Perceived psychological stress and associated factors in the early stages of the coronavirus disease 2019 (COVID-19) epidemic: Evidence from the general Chinese population

Synergy between psychological impact and biochemical manifestation of stress among the COVID-19 pandemic-affected population

Objective

Due to the COVID-19 pandemic, many countries around the world experienced an unprecedented increase in stress in the general population. Even after normal life has been reestablished, the new normal is punctuated by severely impacted vulnerable groups. Stress-associated symptoms display an intricate relationship with biochemical modulations, which coordinate the stress response. Identifying these biochemical factors is inherent to deciphering the mode of treatment needed to diminish the health-care gap resulting from the pandemic.

Methods

We applied psychological measures using the perceived stress (PS) and COVID-19 anxiety (CA) scales and preventive health behavior (PHB) to evaluate stress in the general population. Biochemical markers of stress, that is, total antioxidant capacity (TAC), thiobarbituric acid reactive substances (TBARS), cortisol, and C-reactive protein (CRP) were tested in the serum samples of the participants. Statistical analysis was carried out using SPSS version 22.0.

Results

Stress scores for PS, CA, and PHB indicate the prevalence of moderate-to-high stress among participants, and a correlation between psychological stress and biochemical correlates, TAC, TBARS, cortisol, and CRP. Serum concentrations of TBARS, Cortisol, and CRP were found to be significantly increased, while the TAC was decreased across all stress types and levels. Our findings demonstrate a positive correlation between PS, CA, PHB TBARS, cortisol, and CRP and a strong negative correlation with TAC.

Conclusion

The results of this study will help in tailoring targeted interventions and preventive regimes to mitigate COVID-19-associated anxiety and stress disorders prevailing even after the actual pandemic has subsided.

Measuring COVID-19 related stress and its associated factors among the parents of school-aged children during the first lockdown in France

BACKGROUND

The COVID-19 pandemic placed important challenges on parents, as they had to meet various demands during lockdown, including childcare, work and homeschooling. Therefore, the current study aimed to investigate perceived stress levels among the parents of school-aged children and explore their association with sociodemographic, environmental and psychological factors during lockdown.

METHODS

A cross-sectional study was conducted among the parents of school-aged children ages 8 to 18, who lived in the Grand Est region of France during the first wave of the pandemic. An online survey collected sociodemographic data, living and working conditions, and exposure to COVID-19 as well as parent's levels of perceived stress (PSS-10), self-perceived health status (SF-12), social support (MSPSS) and resilience (BRS). Multivariable logistic regression models were conducted to evaluate the association between moderate to severe perceived stress and various factors.

RESULTS

In total, 734 parents were included. The results indicated that 47% were experiencing moderate stress and 7.2% were experiencing severe stress. Factors most strongly associated with risk of moderate to severe levels of stress were lower levels of parental resilience (OR = 3.8, 95% CI: 2.2-6.6) and poor self-perceived mental health status (OR = 7.3, 95% CI: 5.0-10.8). The following risk factors were also identified: female sex; being in the age range of 35-44; difficulties isolating and contracting COVID-19, which involved hospitalization and separation or isolation from family. The support of friends (OR = 0.8, 95% CI: 0.7-1.0) and family (OR = 0.5, 95% CI: 0.3-0.8) were protective factors.

CONCLUSIONS

These findings suggest that supportive and preventive programs should focus on the improvement of resilience and mental health management to promote parents' wellbeing. Research has to focus both on individuals' inner potential for increasing resilience and the environmental resources to be activated. Building and boosting resilience among parents could serve as a protective factor against negative outcomes for them and their families.

Emerging Adult Resilience to the Early Stages of the COVID-Pandemic: A Systematic Scoping Review

Human resilience to COVID-19 related stressors remains a pressing concern following the aftereffects of the pandemic and in the face of probable future pandemics. In response, we systematically scoped the available literature (n = 2030 records) to determine the nature and extent of research on emerging adults' adaptive responses to COVID-19 stressors in the early stages of the pandemic. Using a multisystem resilience framework, our narrative review of 48 eligible studies unpacks the personal, relational, institutional and/or physical ecological resources that enabled positive emerging adult outcomes to COVID-18 stressors. We found that there is a geographical bias in studies on this topic, with majority world contexts poorly represented. Resources leading to positive outcomes foregrounded psychological and social support, while institutional and ecological supports were seldom mentioned. Multisystemic combinations of resources were rarely considered. This knowledge has valuable implications for understanding resilience in the context of other large-scale adverse conditions.

I Believe I Can Try: Self-Efficacy, Pandemic Behaviors, Coping, and Learning

While colleges and universities grapple with delivering instruction face-to-face during the pandemic, there is still a lot to learn from remote teaching experiences. The present study aimed to predict self-reported learning during the first year of the pandemic. Building on previous scholarship on the topic, we focus on the moderating effects of self-efficacy, and the mediating effects of coping styles on the relationship between stress and self-reported learning experiences. We also included self-perceptions of class effort, the instructor, and changes in class, personal, professor, and health behaviors. Students (N = 272) in Introductory Psychology classes participated in an online survey as part of a class research requirement. Analyses demonstrated that self-efficacy predicted differences in many measures associated with learning and predicted learning over and above all other variables entered in a hierarchical regression. The relationship between stress and learning was mediated by coping, but not moderated by self-efficacy. These results suggest student beliefs about their ability to perform online are important to learning outcomes, but coping mechanisms mediate the relationship of stress and learning. Especially while teaching during pandemic times using different modalities, instructors will do well to directly address students' perceptions of their own ability and build self-efficacy.

TElewoRk-RelAted Stress (TERRA), Psychological and Physical Strain of Working From Home During the COVID-19 Pandemic: A Systematic Review

BACKGROUND

Many workers shifted to working from home due to the COVID-19 pandemic. This review aims to investigate if this sudden change caused an increase in TElewoRk-RelAted stress (TERRA) which is defined as physical and mental stress caused by telework.

METHODS

A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed of three scientific databases (PubMed, ISI Web of Knowledge, and Scopus), which also included a quality assessment. Articles measuring stress, psychological or physical, in remote workers, published from December 2019 through August 2021 were included in the review. Results were extracted by reporting: authors, country, study design, type of workers, sample, questionnaires and measurements, and outcomes. Data were synthesized quantitatively for country, type of workers, and outcomes.

RESULTS

Out of the 518 articles found in the three databases, 19 articles were included in the systematic review (10,012 participants overall), and 78.9% of these highlighted an increase in TERRA levels in remote workers. Among 85.7% of the studies considering gender as a variable, TERRA levels were higher in female workers. Twelve (63.2%) of the studies investigated psychological well-being, two (10.5%) focused on the physical well-being of remote workers, three (15.8%) investigated both, and two studies had other outcomes (10.5%).

CONCLUSIONS

Considering the redefinition of workplaces dictated by the COVID-19 pandemic, this review highlights the emerging issue of remote work and the use of technology in working from home, emphasizing a rapidly growing occupational health problem. Remote workers need to be provided with emotional and technical support to prevent TERRA in remote workers.

Stress-Buffering Effects of Social Support on Tourism Employees during the COVID-19 Pandemic: A Moderated Mediation Model

Since the beginning of 2020, China's tourism industry has been severely impacted by the COVID-19 pandemic, and domestic tourism revenues have plummeted. Tourism employees have faced reduced working hours, job instability, shut down, and unemployment. In the context of the normalization of epidemic prevention, the tourism industry is recovering slowly and uncertainly, and many tourism employees face increasing employment stress. To investigate the relationship between social support and employment stress among tourism employees, 308 tourism employees were surveyed, and the mediating role of positive coping styles and the moderating role of psychological resilience were examined using structural equation modeling. The results revealed three key findings: social support significantly and negatively influenced the employment stress of tourism employees; positive coping styles significantly mediated the relationship between social support and employment stress among tourism employees; and psychological resilience moderated the relationship between social support and employment stress among tourism employees, as well as moderating the relationship between social support and positive coping style. The current findings help to deepen the understanding of the relationship between social support and employment stress, and they have important implications for alleviating the employment stress of tourism employees in the context of the pandemic.

COVID-19 pandemic and lockdown: impact on parents' stress level and infant care in a tertiary neonatal unit

Neonatal intensive care unit (NICU) admission increases parents' stress levels and it might be even higher in the crisis of coronavirus disease 2019 (COVID-19) pandemic and lockdown. This study was done to identify the stress levels of parents of admitted neonates and the difficulties encountered in neonatal care and follow-up during the COVID-19 pandemic and lockdown. The Parental Stressor Scale (PSS:NICU) and Perceived Stress Scale (PeSS) were used to identify the stress levels of parents of admitted neonates. Online survey form with a structured questionnaire comprising PeSS and NICU:PSS was sent through messaging app (Google form) after informed consent. PSS score of <14 was considered low stress, 14-26 moderate and >26 as high. A total of 118 parental responses (mother /father in 26, both in 46) for 72 admitted neonates, were obtained. The mean (SD) PeSS score was 19.7 (5.8%) and 92 (78%) had moderate stress while 11 (9%) had high stress. In NICU:PSS, sights-sounds and parental role had more median scores: 2.25 (1-3.75) and 2.21 (1-3.57), respectively. Maternal and paternal NICU:PSS (p-0.67) and PeSS (p-0.056) scores were not statistically different. Keeping nil per oral, invasive ventilation, culture-positive sepsis, fathers' transport difficulty and longer duration of mothers' and neonates' hospital stay was associated with increased NICU: PSS scores. Twenty (29%) parents could not bring their child for follow-up and there was a delay in immunisation in 21 (30%). The pandemic and the lockdown might have disrupted antenatal and postnatal follow-ups further adding to the parental stress.

Depression, anxiety and stress among people infected with COVID-19 in Dhaka and Chittagong cities

Background

Covid-19 is an acute respiratory infectious disease caused by novel coronavirus 2019. Many individuals have suffered or are experiencing psychological symptoms due to feelings of isolation, insecurity and instability triggered by Covid-19. This study aimed to explore the perceived psychological distress and associated factors among people infected with Covid-19 in Dhaka and Chittagong cities.

Methods

Using the face-to-face interview method, a survey was conducted from 23 April to 22 May 2021 on a questionnaire on depression, anxiety and stress scale (DASS-21), socio-demographic, economic and health factors. Among those who had ever been infected with Covid-19, a total of 2092 respondents (1180 from Dhaka and 912 from Chittagong) were randomly selected and interviewed. χ2 test for independence of attributes was employed to observe the association of various socioeconomic, cultural, demographic and health factors with psychological distress. Moreover, multinomial logistic regression analysis was performed to explore the factors that contributed to psychological distress.

Results

Among participants from Dhaka, of three mental health conditions, the prevalence was higher for anxiety (80.0%), followed by stress (64.2%) and depression (59.8%), respectively. Anxiety was also more prevalent (57.3) among respondents in Chittagong, followed by depression (47.7%) and stress (39.5%). As the coexistence of symptoms, 52.8% of respondents in Dhaka, 34.4% in Chittagong experienced depression, anxiety and stress simultaneously. Moreover, in both Dhaka and Chittagong, all three psychological symptoms were strongly correlated in pairs. Multivariate analysis revealed that the most consistent factors associated with mild to moderate (MM), and severe to extremely severe (SES) depression were respondents from Chittagong who were illiterate or primary educated (OR = 0.166, CI: 0.076–0.364 for MM and OR = 0.041, CI: 0.013–0.131 for SES), male (OR = 0.999, CI: 0.666–1.496 for MM and OR = 0.395, CI: 0.249–0.625 for SES), single (OR = 0.393, CI: 0.157–0.982 for MM and OR = 0.121, CI: 0.049–0.303 for SES) and married (OR = 0.403, CI: 0.177–0.916 for MM and OR = 0.075, CI: 0.033–0.167 for SES), had a family of size ≤ 4 (OR = 0.253, CI: 0.140–0.458 for MM and OR = 0.114, CI: 0.059–0.218 for SES) and a family of size 5–6 (OR = 0.151, CI: 0.084–0.272), and no family members at risk being infected with Covid-19 (OR = 0.699, CI: 0.487–1.002 for MM and OR = 0.332, CI: 0.199–0.522 for SES). The analysis yielded similar findings for the other two mental health subscales, such as anxiety and stress. For respondents in Dhaka, the effect of factors other than sex on psychological distress was the opposite in Chittagong. Overall, psychological distress during the outbreak was greater among respondents in Dhaka than in Chittagong if respondents were not classified based on various characteristics.

Conclusion

This study showed that in both Dhaka and Chittagong, a substantially large portion of Covid-19-infected respondents experienced all three psychological distress (e.g., depression, anxiety and stress). Regardless of the dissimilarity between the results in Dhaka and Chittagong, better mental health support was needed for women in both cities.

Stress Perception and Coping Strategies of Students on Both Sides of the EU's Eastern Border during the COVID-19 Pandemic

The aim of the study was to compare the perception of stress and the characteristic coping-strategies among students in the context of the different anti-pandemic measures taken in Belarus, Poland, and the Russian exclave of Kaliningrad. A cross-sectional online survey using standardized questionnaires (Perceived Stress Scale-PSS-10 and Brief-COPE-Mini-COPE inventory) was conducted among 3113 students of seven universities in three neighboring regions on both sides of the eastern border of the EU. The groups that are the most prone to stress are the Polish and Russians students. Among the students from Belarus, 122 (13.7%) have high levels of stress symptoms. Among the respondents from Poland-238 (19.4%), and 191 (19.2%) from Kaliningrad have high levels of stress, respectively. The different approaches of the authorities to the COVID-19 pandemic diversified the choice of students' stress coping strategies. The behavior of the students from Kaliningrad and Poland was similar. The Belarusian students used active coping strategies less often, while an avoidance-focused style, and denial were more frequent. The neglect of restrictive anti-pandemic measures by the Belarusian students was manifested by a higher incidence of disease and minimal use of vaccinations.

Uncertainty and psychological distress during COVID-19: What about protective factors?

The present study examined the relationship between perceived uncertainty and depression/ anxiety symptoms during the COVID-19 pandemic and it tested the moderating roles of resilience and perceived social support in this relationship. A cross-sectional study was conducted between March 31st and May 15th, 2020, using an online, multi-language, international survey built within Qualtrics. We collected data on sociodemographic features, perceived uncertainty, perceived social support, depression and anxiety symptoms, and resilience. A moderation model was tested using model 2 of Hayes' PROCESS macro for SPSS. The study included 3786 respondents from 94 different countries, 47.7% of whom reported residence in the United States of America. Results demonstrated that higher perceived uncertainty was associated with more symptoms of depression and anxiety. Higher resilience levels and higher perceived social support were associated with fewer depression and anxiety symptoms. The moderation hypotheses were supported; the relationship between uncertainty and symptoms of depression and anxiety decreased as levels of resilience increased and as perceived social support increased. The results suggest that resilience and social support could be helpful targets to reduce the negative effects of uncertainty on depression and anxiety symptoms.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03244-2.

Factors related to perceived stress during the COVID-19 epidemic context among the general population in China: A cross-sectional nationwide study

BACKGROUND

This study aimed to investigate factors related to high stress levels among the general population in China during the novel coronavirus disease (COVID-19) pandemic when its containment measures were in place and to identify the most stressed populations.

METHODS

A nationwide study was conducted online among 5,039 adults in all 31 provinces in mainland China between March 1 and March 16, 2020. Bivariate analysis and multivariate logistic regressions were performed to explore the related factors of high perceived stress.

RESULTS

Among all respondents, 36.0% reported a high level of stress. Respondents in Hubei province (the epicenter) were more likely to report high stress levels than those in low epidemic areas. Respondents who went outside every day or every other day reported greater odds of experiencing a high level of stress than those who went outside every 8-14 days. People with higher risk perceptions were more prone to report high stress levels. Respondents aged 16-35 were more likely to report high stress than respondents aged 46 or older. Lower household income and lower health literacy were related to increased odds of reporting high stress levels.

LIMITATIONS

We used a convenience sample and self-reported survey data.

CONCLUSIONS

We identified risk factors for high stress levels related to the epidemic (epidemic intensity in residential areas, risk perception, and frequency of going outside) and other vulnerabilities (younger age, low household income, low health literacy). Our findings can directly inform interventions and policies for mitigating stress among the general population for this or future epidemics.

University students' strategies of coping with stress during the coronavirus pandemic: Data from Poland

The COVID-19 pandemic has changed the functioning of universities worldwide. In Poland, the transfer to online teaching was announced without prior warning, which radically changed students' daily functioning. This situation clearly showed the students' helplessness and difficulties with coping with this new, stressful situation, highlighted in many previous studies. A sudden and far-reaching change in daily functioning caused anxiety, depression, and stress in this group. Thus, from a pedagogical and psychological point of view, it is pertinent to examine the students' strategies of coping with stress caused by the COVID-19 pandemic. To this end, in 2020, a sample of Polish students was anonymously measured using the Mini-COPE questionnaire. Data was gathered from 577 students from 17 universities. The statistical analysis showed that during the coronavirus pandemic, Polish students most often used the coping strategies of: acceptance, planning, and seeking emotional support. Such factors as age, gender, and place of residence influenced the choice of specific strategies of coping with stress during the COVID-19 pandemic. The results also showed that the youngest students had the lowest coping skills. The results allow for concluding that the students' maladaptive strategies of coping with stress, especially during the pandemic, may result in long-term consequences for their psychophysiological health and academic achievements. Thus, based on the current results and on the participatory model of intervention, a support program for students is proposed which would involve psychological, organizational, and instrumental support.

The Prevalence of Psychological Status During the COVID-19 Epidemic in China: A Systemic Review and Meta-Analysis

The COVID-19 is creating panic among people around the world and is causing a huge public mental health crisis. Large numbers of observational studies focused on the prevalence of psychological problems during the COVID-19 pandemic were published. It is essential to conduct a meta-analysis of the prevalence of different psychological statuses to insight the psychological reactions of general population during the COVID-19 epidemic in China. Sixty six observational studies about the psychological statuses of people during the COVID-19 were included, searching up to 1 December 2020. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used to evaluate the quality of the included studies. OpenMeta[Analyst] was used for the data analysis. High prevalence of acute stress and fear symptoms were observed in the early period of the epidemic. Additionally, anxiety and depression symptoms continued at a high prevalence rate during the epidemic. It should alert the lasting mental health problems and the risk of post-traumatic stress disorder and other mental disorders. Systematic Review Registration: PROSPERO CRD 42020171485.