Psychological Distress in Quarantine Designated Facility During COVID-19 Pandemic in Saudi Arabia

The psychological impact of supervised quarantine facilities for the mitigation of COVID-19: A systematic review

BACKGROUND

Government mandated quarantine outside the home was implemented to mitigate COVID-19 in some countries. Individual studies report that this can result in psychological distress. Investigating levels of distress and associated risk factors across different settings would inform public health models of care during future pandemics. However, no previous systematic reviews have been conducted on the topic. Therefore, we systematically reviewed international research on the prevalence and risk factors of psychological distress within supervised quarantine facilities during the COVID-19 pandemic.

METHODS

A systematic review of the literature was conducted using Medline, Psychological and Behavioural Sciences, Psych Info, Cochrane databases and Google Scholar from January 2020 until June 2023. Relevant quantitative studies published in English were included.

RESULTS

13 studies (pooled participants n = 4366) were included in this review. The prevalence of psychological distress varied widely across the included studies (depression 4%-63%; anxiety 4%-100%; stress 1%-68%). Associated risk factors identified were also heterogeneous between studies and facilities.

CONCLUSION

In future pandemics, the benefits of infection mitigation need to be weighed against the risk of psychological distress. Models of care utilising specifically designed facilities, with greater freedoms, increased comfort and ease of access to mental health services may limit psychological distress.

Exploring the challenges of social participation during COVID-19 in Saudi Arabia through an occupational therapy lens

Aim

To measure the social participation of people in Saudi Arabia during the COVID-19 pandemic.

Subject and methods

A cross-sectional survey was conducted among people in Saudi Arabia to measure their participation in social activities during the COVID-19 pandemic. A validated questionnaire of Social Participation Scale was used to collect data from five main regions in Saudi Arabia through social media platforms. Means, frequencies, and percentages were calculated through descriptive analysis. Mean scores and standard deviation of social participation of participants were also presented.

Results

The total number of participants was 1,560 including Saudi (87.3%) and non-Saudi (12.7%) nationals. Most participants (60.2%) were female. The age of participants ranged between 16 and 24 years old. Around 62.1% of participants were married, 63.2% were educated, 48.4 were employed and 82% were from the Eastern region. Around 72% of participants earned <10,000 riyals per month compared to those (27.3%) who earned <5,000 riyals per month. A total 72.7% of the participants have been diagnosed by COVID-19. The mean score of social participation was 47.81 (SD = 0.27). Most participants (62.7%) reported that social participation was severely restricted. Around 68.2% of the participants were quarantined at the facilities.

Conclusion

The social participation of people in Saudi Arabia had been severely restricted during the COVID-19 pandemic. An early assessment of people's social participation would help to identify their problems and needs, to help them improve their participation in social activities and thus increase their overall quality of life.

Post implementation quarantine recommendations that support preparedness: A systematic review and quarantine implementation capability framework

BACKGROUND

During COVID-19, countries utilised various quarantine systems to achieve specific outcomes. At different stages and durations, voluntary and mandatory quarantine occurred in homes, hotels and facilities based on local and national elimination strategies. Countries are incorporating quarantine lessons from COVID-19 into revising pandemic plans as part of the World Health Organization's Preparedness and Resilience for Emerging Threats (PRET) activities. This review aimed to amalgamate quarantine post implementation recommendations from a whole-of-system perspective.

METHODS

This review utilised MEDLINE, Embase, CINAHL, APA, and PsycINFO. To capture all pandemics, no date restriction was applied. Recommendations were synthesised and inductively grouped into quarantine capability categories. This review was registered in PROSPERO (CRD42023420765).

RESULTS

A total of 449 published articles were screened, with 51 articles included and 156 recommendations extracted. Recommendations were grouped into 15 quarantine capability categories, comprising governance, preparation, infection prevention and control, ventilation, compliance, data, information and technology, safety-quality-risk, communication, healthcare model, home quarantine, hotel quarantine, facility quarantine, workforce, and resident considerations. The capability categories were further consolidated into strategic, structural, and operational domains to support the whole-of-system perspective.

CONCLUSION

The quarantine implementation capability framework generated provides comprehensive and deeper insights into the essential capabilities required for quarantine systems to support governments in PRET activities, including reviewing and revising pandemic plans and developing quarantine preparedness exercises.

A systematic review of studies on stress during the COVID-19 pandemic by visualizing their structure through COOC, VOS viewer, and Cite Space software

Background

The COVID-19 epidemic generated different forms of stress. From this period, there has been a remarkable increase in the quantity of studies on stress conducted by scholars. However, few used bibliometric analyses to focus on overall trends in the field.

Purpose

This study sought to understand the current status and trends in stress development during COVID-19, as well as the main research drives and themes in this field.

Methods

2719 publications from the Web of Science(WOS) core repository on stress during COVID-19 were analyzed by utilizing Co-Occurrence (COOC), VOS viewer, and Cite Space bibliometric software. The overall features of research on stress during COVID-19 were concluded by analyzing the quantity of publications, keywords, countries, and institutions.

Results

The results indicated that the United States had the largest number of publications and collaborated closely with other countries with each other. University of Toronto was the most prolific institution worldwide. Visualization and analysis demonstrated that the influence of stress during COVID-19 on the work, life, mental and spiritual dimensions is a hot research topic. Among other things, the frequency of each keyword in research on stress during COVID-19 increased from 2021 to 2022, and the researchers expanded their scope and study population; the range of subjects included children, nurses, and college students, as well as studies focusing on different types of stress, and emphasizing the handling of stress.

Conclusion

Our findings reveal that the heat of stress research during COVID-19 has declined, and the main research forces come from the United States and China. Additionally, subsequent research should concern more on coping methods with stress, while using more quantitative and qualitative studies in the future.

The psychological well-being of people in a COVID-19 supervised quarantine facility: A mixed methods study

WHAT IS KNOWN ON THE SUBJECT?: Supervised Quarantine has been shown to impact the psychological well-being of those in quarantine both during the COVID-19 pandemic and in previous pandemics. There are few studies regarding the psychological impact of supervised quarantine for the purpose of COVID-19 mitigation. There is little research regarding the psychological well-being of professionals maintaining quarantine, despite the fact they risk potential psychological distress. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper addresses the paucity of knowledge regarding the psychological well-being of those undergoing quarantine in a purpose-built facility. The quarantined study population involved uniquely domestic arrivals and also professionals maintaining quarantine. Lack of control, isolation and miscommunication were perceived as challenging mental well-being. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Although psychological distress in Domestic arrivals appeared low, there are still identifiable stresses on mental well-being. Mental health workers need to be cognizant that point entry to COVID-19 quarantine (Domestic vs. International as well as specific regions) may influence risk of psychological distress. Mental Health nurses supporting those in quarantine should afford quarantined individuals a degree of choice, establish regular clear communication and consider how to establish peer support mechanisms within the quarantine environment.

ABSTRACT

INTRODUCTION: Supervised quarantine may compromise psychological well-being. There is equivocal evidence regarding psychological distress in compulsory supervised quarantine facilities.

AIMS

To evaluate the mental well-being of people undergoing and working in a supervised COVID-19 quarantine facility.

METHOD

Mixed methodology was used, including a cross-sectional analysis of psychological distress (DASS-21) and individual semi-structured interviews (10 professionals maintaining quarantine and 10 quarantined persons).

RESULTS

Overall levels of psychological distress were low. Those quarantining from Victoria had significantly lower depression scores compared to all other departure points. Qualitative analysis identified distress being linked to a lack of control, isolation and miscommunication.

DISCUSSION

Quarantine was associated with low levels of psychological distress. This was lower in people travelling from Victoria, a state where there were higher rates of infections and restrictions. Interviews showed that psychological distress was conceptualized as being associated with supervised quarantine, but participants recognized the overall importance of quarantine.

IMPLICATIONS FOR PRACTICE

Mental health professionals supporting quarantined people should consider original departure points may predict levels of psychological distress. Implementing ways of gaining control through affording choice, improving communication channels and establishing peer support networks within quarantine settings may help maintain mental well-being.

Comparative Assessment of Oral Health Attitudes and Behaviors of First-Time and Previous Dental Patients Undergoing Exodontia Treatment During the COVID-19 Pandemic in Private Dental Clinics in Riyadh City, Saudi Arabia

Background

The COVID-19 lockdown affected oral health behaviors. This study aims to assess and compare the oral health attitudes and behaviors of first-time and previous patients undergoing dental extractions during the COVID-19 pandemic at private dental clinics in Riyadh City, Saudi Arabia.

Methods

This cross-sectional study was conducted among patients aged 18-65 years undergoing dental extractions at private dental clinics in Riyadh City, Saudi Arabia. Four hundred and eighty patients were selected using a convenient sampling methodology. A structured, close-ended questionnaire investigated demographic information, tooth extraction attendance, and oral health attitudes and behaviors using 20 items Hiroshima University Dental Behavioral Inventory (HUDBI).

Results

A total of 480 exodontia patients [282 (58.8%) males and 198 (41.2%) females] participated in this study. All patients used a stiff-bristled toothbrush and were concerned about their teeth' color and bad breath. Similarly, all the participants did not feel brushed unless they used strong strokes, and the dentist told them to brush very well. An overall mean HUDBI score of 6.34±1.12 was observed. Patients with a primary education (5.61±0.79), income ≤5000 SAR (6.00±0.92), residing in rural areas (5.84±0.93), and government employees (5.62±0.96) exhibited lower HU-DBI scores compared to their counterparts. The study revealed a significant variation in HUDBI scores across different demographic factors, including education, income, residence, occupation, and reason for extraction (p<0.001). The HUDBI score of first-time attendees to dental extraction (5.88±1.03) was found to be significantly poorer than to those of previous attendees (6.63±1.09), (p<0.001).

Conclusion

Patients who underwent dental extractions at private dental clinics in Riyadh City, Saudi Arabia, during the post-lockdown COVID-19 pandemic exhibited average oral health attitudes and behaviors. Oral health attitudes and behaviors differed by socioeconomic status. Patients undergoing dental extractions for reasons other than dental caries and periodontal diseases and first-time attendees demonstrated poor oral health attitudes and behaviors.

Impact of quarantine on sleep quality and psychological status in COVID-19 suspected cases in Riyadh, Saudi Arabia

Aim

The purpose of this study was to investigate into mental health outcomes such as stress, anxiety, and depression, as well as sleep quality in suspected COVID-19 quarantined cases.

Methods

This is a cross-sectional study that used an online survey to target suspected COVID-19 cases in quarantine facilities. Data were collected on several aspects of participants' sociodemographic characteristics, sleep disturbance, and mental health status. Depression, anxiety, stress scale and Pittsburgh Sleep Quality Index were used to measure both the psychological impact and mental health status.

Results

Of the 362 people who took the survey, 234 (64.6%) were men, and 148 were between the ages of 26-35. Poor sleep was found to be prevalent in 65% of study participants. The rates of individuals reporting severe depression, anxiety, and stress symptoms were 14.6%, 15%, and 15%, respectively. According to the findings, there were significant gender differences in depression and anxiety (p = 0.001). When compared to the other age groups, participants aged 26-35 reported the highest level of stress (p = 0.001). Being male [OR = -1.23, 95% CI (-2.75-1.95) P = 0.050], single [OR = 0.98, CI (0.15-4.20), P = 0.001], and a healthcare worker [OR = -2.20, 95% CI (-2.59-1.82), P = 0.001] were all associated with poor sleep quality.

Conclusion

Approximately-one-third of quarantine COVID-19 patients had poor sleep quality with mild-moderate depression. Both anxiety and stress scales were prevalent in nearly half of the studied samples.

Understanding the Psychological Well-Being of International Arrivals in a Purpose-Designed Australian COVID-19 Quarantine Facility

Equivocal evidence suggests that mandatory supervised quarantine can negatively affect psychological well-being in some settings. It was unclear if COVID-19 supervised quarantine was associated with psychological distress in Australia. The sociodemographic characteristics associated with distress and the lived experiences of quarantine are also poorly understood. Therefore, this study aimed to evaluate the mental well-being of international arrivals undergoing supervised COVID quarantine in a purpose designed facility in the Northern Territory, Australia. We conducted a concurrent triangulation mixed-methods study comprising of an observational cross-sectional survey (n = 117) and individual qualitative interviews (n = 26). The results revealed that several factors were associated with distress, including significantly higher levels of depression for those who smoked, drank alcohol, had pre-existing mental health conditions and had no social networks in quarantine. Levels of psychological distress were also related to waiting time for re-entry (the time between applying to repatriate and returning to Australia) and flight origin. Qualitative data showed that despite quarantine being viewed as necessary, unclear communication and a perception of lack of control were affecting emotional well-being. This information is useful to inform the further development of models to identify those at most risk and support psychological well-being in quarantine settings.

Exploring experiences of quarantined people during the early phase of COVID-19 outbreak in Southern Nations Nationalities and Peoples’ Region of Ethiopia: A qualitative study

Background

Ethiopia enforced extremely rigorous contact tracing and mandatory quarantine for all suspected contact and travelers entering the country for a period of 14-days duration during the early phases of the COVID-19 outbreak. Several studies investigated the experience of quarantined people because of COVID-19 or previous outbreaks. However, quarantine is often perceived differently in different cultures because of its historical association with class, gender, ethnicity, politics, and prejudices. To our knowledge, there is limited literature on quarantine experience in Ethiopia related to either COVID-19 or other infectious diseases. Therefore, this study was aimed to explore quarantine experience of people in Southern Nations Nationalities and Peoples’ Region (SNNPR) of Ethiopia during early phase of COVID-19 pandemic.

Methods

The study implemented an exploratory qualitative research design using a phenomenological approach. Face-to-face in-depth interviews were conducted with purposively recruited 29 respondents. Digitally recorded audio files have been listened to several times and verbatim transcriptions were done. The transcribed narratives were examined independently and content analysis was carried out through reading and re-reading the verbatim several times, open coding, grouping, categorizing, and abstracting the final themes.

Results

Three broad themes were identified and characterized the experiences of quarantined people due to COVID-19. These themes were a) handling of the suspected person, b) adverse effects of quarantine and c) coping strategies. In addition, quarantine refusals; injustice in quarantine; quarantine errors; psychological distress; physiological changes; social effects; financial losses; personal and social coping strategies were the emerged sub-themes.

Conclusions

This study explored a range of complex experiences of quarantined people because of the COVID-19 outbreak in SNNPR. The quarantined people included in this study were adversely affected psychologically, physiologically, socially, and economically. They also experienced quarantine errors and injustice. There is a need to gather clear justification for close contact before forcing the suspect for mandatory quarantine. In addition, there is a need to develop risk communication strategy to approach suspected contacts for quarantine. Moreover, assessing psychological, physiological, social, and economic impacts of quarantine on the individuals while they are in quarantine and after release could be important. The use of personal and social coping strategies including psychosocial support may lessen the adverse impacts of the quarantine.

The psychological impact of quarantine due to COVID-19: A systematic review of risk, protective factors and interventions using socio-ecological model framework

Background

Though quarantine is a pertinent control measure for the spread of COVID-19, it is equally important to consider its negative impacts, as it causes severe psychological, emotional, and financial problems not only for those who are quarantined but also for many others who are directly or indirectly connected to those who are quarantined. There appears to be a need to synthesise the available literature evidence on the psychological impact of quarantine experience, especially the multilevel risk factors that make individuals vulnerable to psychological impact and the protective factors to deal with the negative effects of quarantine.

Objective

This systematic review attempted to identify the various psychological impacts associated with the experience of quarantine, the risk and protective factors and list out various psycho-social interventions that can minimise the risks and facilitate the protective factors associated with the experience of quarantine.

Methods

A systematic search adhering to the PRISMA guidelines was performed in four databases PubMed, Scopus, PsycNet, Web of Science and 10518 articles related to COVID-19 and quarantine were obtained. After screening processes and quality assessment using standard checklist 74 articles that fulfilled the eligibility criteria were chosen for the final review.

Findings

Individuals subjected to quarantine had anxiety, depression, post-traumatic stress symptoms, sleep problems, and somatic difficulties. Some of the key risk factors during quarantine are young age, female gender, low money, fear of infection, poor sleep quality, reduced physical activity, increased sedentary behaviours, and a lack of social support. Financial difficulties and stigma remained risk factors even after the quarantine period had ended. Key protective factors were coping skills, home based exercise, leisure, recreational activities, maintaining relationships using social media and availability of mental health services. The findings also highlight the necessity for tele mental health interventions to address the psychological effects of quarantine.

Conclusion

Multilevel interventions are required to minimise the impact of risk factors and enhance protective factors.

The Psychological Impact of Quarantine During the COVID-19 Pandemic on Quarantined Non-Healthcare Workers, Quarantined Healthcare Workers, and Medical Staff at the Quarantine Facility in Saudi Arabia

Background

COVID-19 is a viral infectious disease that spreads quickly through droplets. It is highly contagious and could overwhelm the health system. Because of that, many governments established health quarantines for suspected infected people to minimize the spread of this disease.

Objective

This study aimed to assess the prevalence of depression, anxiety, and stress symptoms and to address the associated risk factors among quarantined non-healthcare workers, quarantined healthcare workers, and medical staff in the Ministry of Health quarantine facility.

Patients and Methods

We conducted an analytical cross-sectional study at the health quarantine in Jazan, Saudi Arabia. The total number of participants was 301 individuals. Furthermore, the study questionnaire was composed of three sections, the first two were the background and clinical characteristics, and the last one was DASS 21 scale. Also, we used SPSS software to analyze the data. Lastly, we implemented logistic regression to assess the predictors of depression, anxiety, and stress symptoms.

Results

The prevalence of depression, anxiety, and stress symptoms among quarantined non-healthcare workers were 51.9%, 60.2%, and 40.6%, respectively. These prevalences were 25.0%, 29.8%, and 16.9% among quarantined healthcare workers and 20.5%, 20.5%, and 27.3% among the medical staff. The predictors of depression, anxiety, and stress symptoms among the study participants were female gender, perceived COVID-19 stigma, presence of other relatives in quarantine, comorbidities, and abnormal sleep duration.

Conclusion and Recommendations

Health quarantine is an environment that could negatively affect people's mental health. The quarantined non-healthcare workers were the most affected study participants inside this environment. Therefore, the availability of mental health services there could minimize their depression, anxiety, and stress symptoms. Moreover, a home quarantine would be better to reduce these negative symptoms whenever possible.

The Arabic Version of the Impact of Event Scale-Revised: Psychometric Evaluation among Psychiatric Patients and the General Public within the Context of COVID-19 Outbreak and Quarantine as Collective Traumatic Events

The Coronavirus Disease-19 (COVID-19) pandemic has provoked the development of negative emotions in almost all societies since it first broke out in late 2019. The Impact of Event Scale-Revised (IES-R) is widely used to capture emotions, thoughts, and behaviors evoked by traumatic events, including COVID-19 as a collective and persistent traumatic event. However, there is less agreement on the structure of the IES-R, signifying a need for further investigation. This study aimed to evaluate the psychometric properties of the Arabic version of the IES-R among individuals in Saudi quarantine settings, psychiatric patients, and the general public during the COVID-19 outbreak. Exploratory factor analysis revealed that the items of the IES-R present five factors with eigenvalues > 1. Examination of several competing models through confirmatory factor analysis resulted in a best fit for a six-factor structure, which comprises avoidance, intrusion, numbing, hyperarousal, sleep problems, and irritability/dysphoria. Multigroup analysis supported the configural, metric, and scalar invariance of this model across groups of gender, age, and marital status. The IES-R significantly correlated with the Depression Anxiety Stress Scale-8, perceived health status, and perceived vulnerability to COVID-19, denoting good criterion validity. HTMT ratios of all the subscales were below 0.85, denoting good discriminant validity. The values of coefficient alpha in the three samples ranged between 0.90 and 0.93. In path analysis, correlated intrusion and hyperarousal had direct positive effects on avoidance, numbing, sleep, and irritability. Numbing and irritability mediated the indirect effects of intrusion and hyperarousal on sleep and avoidance. This result signifies that cognitive activation is the main factor driving the dynamics underlying the behavioral, emotional, and sleep symptoms of collective COVID-19 trauma. The findings support the robust validity of the Arabic IES-R, indicating it as a sound measure that can be applied to a wide range of traumatic experiences.

The lived experience of hotel isolation and quarantine at the Aotearoa New Zealand border for COVID-19: A qualitative descriptive study

Hotel-based Managed Isolation and Quarantine (MIQ) is a key public health intervention in Aotearoa New Zealand's (NZ) COVID-19 border control strategy for returning citizens and permanent residents. We aimed to investigate the experience of transiting through MIQ in NZ, to inform future refinements of this type of system. A qualitative thematic analysis method was utilised to explore experiences in depth with seventy-five individuals who had undergone MIQ in NZ between April 2020 and July 2021. Participants were interviewed by telephone or Zoom or completed an online qualitative questionnaire. Interviews were audio recorded, transcribed and coded; questionnaire responses were sorted and coded. All data were subjected to thematic analysis. Three main themes described the key elements of the participants' experience of MIQ that influenced their overall experiences: 1) The MIQ process, 2) MIQ Hotels, and 3) Individual experience. The variation in participants' overall experience of MIQ was strongly influenced by their perceptions of how well the MIQ process was managed (including communication, flexibility, and compliance with disease prevention and control measures); and the quality of the hotels they were allocated to (in particular hotel staff, meals and information). This valuable insight into the experience of individuals in NZ MIQ hotels can inform better planning, management and implementation of the MIQ process for NZ and adds to the literature of countries utilising such strategies to minimise the transmission of COVID-19, whilst protecting the wellbeing of those using the system.

Mental Health in Hospitalised COVID 19 Patients in Quarantine During Second Wave in a South Indian Private Teaching Hospital

BACKGROUND

Covid 19 lockdown measures were taken all of a sudden during the devastating second wave in India, when there was a considerable loss and suffering in the country. The coronavirus disease 2019 (COVID 19) pandemic has led to unprecedented hazards to mental well-being globally.

PURPOSE

To assess the prevalence and evaluate risk factors of depression, insomnia or sleep disturbances and suicidal ideation among covid 19 positive patients admitted in covid wards with mild-to-moderate disease.

MATERIALS AND METHODS

A total of 635 hospitalised patients who were covid-19 positive were requested to fill an online quality of life pre-validated questionnaire comprising of 4 sections - the sociodemographic information section, health care assessment related to depression symptoms, insomnia assessment and assessment of suicidal ideation. The survey comprised of pre-validated questions on sociodemographics, knowledge of covid 19, fear of covid 19, insomnia, feeling of sadness, depression, feeling of rejection and suicidal ideation among the covid 19 positive inpatients in quarantine due to mild or moderate covid 19 disease.

RESULTS

The prevalence of depression and insomnia or sleep disturbances after being diagnosed as covid 19 positive and hospitalized was nearly 40% and 28.8%, respectively, among the inpatients. Depression was significantly observed in female group (p < 0.001), unmarried or separated individuals (p < 0.001), housewives (p < 0.001) and patients with comorbidities (p < 0.001). Insomnia was more likely to be present in elderly covid positive patients (p < 0.001) and separated or divorced group of participants (p < 0.001). The prevalence of suicidal ideation was 5% of the total covid 19 positive patients participated in this study, and it was significantly observed among separated or divorced patients, cancer patients, patients from suburban residence and among graduates (p < 0.001).

CONCLUSION

Covid 19 is associated with major psychological impact among the patients suffering from thus warrants counselling.

The Depression Anxiety Stress Scale 21: Development and Validation of the Depression Anxiety Stress Scale 8-Item in Psychiatric Patients and the General Public for Easier Mental Health Measurement in a Post COVID-19 World

Despite extensive investigations of the Depression Anxiety Stress Scales-21 (DASS-21) since its development in 1995, its factor structure and other psychometric properties still need to be firmly established, with several calls for revising its item structure. Employing confirmatory factor analysis (CFA), this study examined the factor structure of the DASS-21 and five shortened versions of the DASS-21 among psychiatric patients (N = 168) and the general public (N = 992) during the COVID-19 confinement period in Saudi Arabia. Multigroup CFA, Mann Whitney W test, Spearman's correlation, and coefficient alpha were used to examine the shortened versions of the DASS-21 (DASS-13, DASS-12, DASS-9 (two versions), and DASS-8) for invariance across age and gender groups, discriminant validity, predictive validity, item coverage, and internal consistency, respectively. Compared with the DASS-21, all three-factor structures of the shortened versions expressed good fit, with the DASS-8 demonstrating the best fit and highest item loadings on the corresponding factors in both samples (χ2(16, 15) = 16.5, 67.0; p = 0.420, 0.001; CFI = 1.000, 0.998; TLI = 0.999, 0.997; RMSEA = 0.013, 0.059, SRMR = 0.0186, 0.0203). The DASS-8 expressed configural, metric, and scalar invariance across age and gender groups. Its internal consistency was comparable to other versions (α = 0.94). Strong positive correlations of the DASS-8 and its subscales with the DASS-21 and its subscales (r = 0.97 to 0.81) suggest adequate item coverage and good predictive validity of this version. The DASS-8 and its subscales distinguished the clinical sample from the general public at the same level of significance expressed by the DASS-21 and other shortened versions, supporting its discriminant validity. Neither the DASS-21 nor the shortened versions distinguished patients diagnosed with depression and anxiety from each other or from other psychiatric conditions. The DASS-8 represents a valid short version of the DASS-21, which may be useful in research and clinical practice for quick identification of individuals with potential psychopathologies. Diagnosing depression/anxiety disorders may be further confirmed in a next step by clinician-facilitated examinations. Brevity of the DASS-21 would save time and effort used for filling the questionnaire and support comprehensive assessments by allowing the inclusion of more measures on test batteries.

COVID-19 lockdown and lifestyles: A narrative review

Background: The primary objective worldwide during the coronavirus disease 2019 (COVID-19) pandemic has been controlling disease transmission. However, lockdown measures used to mitigate transmission have affected human behavior and altered lifestyles, with a likely impact on chronic non-communicable diseases. More than a year into the pandemic, substantial peer-reviewed literature has emerged on altered lifestyles following the varying lockdown measures imposed globally to control the virus spread. We explored the impact of lockdown measures on six lifestyle factors, namely diet, physical activity, sleep, stress, social connectedness, and the use of tobacco, alcohol, or other harmful substances. Methods: We comprehensively searched PubMed and the World Health Organization’s global literature database on COVID-19 and retrieved 649 relevant articles for the narrative review. A critical interpretative synthesis of the articles was performed. Results: Most of the articles included in the review identified the negative effect of lockdown measures on each of the lifestyle factors in many parts of the world. Encouraging lifestyle trends were also highlighted in a few articles. Such trends can positively influence the outcome of lifestyle-related chronic diseases, such as obesity and diabetes. Conclusions: The COVID-19 pandemic provides an opportunity to better understand the negative impact of strict lockdown measures on lifestyles. At the same time, it helps us identify and initiate positive behavioral changes, which, if consolidated, could improve chronic disease outcomes. It is up to governments, communities, and healthcare/academic entities to derive benefit from lessons learned from the pandemic, with the ultimate objective of better educating and promoting healthy lifestyles among communities.