the source of heterogeneity. Meta-regression model was used to calculate the proportion of the variance explained by subgroup moderators.

RESULTS

Forty eligible studies (n = 15,538) were identified. The results revealed a pooled prevalence of PTSS of 17.0% (95%CI: 13.5%-21.2%), higher than that of previous epidemiological survey, with high between-studies heterogeneity (Q = 1199, I2 = 96.75%, p < .001). There was variance of prevalence in different countries (4.0%-36.5%) and epidemics (12.1%-36.5%). The prevalence of PTSS showed the feature of fluctuation in the change of time (Q = 6.173, p = .290). Patients had higher prevalence (26.2%) compared to healthcare workers (HCWs) (18.5%) and community samples (12.4%) and frontline HCWs had marginally significantly higher estimated rate than general HCWs (22.2%, 95%CI:16.0%-30.1% vs. 10.4%, 95%CI: 6.4%-16.6%). The variance of prevalence screened by interview and self-reported was significant (Q = 3.393, p = .05) and studies with higher quality possessed lower prevalence (high:12.4%; moderate: 17.3%; low: 18.0%). The total variance explained by subgroup moderators was estimated 64% by meta regression model.

LIMITATIONS

Limitations include high level of heterogeneity between studies and within subgroups as well as the lack of studies with high quality and using probability sampling.

CONCLUSIONS

This study suggested that the PTSS was common under the influence of PHEs. It was crucial to further explore the psychological mechanism and effective strategies for prevention and intervention in future research with more high-quality studies.

Post-Traumatic Growth and Stress-Related Responses During the COVID-19 Pandemic in a National Representative Sample: The Role of Positive Core Beliefs About the World and Others

Given the need to understand both the negative and positive psychological consequences of the current global COVID-19 pandemic (Brewin et al. in Perspectives in Public Health 10.1177/1757913920957365 2020), the aim of this study was to test a cognitive model of post-traumatic symptoms (PTS) and post-traumatic growth (PTG) during confinement caused by the SARS-COV-2 epidemic. In line with cognitive models of trauma elaboration (Park in Psychological Bulletin 10.1037/a0018301), we included in our model some beliefs associated to the world (e.g., primal beliefs about a good world), to the self (e.g., death anxiety or orientation toward the future) and to others (e.g., suspiciousness or identification with humanity). To evaluate the explanatory model, a national representative sample of adults between the ages of 18 and 75 (N = 1951) was surveyed between 7th and 13th April, 2020, in the middle of a strict 7-week national confinement. Structural equation modelling yielded a very similar model to the one initially specified. The results highlight the role of both negative and positive core beliefs, which are pertinent to the current pandemic threat, in the appearance of PTS and PTG, respectively. In short, primal beliefs about a good world, openness to the future and identification with humanity were associated with PTG; while suspiciousness, intolerance of uncertainty, anxiety about death and also identification with humanity were associated with PTS and consequent impairment. This is an innovative study of different pathways to traumatic responses and growth during a pandemic. Future research is needed to replicate its findings.

Psychological Effects of People Isolated in Hubei Due to COVID-19 Epidemic

The Coronavirus Disease 2019 (COVID-19) epidemic broke out from Wuhan in Hubei province, China, spread nationwide and then gradually developed into other countries in the world. The implementation of unprecedented strict isolation measures has affected many aspects of people's lives and posed a challenge to psychological health. To explore whether people isolated for 14 days due to having contact with COVID-19 patients had more psychosocial problems. We conducted an online survey from February 29 to March 10, 2020. Depression, anxiety, post-traumatic stress disorder (PTSD) symptoms, and coping style were assessed by the Patient Health Questionnaire-9 (PHQ-9), 7-item Generalized Anxiety Disorder Scale (GAD-7), Impact of Event Scale-Revised (IES-R), and Simplified Coping Style Questionnaire-20-Chinese Version. This study included 1,315 isolated respondents in Hubei province (58.5% located in Wuhan). 69.3% respondents isolated at home, 30.7% respondents isolated at centralized quarantined spot. Of all respondents, 66.8% reported depressive symptoms, 49.7% reported anxiety symptoms, 89.0% reported PTSD symptoms. The Cronbach α of the IES-R, PHQ-9, GAD-7, and total SCSQ-20 were 0.935, 0.847, 0.843, and 0.888, respectively. Persons who isolated at home were associated with a lower risk of PTSD, depressive and anxiety symptoms (P < 0.01). People who knew someone to have COVID-19 were associated with severe symptoms of PTSD symptoms (P = 0.001). As for coping style, higher level of passive coping style was associated with severe symptoms of PTSD, depression and anxiety (P < 0.001). Our findings identify that person isolated during the COVID-19 epidemic was associated with high proportion of depression, anxiety, and PTSD symptoms. Public health officials should be aware of and prepared to take necessary measures.

Prevalence of anxiety and depression symptoms, and association with epidemic-related factors during the epidemic period of COVID-19 among 123,768 workers in China: A large cross-sectional study

BACKGROUND

COVID-19 has gained intense attention globally. However, little is known about the COVID-19-ralated mental health status among workers.

METHODS

The cross-sectional online survey with 123,768 workers was conducted from February 2, 2020 to February 7, 2020 on a mega-size labor-intensive factory in Shenzhen, China. Oral consent was obtained prior to the questionnaire survey. The information collected in the survey included demographic characteristics, psychological symptoms, COVID-19-related information, and demands for psychological education and interventions. Symptoms of anxiety and depression were measured by the Zung's Self-Rating Anxiety Scale and Self-Rating Depression Scale. Logistic regression models were performed to determine the association between related factors and mental health status.

RESULTS

The prevalence of anxiety and depression symptoms was 3.4% and 22.8%, respectively. The dominant epidemic-related factors were having confirmed cases in the community (odds ratio [OR], 2.75, 95% CI, 2.37-3.19) and having confirmed friends (OR, 2.44; 95% CI, 1.69-3.52) for the increased risk of anxiety and depression symptoms, respectively. Nevertheless, major traditional risk factors such as general or poor health status and always drinking alcohol were still the dominant factors associated with the increased risk of anxiety and depression symptoms. Overall, 67.3% and 26.8% workers reported desire for psychological education and interventions, respectively.

LIMITATIONS

All assessments were self-reported, resulting in a risk of method bias.

CONCLUSIONS

Our findings show a relatively low prevalence of anxiety symptoms, a relatively high prevalence of depression symptoms, and urgent demand for psychological education and interventions among workers during the COVID-19 outbreak.

How to Assess Perceived Risks and Safety Behaviors Related to Pandemics: Developing the Pandemic Risk and Reaction Scale during the Covid-19 Outbreak

Objective: The aim of the present study was to develop a self-report questionnaire to assess the level of perceived risks and safety behaviors during pandemics. Method : We went through recommended phases and their corresponding steps to create a valid and reliable scale: (a) item development (including 1. domain identification and item generation, 2. content validity), (b) scale development (including 1. pretesting questions, 2. sampling and survey administration, 3. item reduction, and 4. extraction of factors), and (c) scale evaluation (including 1. tests of dimensionality, 2. tests of reliability, and 3. tests of validity). Results: We found four factors with eigenvalues greater than 1 that were accounted for 0.63 of the total variance. The 4-factor solution showed all items had factor loading greater than 0.4 and each belonged to one factor. The fit indices indicated the 4-factor solution model was fitted to our data. Conclusion: In sum, the Pandemic Risk and Reaction Scale (PRRS) is a valid and reliable self-reported scale to assess the level of perceived risk and safety behaviors during pandemics.

Prevalence of Mental Health Problems During Virus Epidemics in the General Public, Health Care Workers and Survivors: A Rapid Review of the Evidence

Background: The swift spread of SARS-CoV-2 provides a challenge worldwide. As a consequence of restrictive public health measures like isolation, quarantine, and community containment, the provision of mental health services is a major challenge. Evidence from past virus epidemics and the current SARS-CoV-2 outbreak indicate high prevalence rates of mental health problems (MHP) as short- and long-term consequences. However, a broader picture of MHP among different populations is still lacking. Methods: We conducted a rapid review on MHP prevalence rates published since 2000, during and after epidemics, including the general public, health care workers, and survivors. Any quantitative articles reporting on MHP rates were included. Out of 2,855 articles screened, a total of 74 were included in this review. Results: Most original studies on MHP were conducted in China in the context of SARS-CoV-1, and reported on anxiety, depression, post-traumatic stress symptoms/disorder, general psychiatric morbidity, and psychological symptoms. The MHP rates across studies, populations, and epidemics vary substantially. While some studies show high and persistent rates of MHP in populations directly affected by isolation, quarantine, threat of infection, infection, or life-threatening symptoms (e.g., health care workers), other studies report minor effects. Furthermore, even less affected populations (e.g., distant to epidemic epicenter, no contact history with suspected or confirmed cases) can show high rates of MHP. Discussion: MHP vary largely across countries and risk-groups in reviewed studies. The results call attention to potentially high MHP during epidemics. Individuals affected directly by an epidemic might be at a higher risk of short or even long-term mental health impairments. This study delivers insights stemming from a wide range of psychiatric instruments and questionnaires. The results call for the use of validated and standardized instruments, reference norms, and pre-post measurements to better understand the magnitude of the MHP during and after the epidemics. Nevertheless, emerging MHP should be considered during epidemics including the provision of access to mental health care to mitigate potential mental impairments.

The Anxiety-Buffer Hypothesis in the Time of COVID-19: When Self-Esteem Protects From the Impact of Loneliness and Fear on Anxiety and Depression

INTRODUCTION

The coronavirus (COVID-19) disease has spread worldwide, generating intense fear of infection and death that may lead to enduring anxiety. At the same time, quarantine and physical isolation can intensify feelings of dispositional loneliness that, by focusing on thoughts of disconnection from others, can trigger intense anxiety. Anxiety, generated by both fear of COVID-19 and dispositional loneliness, can activate negative expectations and thoughts of death, potentially generating alarming depressive symptoms. However, the anxiety-buffer hypothesis suggests that self-esteem acts as a shield (buffer) against mental health threats - fear and loneliness - thus hampering anxiety and depressive symptoms.

OBJECTIVE

This study aims to test the process - triggered by COVID-19 fear and loneliness - in which self-esteem should buffer the path leading to anxiety symptoms, then to depression.

METHODS

An observational research design with structural equation models was used. A sample of 1200 participants enrolled from the general population answered an online survey comprising: the fear of COVID-19 scale, the UCLA loneliness scale, the Rosenberg self-esteem scale, and the anxiety and depression scales of the Symptom Checklist-90-Revised.

RESULTS

Structural equation models showed the link between anxiety symptoms (mediator) with both the fear of COVID-19 and dispositional loneliness (predictors), as well as its association with consequent depressive symptomatology (outcome). In line with the anxiety-buffer hypothesis, self-esteem mediated the relationship between the predictors and their adverse psychological consequences.

CONCLUSION

Self-esteem represents a protective factor from the antecedents of depression. Targeted psychological interventions should be implemented to minimize the psychological burden of the disease whilst promoting adaptation and positive psychological health outcomes.

Prevalence of anxiety and depression symptom, and the demands for psychological knowledge and interventions in college students during COVID-19 epidemic: A large cross-sectional study

BACKGROUND

Although studies have suggested experiencing the epidemic of severe infectious diseases increased the prevalence of mental health problems, the association between COVID-19 epidemic and risk of anxiety and depression symptom in college students in China was unclear.

METHODS

A large cross-sectional online survey with 44,447 college students was conducted in Guangzhou, China. The Zung's Self-rating Anxiety Scale (SAS) and the Center for Epidemiologic Studies Depression Scale (CES-D Scale) were used to define the anxiety and depression symptom, respectively. Multivariable logistic regression models were used to analyze the association between COVID-19 epidemic and risk of anxiety and depression symptom.

RESULTS

The prevalence of anxiety and depression symptom was 7.7% (95% confidence interval [CI]: 7.5%, 8.0%) and 12.2% (95%CI: 11.9%, 12.5%), respectively. Compared with students who reported have not infected or suspected cases in family members and relatives, students who reported having confirmed (OR=4.06; 95%CI: 1.62, 10.19; P = 0.003), and suspected (OR=2.11; 95%CI: 1.11, 4.00; P = 0.023) cases in family members and relatives had higher risk of depression symptom. Additionally, the proportions of students with anxiety and depression symptom reported more demand of psychological knowledge and interventions than those without (P<0.001).

LIMITATIONS

All the data in this study was collected through online questionnaire, and we did not evaluate the reliability and validity.

CONCLUSIONS

The prevalence of anxiety and depression symptom was relatively low in college students, but the COVID-19 epidemic-related factors might be associated with higher depression symptom risk.

Prevalence of anxiety, depression and post-traumatic stress disorder among Ebola survivors in northern Sierra Leone: a cross-sectional study

Background

There is limited data available on the long-term mental health impact of Ebola virus disease (EVD) on survivors despite the disease experience of survivors meeting the criteria of a traumatic event as defined in the Diagnostic and Statistical Manual of Mental Disorders version IV (DSM IV). This study aimed to assess the prevalence and predictive factors of anxiety, depression and posttraumatic stress disorder among EVD survivors, approximately 2 years after discharge from the Ebola treatment centre (ETC).

Methods

We conducted a cross-sectional study between May and August 2017 among 197 adults Ebola survivors in Bombali district, Northern Sierra Leone. We collected information about demographics, mental health status and possible predictive factors. The HAD scale was used to measure anxiety and depression. PTSD was measured using the PTSD-checklist (PCL). Chi-square test or Fisher exact two-tailed tests were used to test for associations and the multiple logistic regressions model to determine factors that were independently associated with the outcome variables.

Results

The mean anxiety, depression and PTSD scores were (5.0 ± 3.9), (7.1 ± 3.8) and (39.5 ± 6.4) respectively. Based on cut-off scores, the prevalence of anxiety (HADs score ≥ 8), depression (HADs score ≥ 8) and PTSD (PCL ≥ 45) among Ebola survivors were (n = 49, 24.9%), (n = 93, 47.2%) and (n = 43, 21.8%) respectively. Older Ebola survivors (≥30 years) were more likely to show symptoms of depression (AOR = 8.5, 95% CI: 2.68–27.01, p = 0.001) and anxiety (AOR = 3.04; 95%CI: 1.2–7.7, p = 0.019) compared to younger ones (< 30 years). In addition, Ebola survivors who experienced a decreased level of exercise post-ETC discharge were more likely to show symptoms of depression (AOR = 2.63; 95%CI: 1.25–5.54, p = 0.011) and anxiety (AOR = 3.60; 95%CI: 1.33–9.72, p = 0.012) compared to those whose exercise remained the same post-ETC discharge.

Conclusion

Our findings show that anxiety, depression and PTSD are common among the Ebola survivors in Bombali district, Northern Sierra Leone, and that underscores the need to diagnose and manage mental health morbidities among Ebola survivors long after their recovery from Ebola virus disease. Cognitive Behaviour Therapy (CBT) and Interpersonal Therapy (IPT) need to be explored as part of overall mental healthcare package interventions.

The Role of Public Trust and Media in the Psychological and Behavioral Responses to the COVID-19 Pandemic

Objective: We investigated the level of psychological problems, perceived risk, safety behaviors, and the potential roles of demographic variables, public trust, media, and prior anxiety to illness during the COVID-19pandemic among Iranians. Method : In this cross sectional study, using a convenient and snowball sampling method, we distributed an online questionnaire to participants and collected data on their demographic variables, mental health status, the consumption of and level of trust to various media, the level of public trust, and perceived risk and safety behaviors regards COVID-19. Our final sample consisted of 1881 Iranian residents. We used descriptive analysis, bivariate correlation, univariable and multivariable linear regression analysis, and univariable and multivariable logistic regression analysis for data analysis. Results: The mental health problems have increased in comparison to past national survey; 24.1% vs 10.39% for depression, 37.93% vs 16.7% for social dysfunction, and 41.33% vs 29.5% for anxiety, and 31.12% vs 29.08% for somatization. We also found high percent of acute stress 52.71% (95% CI: 50.45-54.96). Being female, married, and having a higher educational level increased the odds of safety behaviors. Public trust and national media can regulate the negative effect of the pandemic, while increasing perceived risk and appropriate safety behaviors can decrease psychological problems and disorders. However, social media increases perceived risk, safety behaviors, and psychological problems, especially severe acute stress. Conclusion: We are in the early stages of the COVID-19 pandemic and its negative effects will increase. Many people have lost their relatives, their jobs, their social contacts, and are faced with a surge of negative news. Authorities should consider these critical issues and adopt appropriate communicative and supportive approaches to prevent their negative effects at both individual and societal levels.

Prevalence of mental health problems in populations affected by the Ebola virus disease: A systematic review and meta-analysis

Studies have shown that, in addition to being associated with a high mortality rate, Ebola Virus Disease (EVD) is also related with mental health problems. This study aimed to determine prevalence of mental health problems and associated factors among survivors and individuals affected by EVD. A systematic review of peer-reviewed empirical studies was conducted using EMBASE, PubMed, PsycINFO and PsyARTICLES. A random effects meta-analysis was performed on the proportions of people diagnosed with depression after an EVD outbreak. Of 205 studies initially identified, 21 were included in the systematic review and 10 in the meta-analysis. Results indicated that EVD is associated with depression, anxiety, post-traumatic stress disorder, obsessive-compulsive disorder, among others. Results revealed that one person out of five affected to EVD has been diagnosed with depression (standardized mean difference 19.92%, 95% CI 10.43%; 34.70). The I² provided evidence of heterogeneity in the results. This study demonstrated the evidence of the impact of EVD on the mental health of survivors and individuals affected by EVD. Further studies should consider the mental health consequences of EVD to plan culturally sensitive prevention and intervention programs based on the experience of communities affected by EVD.

Neurological, Cognitive, and Psychological Findings Among Survivors of Ebola Virus Disease From the 1995 Ebola Outbreak in Kikwit, Democratic Republic of Congo: A Cross-sectional Study

Background

Clinical sequelae of Ebola virus disease (EVD) have not been described more than 3 years postoutbreak. We examined survivors and close contacts from the 1995 Ebola outbreak in Kikwit, Democratic Republic of Congo (DRC), and determined prevalence of abnormal neurological, cognitive, and psychological findings and their association with EVD survivorship.

Methods

From August to September 2017, we conducted a cross-sectional study in Kikwit, DRC. Over 2 decades after the EVD outbreak, we recruited EVD survivors and close contacts from the outbreak to undergo physical examination and culturally adapted versions of the Folstein mini-mental status exam (MMSE) and Goldberg anxiety and depression scale (GADS). We estimated the strength of relationships between EVD survivorship and health outcomes using linear regression models by comparing survivors versus close contacts, adjusting for age, sex, educational level, marital status, and healthcare worker status.

Results

We enrolled 20 EVD survivors and 187 close contacts. Among the 20 EVD survivors, 4 (20%) reported at least 1 abnormal neurological symptom, and 3 (15%) had an abnormal neurological examination. Among the 187 close contacts, 14 (11%) reported at least 1 abnormal neurologic symptom, and 9 (5%) had an abnormal neurological examination. EVD survivors had lower mean MMSE and higher mean GADS scores as compared to close contacts (MMSE: adjusted coefficient: −1.85; 95% confidence interval [CI]: −3.63, −0.07; GADS: adjusted coefficient: 3.91; 95% CI: 1.76, 6.04).

Conclusions

EVD survivors can have lower cognitive scores and more symptoms of depression and anxiety than close contacts more than 2 decades after Ebola virus outbreaks.

Coronavirus Outbreak and Stress in Iranians

Iran has faced one of the worst COVID-19 outbreaks in the world, and no studies to date have examined COVID-19-related stress in the general Iranian population. In this first population-based study, a web-based survey was conducted during the peak of the outbreak to assess stress and its correlates in the Iranian population. A 54-item, valid, and reliable questionnaire, including items on demographic characteristics and past medical history, stress levels, awareness about signs and symptoms of COVID-19, knowledge about at-risk groups and prevention methods, knowledge about transmission methods, trust in sources of information, and availability of facemasks and sanitizers, was deployed via social and mass media networks. A total of 3787 Iranians participated in the study where the majority of the participants were females (67.4%), employed (56.1%), from developed provinces (81.6%), without chronic diseases (66.6%), and with ≥13 years of formal education (87.9%). The mean age of study participants was 34.9 years (range = 12-73), and the average stress score was 3.33 (SD = ±1.02). Stress score was significantly higher for females, those who were 30-39 years old, housewives, those with chronic diseases, individuals who were aware that there is no vaccine to prevent COVID-19, those who could not get facemasks or sanitizers, and individuals with higher knowledge about at-risk groups (p < 0.05). There was a significant correlation of stress scores with knowledge about prevention methods for COVID-19 (r = 0.21, p = 0.01) and trust in sources of information about COVID-19 (r = -0.18, p = 0.01). All of the predictors, except knowledge of two important at-risk groups and education, had a significant effect on stress scores based on a multivariate regression model. The COVID-19 outbreak could increase stress among all population groups, with certain groups at higher risk. In the high-risk groups and based on experience with previous pandemics, interventions are needed to prevent long-term psychological effects. Professional support and family-centered programs should be a part of pandemic mitigation-related policymaking and public health practices.

Behavioral Health and Response for COVID-19

Research from financial stress, disasters, pandemics, and other extreme events, suggests that behavioral health will suffer, including anxiety, depression, and posttraumatic stress symptoms. Furthermore, these symptoms are likely to exacerbate alcohol or drug use, especially for those vulnerable to relapse. The nature of coronavirus disease 2019 (COVID-19) and vast reach of the virus, leave many unknows for the repercussions on behavioral health, yet existing research suggests that behavioral health concerns should take a primary role in response to the pandemic. We propose a 4-step services system designed for implementation with a variety of different groups and reserves limited clinical services for the most extreme reactions. While we can expect symptoms to remit overtime, many will also have longer-term or more severe concerns. Behavioral health interventions will likely need to change overtime and different types of interventions should be considered for different target groups, such as for those who recover from COVID-19, health-care professionals, and essential personnel; and the general public either due to loss of loved ones or significant life disruption. The important thing is to have a systematic plan to support behavioral health and to engage citizens in prevention and doing their part in recovery by staying home and protecting others.

National and regional prevalence of posttraumatic stress disorder in sub-Saharan Africa: A systematic review and meta-analysis

BACKGROUND

People living in sub-Saharan Africa (SSA) are disproportionately exposed to trauma and may be at increased risk for posttraumatic stress disorder (PTSD). However, a dearth of population-level representative data from SSA is a barrier to assessing PTSD. This manuscript sought to calculate pooled PTSD prevalence estimates from nationally and regionally representative surveys in SSA.

METHODS AND FINDINGS

The search was conducted in PubMed, Embase, PsycINFO, and PTSDpubs and was last run between October 18, 2019, and November 11, 2019. We included studies that were published in peer-reviewed journals; used probabilistic sampling methods and systematic PTSD assessments; and included ≥ 450 participants who were current residents of an SSA country, at least 50% of whom were aged between 15 and 65 years. The primary outcomes were point prevalence estimates of PTSD across all studies, and then within subgroups. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42016029441). Out of 2,825 unique articles reviewed, 25 studies including a total of 58,887 eligible participants (54% female) in 10 out of the 48 countries in SSA were identified. Most studies enrolled any adult aged 18 years or older. However, some studies only enrolled specific age brackets or persons as young as 15 years old. Six studies were national surveys, and 19 were regional. There were 4 key findings in the meta-analysis: (1) the overall pooled prevalence of probable PTSD was 22% (95% CI 13%-32%), while the current prevalence-defined as 1 week to 1 month-was 25% (95% CI 16%-36%); (2) prevalence estimates were highly variable, ranging from 0% (95% CI 0%-0%) to 74% (95% CI 72%-76%); (3) conflict-unexposed regions had a pooled prevalence of probable PTSD of 8% (95% CI 3%-15%), while conflict-exposed regions had a pooled prevalence of probable PTSD of 30% (95% CI 21%-40%; p < 0.001); and (4) there was no significant difference in the pooled prevalence of PTSD for men and women. The primary limitations of our methodology are our exclusion of the following study types: those published in languages other than English, French, and Portuguese; smaller studies; those that focused on key populations; those that reported only on continuous measures of PTSD symptoms; and unpublished or non-peer-reviewed studies.

CONCLUSIONS

In this study, PTSD symptoms consistent with a probable diagnosis were found to be common in SSA, especially in regions exposed to armed conflict. However, these studies only represent data from 10 of the 48 SSA countries, and only 6 studies provided national-level data. Given the enormous heterogeneity expected across the continent, and also within countries and regions, this review cannot speak to rates of PTSD in any regions not included in this review. Thus, substantial gaps in our knowledge of PTSD prevalence in SSA remain. More research on population-level prevalence is needed to determine the burden of trauma symptoms and PTSD in SSA and to identify acceptable and feasible approaches to address this burden given limited mental healthcare resources.

Institutional trust and misinformation in the response to the 2018-19 Ebola outbreak in North Kivu, DR Congo: a population-based survey

BACKGROUND

The current outbreak of Ebola in eastern DR Congo, beginning in 2018, emerged in a complex and violent political and security environment. Community-level prevention and outbreak control measures appear to be dependent on public trust in relevant authorities and information, but little scholarship has explored these issues. We aimed to investigate the role of trust and misinformation on individual preventive behaviours during an outbreak of Ebola virus disease (EVD).

METHODS

We surveyed 961 adults between Sept 1 and Sept 16, 2018. We used a multistage sampling design in Beni and Butembo in North Kivu, DR Congo. Of 412 avenues and cells (the lowest administrative structures; 99 in Beni and 313 in Butembo), we randomly selected 30 in each city. In each avenue or cell, 16 households were selected using the WHO Expanded Programme on Immunization's random walk approach. In each household, one adult (aged ≥18 years) was randomly selected for interview. Standardised questionnaires were administered by experienced interviewers. We used multivariate models to examine the intermediate variables of interest, including institutional trust and belief in selected misinformation, with outcomes of interest related to EVD prevention behaviours.

FINDINGS

Among 961 respondents, 349 (31·9%, 95% CI 27·4-36·9) trusted that local authorities represent their interest. Belief in misinformation was widespread, with 230 (25·5%, 21·7-29·6) respondents believing that the Ebola outbreak was not real. Low institutional trust and belief in misinformation were associated with a decreased likelihood of adopting preventive behaviours, including acceptance of Ebola vaccines (odds ratio 0·22, 95% CI 0·21-0·22, and 1·40, 1·39-1·42) and seeking formal health care (0·06, 0·05-0·06, and 1·16, 1·15-1·17).

INTERPRETATION

The findings underscore the practical implications of mistrust and misinformation for outbreak control. These factors are associated with low compliance with messages of social and behavioural change and refusal to seek formal medical care or accept vaccines, which in turn increases the risk of spread of EVD.

FUNDING

The Harvard Humanitarian Initiative Innovation Fund.

The prevalence of PTSD and major depression in the global population of adult war survivors: a meta-analytically informed estimate in absolute numbers

Background: Elevated prevalences of post-traumatic stress disorder (PTSD) and major depression (MD) have been reported in populations exposed to war. However, no global estimates of war survivors suffering from PTSD and/or MD in absolute numbers have been reported. Objective: We made the first attempt to estimate in absolute numbers how many adult war survivors globally may suffer PTSD and/or MD, which should inform local and global mental health programmes. Method: Drawing on the Uppsala Conflict Database, we reviewed all countries that suffered at least one war within their own territory between 1989 and 2015 (time span chosen on availability of geo-referenced data and population estimates). We then conducted a meta-analysis of current randomized epidemiological surveys on prevalence of PTSD and/or MD among war survivors. Finally, we extrapolated our results from the meta-analysis on the global population of adult war survivors by means of using general population data from the United Nations. Results: We estimate that about 1.45 billion individuals worldwide have experienced war between 1989 and 2015 and were still alive in 2015, including one billion adults. On the basis of our meta-analysis, we estimate that about 354 million adult war survivors suffer from PTSD and/or MD. Of these, about 117 million suffer from comorbid PTSD and MD. Conclusions: Based on the slim available evidence base, the global number of adult war survivors suffering PTSD and/or MD is vast. Most war survivors live in low-to-middle income countries with limited means to handle the enormous mental health burden. Since representative high quality data is lacking from most of these countries, our results contain a large margin of uncertainty and should be interpreted with caution.

Prevalence of depression and posttraumatic stress disorder in adult civilian survivors of war who stay in war-afflicted regions. A systematic review and meta-analysis of epidemiological studies

BACKGROUND

Epidemiological surveys on depression and posttraumatic stress disorder (PTSD) among civilian war survivors in war-afflicted regions have produced heterogeneous prevalence estimates of these conditions.

METHODS

To determine the prevalence of both depression and PTSD in civilian war survivors in the area of conflict, we conducted a systematic search of Medline, PsycInfo, and Pilots databases. We included epidemiological studies that had used structured clinical interviews. We conducted random effects meta-analyses on prevalence proportions as well as univariate mixed model meta-regressions.

RESULTS

We included 33 studies that assessed prevalences of depression (k = 18) and/or PTSD (k = 30). Across all studies, pooled point prevalences of 0.27 and 0.26 were found for depression and PTSD, respectively. Ten percent of participants fulfilled criteria for both disorders. Surveys with a higher mean age of participants reported higher prevalence of depression. Furthermore, samples with higher rates of unemployment and higher percentages of women reported higher prevalence of PTSD, whereas samples with a higher number of participants living with a partner reported lower prevalence of PTSD.

LIMITATIONS

The findings are limited by poor psychometric reporting practices.

CONCLUSIONS

Our findings suggest that both depression and PTSD are highly prevalent in war survivors who stayed in the area of conflict. Yet, future research on this topic need to focus on psychometric properties of instruments used to assess psychopathology among war survivors. Notwithstanding this limitation, there is an urgent need for large-scale mental health programs that are appropriate for war-affected countries with limited resources and address depression as much as PTSD.