Relationship Between Public Mental Health and Immune Status During the COVID-19 Pandemic: Cross-Sectional Data from Saudi Arabia

Stress during Home Confinement Is Associated with Eating Misalignment among Adults during COVID-19 Lockdown

BACKGROUND

The COVID-19 pandemic forced Saudi Arabia to implement several measures including mandatory home confinement, banning entry to many cities, and suspending religious activities. Studies have reported inconsistent findings of the effect of home confinement on lifestyle factors. This study aims to assess the psychological impact of COVID-19 during home confinement and explore its association with dietary habits and weight change.

METHODS

A cross-sectional study was conducted among Saudi adults using an online survey between May and June 2020. Data on dietary habits, sleep quality, and stress were collected.

RESULTS

A total of n = 503 participants responded. Of 254 analyzed, 87% were females, 49% were overweight/obese (body mass index (BMI) ≥ 25 kg/m2), and 79% were under lockdown for >40 days. In multiple linear regression, higher stress scores during confinement were associated with higher stress scores before confinement and poorer sleep quality. In multiple logistic regression, those who did not eat at the same time had higher stress scores compared to those who always ate at the same time, whereas consuming ≥three meals was associated with lower stress scores than consuming one-two meals. The odds of gaining weight during confinement were higher among married adults, those with lower sleep quality, and consuming ≥three meals.

CONCLUSIONS

Stress during home confinement was associated with eating misalignment and the number of meals consumed. Although this study was limited by its cross-sectional design and reliance on self-reported data, it provides valuable insights into the dietary habits and weight-gain associated factors that need to be further explored and addressed in any future restrictions for improved well-being.

The Up-Side of the COVID-19 Pandemic: Are Core Belief Violation and Meaning Making Associated with Post-Traumatic Growth?

The negative impact of the COVID-19 pandemic on mental health has been extensively documented, while its possible positive impact on the individual, defined as Post-Traumatic Growth (PTG), has been much less investigated. The present study examines the association between PTG and socio-demographic aspects, pre-pandemic psychological adjustment, stressors directly linked to COVID-19 and four psychological factors theoretically implicated in the change processes (core belief violation, meaning-making, vulnerability and mortality perception). During the second wave of the pandemic 680 medical patients completed an online survey on direct and indirect COVID-19 stressors, health and demographic information, post-traumatic growth, core belief violation, meaning-making capacity, feelings of vulnerability and perceptions of personal mortality. Violation of core beliefs, feelings of vulnerability and mortality, and pre-pandemic mental illness positively correlated with post-traumatic growth. Moreover, the diagnosis of COVID-19, stronger violation of core beliefs, greater meaning-making ability, and lower pre-existing mental illness predicted greater PTG. Finally, a moderating effect of meaning-making ability was found. The clinical implications were discussed.

Immune fitness and lifestyle habits of Saudi medical students: a cross sectional study

Introduction

Immune function reaches an optimum level in young adults. However, young adults are more likely to adopt potentially harmful habits that may pose a risk to their long-term health and immune fitness, and which eventually may put a substantial burden on the healthcare system. This study aimed to assess the status of medical students' immune fitness, using the immune status questionnaire (ISQ) and exploring the association with the commonly adopted lifestyle habits hypothesized to have an impact on immune functions.

Methods

A descriptive, cross-sectional study was conducted among preclinical students attending the medical school of King Abdulaziz University. An online self-reported questionnaire was used to assess the immune status (ISQ), perceived (momentary) immune fitness, general health, lifestyle habits and students' perception of these lifestyle-associated impacts on immune fitness. Descriptive, Spearman's correlation and stepwise linear regression analyses were performed.

Results

In a pooled sample of 211 participants, the overall ISQ score was 6.00 ± 5.0 with statistically significant abnormally lower scores in females (ISQ 5.00 ± 5.0, p < 0.001). 49.29% of respondents experienced poor immune fitness as measured by the ISQ (<6). The ISQ score was significantly correlated with fast and fatty food consumption (p = 0.003), daytime sleepiness (p = 0.001), and BMI subgroups (p = 0.028) negatively and positively correlated with adherence to a program of exercise (p = 0.005). A total of 41.23% of participants who reported a normal immune health, rated at ≥6 were graded below 6 on the ISQ score. Only 62.6% of students were able to correctly identify the effects of fast and fatty food consumption on immune fitness.

Conclusion

Poor immune fitness was common among medical students in KAU and associated significantly with their adopted lifestyle habits. Although, other factors can be significant contributors, biased immune health perception and lack of awareness of these lifestyle-associated impacts on immune fitness and general health may hinder the adoption of healthier habits. Immune biomarkers should be implemented in future work.

Interplay Between Sociodemographic Variables, Physical Activity, Sleep, Dietary Habits, and Immune Health Status: A Cross-Sectional Study From Saudi Arabia's Western Province

BACKGROUND

In addition to developing effective therapeutic approaches, the maintenance of health also constitutes lifestyle and behavioral aspects related to being more resilient in the event of future illness. Reduced immune health has been linked to reports of more frequent and severe infections as well as a variety of non-communicable diseases, both of which may eventually place a significant burden on the healthcare system. Several lifestyles and behaviors can influence immune health, both positively and negatively. Accordingly, this study aimed to evaluate the immune health status and investigate its relationship with widely practiced lifestyle behaviors that are thought to affect immunological functioning.

DESIGN AND METHOD

Saudi Arabian citizens and international residents of the Western Province were invited to participate in this cross-sectional web-based survey through an online advertisement. The integrated questionnaire on lifestyle (Arab Teens Lifestyle Study) and immune health status (Immune Status Questionnaire (ISQ)) was completed in November 2022 by 1230 participants. Descriptive analysis, Mann-Whitney U test, chi-square, or Fisher's exact test was utilized to investigate the relationships between study variables and immune health status groups. Spearman's or Pearson's correlation coefficients were used to determine correlations between the overall ISQ scores and study variables.

RESULTS

Of the 925 study participants, 34.7% scored below 6 on the ISQ. Of the respondents, 50% had a body mass index of 25 or higher, and 46.3% reported sleeping less than four hours each night. Of the participants, 62-82% did not engage in any form of physical activity. The associations between the ISQ score and weight (p = 0.006), total sleep time per night (p = 0.001), duration of household activities (p < 0.001), and smoking status (p = 0.001) were statistically significant.

CONCLUSIONS

According to the data presented here, reduced immune health as measured by ISQ < 6 was prevalent among residents of Saudi Arabia's Western Province and correlated significantly with obesity, sleep duration, and smoking status. Various measures to mitigate the negative impact of an unhealthy lifestyle on public health and to reverse the observed poor immune health and their economic consequences are highly required.

The Assessment of Immune Fitness

Immune fitness (i.e., adequate functioning of the immune system) is essential to maintain health, prevent and resolve disease, and improve quality of life. This article provides an overview of how to assess immune fitness. It discusses how a single-item rating scale can be used to assess immune fitness. The scale can be used in conjunction with a single "yes" or "no" question asking whether the individual is experiencing reduced immune fitness. Retrospective assessments can be complemented with the Immune Status Questionnaire (ISQ) to provide more insight into the type and frequency of experiencing specific immune-related complaints. Momentary assessments of immune fitness can be complemented with biomarker measurements in body fluids. As individuals may be unaware of systemic inflammation (e.g., biomarker concentrations outside the normal range), it remains critical to combine immune fitness assessments with biomarker measurements of immune functioning.

Guduchi Ghanavati (Ayurveda medication) improves the perceived immunity in individuals at risk of SARS-CoV-2: A Multicentred, controlled, before-and-after study

Introduction During the COVID-19 pandemic in India, Ayurvedic medication (Guduchi Ghanavati, GG) was prescribed by Ayurveda physicians for prevention and management. This study aimed to evaluate the prophylactic effect of GG in individuals with moderate to very high risk of SARS-CoV-2. Methods A multicenter, controlled, quasi-experimental, before-and-after study was conducted on individuals at moderate to very high risk of SARS-COV-2 exposure. In the intervention group (n = 15,992), participants received GG 1 g daily for 28 days in conjunction with standard preventive guidelines (SPG), while in the control group (n = 4953), participants were asked to follow SPG only. Outcomes were the incidence of COVID-19, perceived immune status, quality of life, and safety. The perceived immune status was assessed using a brief Likert-scale questionnaire having common immune-related complaints. Results Of the 20,945 enrolled, 20,574 completed the trial (intervention: 15,729, control: 4845). The percentage of participants who reported the incidence of COVID-19 was marginally lower in the GG+SPG group (41, 0.26%) than in the SPG group (16, 0.33%), leading to 21% (95% CI, -40% to 55%) efficacy of GG. However, the decrease in incidence percentage was statistically insignificant due to the trivial incidences reported. The scores of perceived immune status quality of life improved significantly from baseline in the GG+SPG group (p < 0.001) compared to the SPG group. Conclusion GG is safe and improves perception of immune status in individuals at risk of developing SRAS-CoV-2. However, these findings are inadequate to establish that GG lowers the incidence of COVID-19 necessitating to conduct RCTs in high-risk populations. Clinical Trial Registration CTRI/2020/06/025,525.

Prevalence and factors associated with mental health problems in Saudi general population during the coronavirus disease 2019 pandemic: A systematic review and meta-analysis

This systematic review and meta-analysis generates evidence of the prevalence and associated factors of common mental disorders (i.e., depression, anxiety, and stress) related to the pandemic among the Saudi general population. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive literature search was performed in the respective databases (e.g., PubMed, Scopus, Web of Science), from 22 July to 17 August 2021, and identified a total of 220 articles. Adhering to the inclusion criteria (i.e., original research concerning the prevalence and/or associated factors of depression and/or anxiety and/or stress disorders among the general Saudi population, published in English peer-reviewed journals), 15 studies were included in this review which consisted of a total of 262,656 participants. The overall prevalence of depression, anxiety, and stress was 30% (95% confidence interval [CI]: 22% to 38%, I²  = 99.58%), 20% (95% CI: 16% to 24%, I²  = 99.32%), and 29% (95% CI: 11% to 47%, I²  = 99.76%), respectively. Risk factors of mental health problems were found to be female sex, younger age group, single/divorced marital status, lower education, lower income, non-Saudis, unemployment status, students, being in a small family and living with elderly of the sociodemographic factors. Smokers, less physical activities, lower resilience, reduced immune status, chronic health problems, and psychiatric illness history were associated with a higher degree of mental health problems. In addition, coronavirus disease 2019 (COVID-19)-related risk factors of mental illness included lack of knowledge, fear, worry and concern, family member or friends' infection or death, lockdown restrictions, quarantine, confirmed or suspected of COVID-19 infection, and even pandemic effects. In conclusion, appropriate mental health preventive approaches for the Saudi general people are highly needed, where this review can be worthy of help by providing in detailed information to the respective authorities.