A cross-sectional study on the impact of the COVID-19 pandemic on psychological outcomes: Multiple indicators and multiple causes modeling

The impact of distance education on the socialization of college students in the Covid-19 era: problems in communication and impact on mental health

BACKGROUND

The problems of students' social interaction and psychological well-being associated with online learning dependent on self-directed learning have become an important topic of research in recent years worldwide due to the COVID-19 pandemic, affecting their Social Emotional Learning. This paper aimed to compare the students' loneliness, social anxiety, social interaction, and general psychological well-being at different stages of online learning (at the beginning and the height of the pandemic), considering their criteria (presence/absence of a job and own family).

METHODS

For this, the researchers conducted an electronic survey of students (n = 320) twice, in February and May 2020, using four questionnaires: UCLA loneliness scale-3, Social Anxiety Scale for E-Learning Environments, Social Interaction Scale, and Brief Adjustment Scale. The responses at different stages of online learning were compared using Student's t-test. Differences between employed and unemployed students with or without their own families were determined using the analysis of variance (ANOVA).

RESULTS

The findings showed that unemployed students without their families suffered the most from loneliness. Social interaction online was rated higher by students with their own families; psychological well-being at the beginning of the distance period and social anxiety at the height of the distance period were higher among unemployed students.

CONCLUSIONS

This research can become a theoretical basis for a phase-by-phase study of social predictors for the psychological well-being of higher education students and is of practical value for teachers and administrators of online learning aimed at students' socialization. In addition, it provides education officials with information about how students perceive psychological well-being, anxiety, social interaction, and loneliness during distance learning, which can help officials direct their decisions and reforms to improve interaction in the online environment.

The moderated-mediation role of risk perception and intolerance of uncertainty in the association between residual symptoms and psychological distress: a cross-sectional study after COVID-19 policy lifted in China

BACKGROUND

A considerable number of individuals infected with COVID-19 experience residual symptoms after the acute phase. However, the correlation between residual symptoms and psychological distress and underlying mechanisms are scarcely studied. We aim to explore the association between residual symptoms of COVID-19 and psychological distress, specifically depression, anxiety, and fear of COVID-19, and examine the role of risk perception and intolerance of uncertainty in the association.

METHODS

A cross-sectional survey was conducted by online questionnaire-based approach in mid-January 2023. Self-reported demographic characteristics, COVID-19-related information, and residual symptoms were collected. Depression, anxiety, fear, risk perception and intolerance of uncertainty were evaluated using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Fear of COVID-19 Scale (FCV-19S), COVID-19 Risk Perception Scale and Intolerance of Uncertainty Scale-12 (IUS-12), respectively. Linear regression analyses were conducted to explore the associations. A moderated mediation model was then constructed to examine the role of risk perception of COVID-19 and intolerance of uncertainty in the association between residual symptoms and psychological distress.

RESULTS

1735 participants effectively completed the survey. 34.9% of the patients experienced residual symptoms after acute phase of COVID-19. Psychological distress was markedly increased by COVID-19 infection, while residual symptoms had a significant impact on psychological distress (Ps < 0.001), including depression (β = 0.23), anxiety (β = 0.21), and fear of COVID-19 (β = 0.14). Risk perception served as a mediator between residual symptoms and all forms of psychological distress, while intolerance of uncertainty moderated the effect of risk perception on depression and anxiety.

CONCLUSION

A considerable proportion of patients experience residual symptoms after acute phase of COVID-19, which have a significant impact on psychological distress. Risk perception and intolerance of uncertainty play a moderated-mediation role in the association between residual symptoms and depression/anxiety. It highly suggests that effective treatment for residual symptoms, maintaining appropriate risk perception and improving intolerance of uncertainty are critical strategies to alleviate COVID-19 infection-associated psychological distress.

Burnout increased among university students during the COVID-19 pandemic: a systematic review and meta-analysis

Generally, university students are at risk of burnout. This likely was exacerbated during the COVID-19 pandemic. We aimed to investigate burnout prevalence among university students during the COVID-19 pandemic and examine its distribution across countries, sexes, fields of study, and time-period. PubMed, EMBASE, PsycINFO, World Health Organization's Global COVID-19 database, Scopus, Epistemonikos, ERIC and Google Scholar were searched (protocol: https://doi.org/10.17605/OSF.IO/BYRXW ). Studies were independently screened and extracted. Random-effects meta-analysis was performed. Study quality was appraised, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. We identified 44 primary studies comprising 26,500 students. Global prevalence rates were 56.3% for high emotional exhaustion (EE), 55.3% for high cynicism (CY) and 41.8% for low personal accomplishment (PA). Prevalence of EE, CY, and PA domains varied significantly across fields of study, countries and WHO and World Bank regions, but not sex. All studies demonstrated good internal validity, although substantial heterogeneity existed between studies. The certainty of evidence was rated as moderate. Considering its potentially severe consequences, burnout is a significant public health concern. The development and implementation of evidence-based localized interventions at organizational and individual levels are necessary to mitigate burnout.

Anxiety as a predictor of the age of initiation of tobacco and cannabis use in adolescents and young adults

BACKGROUND

Previous research has shown important links between anxiety and the use of tobacco and cannabis. However, it remains unclear whether anxiety leads youth to start using tobacco and cannabis at an earlier age.

METHODS

Data were drawn from Texas Adolescent Tobacco and Marketing Surveillance System for the years 2019-2021(Waves 9-14). Participants were in 10th-grade, 12th-grade, and two years post-high school at baseline. The outcomes were the age of first use of cigarettes, e-cigarettes, and cannabis. Interval-censoring Cox proportional hazards models were fit to examine the differences in the estimated age of initiation of tobacco and cannabis use by anxiety.

RESULTS

Among the 10th-grade cohort, participants with anxiety had an increased risk of an earlier age of cigarette [AHR = 2.29(1.63-3.23)], e-cigarette [AHR = 1.53(1.17-2.00)], and cannabis [AHR = 1.59(1.23-2.05)] initiation. Among the 12th-grade cohort, participants with anxiety had an increased risk of an earlier age of cigarette [AHR = 1.52(1.21-1.90), e-cigarette [1.25(1.01-1.60)] and cannabis [AHR = 1.35(1.09-1.67] initiation. Among the post-high school cohort, the only significant association found was for cannabis initiation [AHR = 1.33(1.11-1.58). Between ages 18-to-19 years in the 10th-grade cohort, and between ages 20-21 years in the 12th-grade cohort, cumulative incidence of each of the three outcomes initiation doubled among anxious youth.

CONCLUSIONS

This study's findings show that anxiety symptoms can increase the risk of substance use initiation at an earlier age, especially among the youngest adolescent cohort (∼15-to-16-year-olds). These findings highlight the importance of early screening and treatment of anxiety symptoms as a preventive measure to delay or prevent the onset of substance use initiation.

Validity and reliability of the Arabic version of knowledge, attitudes, and practices toward COVID-19 preventative behaviors (KAP COVID-19)

Background

Even though the innovation of COVID-19 vaccination effectively protects against the virus, practicing preventative behaviors is still essential. However, public adherence to preventive behaviors relies mainly on the individuals' knowledge, attitudes, and practices (KAP) toward COVID-19 preventative behaviors. Therefore, it is crucial to evaluate these aspects. Nevertheless, there is no validated scale that assesses KAP toward COVID-19 preventative behaviors. To evaluate the psychometric properties of the Arabic version of knowledge, attitudes, and practices toward coronavirus disease 2019 (COVID-19) preventative behaviors.

Methods

A quantitative descriptive cross-sectional design was used to develop and evaluate the psychometric properties of KAP through specific stages: item development, face, content, convergent and construct validity evaluation, and internal consistency. Data were collected online through "google forms" from June 2020 to July 2020. Both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to assess the construct validity.

Results

A total of 1,363 participants completed the scale. The overall Cronbach's alpha was 0.83, indicating good internal consistency. Exploratory factor analysis supported structural validity for all the scale items with KMO 0.78, 0.60, and 0.81, respectively, and Bartlett's Test of Sphericity = (p < 0.05). Convergent validity was confirmed by a moderate correlation between the KAP scale items, knowledge ranging from r = 0.11 (p < 0.01) to r = 0.62 (p < 0.01), attitude ranging from r = 0.158 (p < 0.01) to r = 0.584 (p < 0.01), and practice ranging from r = 0.383 (p < 0.01) to r = 0.774 (p < 0.01).

Conclusion

The psychometric properties of the scale indicate that the KAP is a valid and reliable scale that can be utilized to evaluate the level of KAP toward COVID-19 preventative behaviors among the population in Saudi Arabia.

Family Communication as a Mediator between Family Resilience and Family Functioning under the Quarantine and COVID-19 Pandemic in Arabic Countries

The coronavirus pandemic has become an unprecedented world crisis in which we have struggled against the most potent threat of the twenty-first century. This pandemic has had a profound impact on individuals and families. Therefore, the study aimed to examine family communication as a mediator of the relationship between family resilience and family functioning under the quarantine and coronavirus pandemic in Algeria and Iraq. This study was conducted among individuals in Iraq and Algeria (N = 361). The respondents completed the Family Communication Scale (FCS), Walsh Family Resilience Questionnaire (WFRQ), and Family Functioning Scale (FFS). Structural equation modeling (SEM) with the bootstrapping method was used to conduct the mediated effects of family communication. Using the bootstrapping method in SEM, family resilience and communication significantly affected family functioning (coefficient = 0.808). Moreover, the direct effect and indirect effect (via family functioning) of family resilience on family functioning were both significant, with coefficients of 0.682 and 0.126. In addition, numerous groups from Iraq and Algeria have been analyzed as a sample and have shown no differences in the relationships between family resilience, family communication, and family functioning. In conclusion, the results showed that family communication mediated the relationship between family resilience and family functioning. Moreover, the type of this mediation seemed to be partial because of the significant direct relationship between family resilience and family functioning. According to the findings, healthcare providers should consider improving family resilience and communication to achieve good family functioning.

The mediation effect analysis of nurse's mental health status and burnout under COVID-19 epidemic

Aim

The objective of this study is to investigate the mental health status of nurses during the outbreak of novel coronavirus pneumonia. Additionally, we aim to analyze the relationship between anxiety, depression, and burnout among nurses. The findings will provide a scientific basis for promoting the psychological health of nurses.

Methods

Using a cross-sectional study, nurses in Quanzhou in May 2020 completed a general information questionnaire, the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and the Maslach Burnout Inventory (MBI). Data analysis was conducted using structural equation model.

Results

372 questionnaires were returned, with a response rate of 92.5%. The prevalence of anxiety and depression among the participants were 45.2 and 41.4%, respectively. The prevalence of severe burnout among nurses was found to be 7.3%. There was a correlation between nurses' anxiety, depression, and job burnout. The correlation coefficients between anxiety and job burnout, depression and job burnout, and anxiety and depression were found to be statistically significant (p < 0.001). Depression plays a mediating role between anxiety and jod burnout (0.584/1.413, 41.3%).

Conclusion

The COVID-19 epidemic has resulted in moderate to high levels of job burnout among nurses. In this context, depression has been found to play a mediating role in the relationship between anxiety and job burnout. It is imperative for hospital administrators to prioritize the mental health of nurses and the provide necessary support to ensure their well-being.

Psychometric Properties of the Perceived Collective Family Efficacy Scale in Algeria

The Perceived Collective Family Efficacy Scale is a tool utilized to assess the effectiveness of a family as a functioning system. The scale has a single-factor structure with good validity and reliability. However, there is a shortage of psychometric evidence of the scale in an Arab context. This study aimed to assess the psychometric properties of the Perceived Collective Family Efficacy Scale among Algerian students. A cross-sectional study was conducted to recruit 300 students from Algerian universities. The students completed the 20-item Perceived Collective Family Efficacy Scale, Arabic version, to measure their beliefs regarding collective efficacy within families. Confirmatory factor analysis (CFA) and the Rasch model were employed to assess the psychometric properties and unidimensionality of the scale. Both CFA and Rasch findings supported the single-factor structure for the Perceived Collective Family Efficacy Scale. Specifically, the CFA indicated that the data aligned with a one-dimensional model. The Rasch analysis revealed favorable indicators of unidimensionality for the scale. Moreover, a thorough examination of the Principal Component Analysis of the Rasch residuals confirmed the existence of a single dimension, which is consistent with the original structure of the Perceived Collective Family Efficacy Scale. These findings provide scientific evidence for the validity and unidimensional nature of the Perceived Collective Family Efficacy Scale. Specifically, the satisfactory psychometric properties findings indicate that the Perceived Collective Family Efficacy Scale could be applied in an Arab context (i.e., in Algerian). The scale's unidimensional structure underscores its effectiveness in measuring beliefs in collective efficacy within families. These results enhance our understanding of family dynamics and provide a reliable measurement tool for assessing family efficacy in similar cultural contexts.

Psychological Toll of the COVID-19 Pandemic: An In-Depth Exploration of Anxiety, Depression, and Insomnia and the Influence of Quarantine Measures on Daily Life

The COVID-19 pandemic, on a global scale, has prompted multifaceted challenges, including a notable psychological toll on the general population. This study uses mixed-method approach for a nuanced exploration of these experiences. Using a phenomenological strategy, qualitative responses from 999 participants were analyzed regarding their pandemic-induced anxiety and the influence of quarantine measures on their lives. Quantitative measures, including the revised Impact of Event Scale (IES-R), patient health questionnaire-9 (PHQ-9), the seven-item generalized anxiety disorder assessment (GAD-7), and Insomnia Severity Index (ISI), were used to quantify trauma, depression, anxiety, and insomnia attributed to COVID-19. Partial least squares structural equation modeling (PLS-SEM) was utilized for quantitative data analysis. The anxiety-related responses were mainly clustered into four themes: life threats, support shortage, economic consequences, and disruptions to family and social life. Subthemes that addressed the perceived effects encapsulated disruptions to academic and professional lives, familial and social relationships, psychopathological stress, and movement limitations. The findings from quantitative analysis revealed the significant associations between COVID-19-related trauma and symptoms of anxiety, depression, and insomnia, as indicated by coefficients exceeding 0.10 (all z-values > 1.96; p-values < 0.05). In conclusion, the findings underscore COVID-19's role in escalating anxiety, influenced by various factors, and its disruptive effects on daily life due to quarantine measures. The strong associations between the pandemic and the symptoms of depression, anxiety, and insomnia underscore the urgency of comprehensive psychological and public health interventions to alleviate these impacts.

Perceptions of the Sense of Security, Belonging, and Acculturative Stress among International Students in China during COVID-19 Outbreak-An Empirical Analysis

Understanding the cross-cultural adaptation of students studying in foreign countries by exploring acculturative stress factors is crucial to ensure the smooth academic performance of the students and, in turn, to enhance the global reputation of their universities. Therefore, it is an area of interest for the authorities (Ministry) and the corresponding management of universities. Using a random sample of 138 international students in China, descriptive and logistic regressions were conducted to assess the levels and influence of acculturative stress factors on cross-cultural adaptation, specifically on international students' sense of security and belonging during the COVID-19 pandemic outbreak. The results revealed that students were most concerned about homesickness, which obtained the highest mean score. The regression results indicated that the perception of fear and discrimination significantly impacted international students' sense of security. The perception of fear, guilt, and how long the student stayed in China also significantly affected the sense of belonging. We argue that the reflections provided herein are essential for universities to improve how they manage and handle international students to mitigate the effects of acculturative stress, particularly when additional stressful conditions are present, such as the COVID-19 pandemic.

Validity and Reliability of a Questionnaire on the Knowledge, Attitudes, Perceptions and Practices toward Food Poisoning among Malaysian Secondary School Students: A Pilot Study

Children in school settings are at risk of contracting food poisoning due to inadequate food safety practices and safe eating behaviors. This research aimed to develop a valid and reliable questionnaire on the knowledge, attitudes, perceptions, and practices (KAP2) toward food poisoning and its prevention among secondary school students. The questionnaire was developed by considering the Health Belief Model (HBM). A pilot study using a cross-sectional survey was conducted in Tangkak, Johor, among 30 selected students using a convenience sampling method. A pre-test was conducted on 15 secondary school students aged 13–17 years old prior to the pilot study, and they were excluded from the pilot study. The constructed knowledge was assessed using the difficulty and discrimination indices. Meanwhile, the reliability of the attitude, practice, and perception components in the questionnaire were assessed using Cronbach’s alpha. Regarding knowledge (34 items), the difficulty index showed that most items (n = 28) were easy, while one was difficult, and the remaining five were within an acceptable range. In addition, the discrimination index of the knowledge component (34 items) showed that twenty-two, three, and one had good, acceptable, and excellent ranges, respectively. Only eight items had a low discrimination power. All items of the attitude and practice components (10 items for each) showed a corrected item-total correlation value of >0.30. Only four out of twenty-one items of the perception component showed an unacceptable range of <0.30. However, following a discussion with the experts, all items were retained. With the incorporation of the HBM, the 75-item adapted food poisoning KAP2 questionnaire is valid and reliable. It can be utilized to measure and generate food poisoning KAP2 among secondary school students in Malaysia.

Determinants and predictors of mental health during and after COVID-19 lockdown among university students in Malaysia

BACKGROUND

Young adults, particularly university students might be at greater risk of developing psychological distress, and exhibiting symptoms of anxiety and depression during the COVID-19 pandemic. The primary objective of this study was to explore and compare the determinants and predictors of mental health (anxiety and depression) during and after the COVID-19 lockdown among university students.

METHODS

This was an observational, cross-sectional study with a sample size of 417 students. An online survey utilizing International Physical Activity Questionnaire-Short Form (IPAQ-SF), General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) was distributed to Universiti Tunku Abdul Rahman students via Google forms.

RESULTS

During lockdown, family income [χ2 (1, n = 124) = 5.155, p = 0.023], and physical activity (PA) [χ2 (1, n = 134) = 6.366, p = 0.012] were associated with anxiety, while depression was associated with gender [χ2 (1, n = 75) = 4.655, p = 0.031]. After lockdown, family income was associated with both anxiety [χ2 (1, n = 111) = 8.089, p = 0.004], and depression [χ2 (1, n = 115) = 9.305, p = 0.002]. During lockdown, family income (OR = 1.60, p = 0.018), and PA (OR = 0.59, p = 0.011) were predictors for anxiety, while gender (OR = 0.65, p = 0.046) was a predictor for depression. After lockdown, family income was a predictor for both anxiety (OR = 1.67, p = 0.011), and depression (OR = 1.70, p = 0.009).

CONCLUSION

Significant negative effects attributed to the COVID-19 lockdown, and certain factors predisposed to the worsening of mental health status in university students. Low family income, PA, and female gender were the major determinants and predictors linked to anxiety and depression.

Impact of media trust and personal epidemic experience on epidemic prevention behaviors in the context of COVID-19: A cross-sectional study based on protection motivation theory

Objective

This study aimed to elucidate the impact of media trust on epidemic prevention motivation and behaviors based on the Protection Motivation Theory (PMT) and to evaluate the moderation effect of personal epidemic experience, which focused on the differences in two groups with or without epidemic experience.

Methods

The exogenous constructs and PMT model and scale were constructed through literature analysis, and a web-based questionnaire survey was conducted among 428 individuals aged above 18 years in China. Statistical analysis and hypothesis testing were performed in SPSS 26 and SmartPLS 3.

Results

Traditional media trust accounted for the largest weight in media trust (w = 0.492, p-value < 0.001), followed by social media (w = 0.463, p-value < 0.001), and interpersonal communication (w = 0.290, p-value < 0.001). Media trust was positively and significantly related to both threat appraisal (β = 0.210, p-value < 0.001) and coping appraisal (β = 0.260, p-value < 0.001). Threat appraisal (β = 0.105, p-value < 0.05) and coping appraisal (β = 0.545, p-value < 0.001) were positively and significantly related to epidemic prevention motivation, which positively and significantly related to epidemic prevention behaviors (β = 0.492, p-value < 0.001). The R² values of epidemic prevention motivation and behavior are 0.350 and 0.240, respectively, indicating an acceptable explanation. Multiple-group analysis revealed five significant differences in paths between the two groups, indicating personal epidemic experience acting as a slight moderator on these paths.

Conclusion

Traditional media trust and social media trust were the important elements in COVID-19 prevention and control, and public health departments and governments should ensure the accuracy and reliability of information from traditional and social media. Simultaneously, the media should balance threat information and efficacy information in order to generate the public's prevention motivation and behaviors.

Validity of Adult Psychopathology Model Using Psychiatric Patient Sample from a Developing Country: Confirmatory Factor Analysis

Objectives. This study is aimed at testing and validating the two-factor measurement model of the Millon Clinical Multiaxial Inventory (MCMI). Specifically, this paper reported construct validity, particularly focusing on convergent and discriminant validities of the internalizing-externalizing MCMI model of adult psychopathology using a psychiatric sample from a developing country, the Republic of Yemen. Methods. MCMI was distributed among 232 outpatients from the Hospital of Taiz City and two private psychiatry clinics in Yemen; data were collected using structured interviews over four months. We used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to explore and confirm the latent structure MCMI and verify the evidence of convergent and discriminant validity. Results. The CFA results indicated that MCMI was a good fit for the internalizing-externalizing two-factor model of adult psychopathology, comparative fit index $\left(\text{CFI}\right)=0.95$ , and $\text{RMSEA}=0.07$ . The results of the CFA provide evidence of convergent and discriminant validity characterized by MCMI with the internalizing-externalizing model. Conclusion. The adult psychopathology of internalizing-externalizing is a valid measurement model of MCMI with ten personality disorders and eight clinical syndromes.

The Associations between Sibling Victimization, Sibling Bullying, Parental Acceptance-Rejection, and School Bullying

Bullying has been identified as the most common form of aggression experienced by school-age youth. However, it is still unclear about the family's influence on school bullying. Therefore, the current study aimed to explore the associations between sibling bullying and school bullying, sibling victimization and school victimization, and parental acceptance-rejection and school bullying victimization. The study was cross-sectional and conducted on a sample of students aged between 11 and 20 years recruited from middle schools in Algeria. The study used a survey adopted from the scale of Sibling Bullying, Student Survey of Bullying Behavior-Revised 2, and the Survey of parental acceptance-rejection in collecting the data. The model's results assessing the association between sibling bullying and school bullying demonstrated that the effect of sibling physical and sibling verbal victims on school victimization was statistically significant. Despite the non-significant effect of sibling emotional victims on school victimization, the effect of sibling physical and sibling verbal bullying on school bullying was statistically significant. However, the effect of sibling emotional bullying on school bullying was not statistically significant. The direct effect of parental acceptance on school victimization was not statistically significant, whereas the effect of parental rejection on school victimization was statistically significant. The direct effect of parental acceptance on school bullying was not statistically significant, while the effect of parental rejection on school bullying was statistically significant. Based on the results, this study provides insights into the understanding of how the family and siblings contribute to school bullying. In particular, sibling victimization, sibling bullying, and parental acceptance-rejection are predictive factors of school bullying among adolescents. Future research should take into account factors based on family to explore the risks of school bullying.