What about heart and mind in the COVID-19 era?

Cardiovascular Disease Complicating COVID-19 in the Elderly

SARS-CoV-2, a single-stranded RNA coronavirus, causes an illness known as coronavirus disease 2019 (COVID-19). The highly transmissible virus gains entry into human cells primarily by the binding of its spike protein to the angiotensin-converting enzyme 2 receptor, which is expressed not only in lung tissue but also in cardiac myocytes and the vascular endothelium. Cardiovascular complications are frequent in patients with COVID-19 and may be a result of viral-associated systemic and cardiac inflammation or may arise from a virus-induced hypercoagulable state. This prothrombotic state is marked by endothelial dysfunction and platelet activation in both macrovasculature and microvasculature. In patients with subclinical atherosclerosis, COVID-19 may incite atherosclerotic plaque disruption and coronary thrombosis. Hypertension and obesity are common comorbidities in COVID-19 patients that may significantly raise the risk of mortality. Sedentary behaviors, poor diet, and increased use of tobacco and alcohol, associated with prolonged stay-at-home restrictions, may promote thrombosis, while depressed mood due to social isolation can exacerbate poor self-care. Telehealth interventions via smartphone applications and other technologies that document nutrition and offer exercise programs and social connections can be used to mitigate some of the potential damage to heart health.

Intimate partner violence: A loop of abuse, depression and victimization

Intimate partner violence has been recognized as a serious public health issue. Exposure to violence contributes to the genesis of, and exacerbates, mental health conditions, and existing mental health problems increase vulnerability to partner violence, a loop that imprisons victims and perpetuates the abuse. A recently described phenomenon is when male violence against females occurs within intimate relationships during youth, and it is termed adolescent or teen dating violence. In this narrative review, factors associated with intimate partner violence and consequences of exposure of children to parental domestic violence are discussed, along with possible intensification of violence against women with the spread of coronavirus disease 2019 pandemic and subsequent lockdown. Intervention programs with a multicomponent approach involving many health care settings and research have a pivotal role in developing additional strategies for addressing violence and to provide tailored interventions to victims. Prevention policy with a particular attention on healthy child and adolescent development is mandatory in the struggle against all forms of violence.

The Impact of the COVID-19 Pandemic on Primary Emotional Systems and Emotional Regulation

(1) Background: The COronaVIrus Disease 2019 (COVID-19) pandemic poses a unique challenge as a severe global crisis affecting physical and psychological health. The main purpose of this work is to study the impact of a traumatic event while also observing the human ability to adapt. One of the first theories to study the adaptive importance of the evolutionary lineage of the affective systems is referred to as BrainMind (Panksepp, 2010). This study aims to explore whether primary emotional systems (PES) and emotion regulation (ER) strategies show differences between the pre- and post- lockdown period; and if positive systems and specific emotion regulation pre-pandemic act as a protective or risk factor for mental and physical wellbeing. (2) Methods: 98 participants who had participated in a previous study before the pandemic were re-contacted to refill the Affective Neuroscience Personality Scale (ANPS) and the Emotion Regulation Questionnaire (ERQ) after the outbreak of the pandemic with the addition of the Symptom Checklist-90-Revised (SCL-90R). (3) Results: The results showed that the COVID-19 lockdown rules had an impact on Emotional Regulation and on a re-balancing of PES. Moreover, pre-pandemic expressive–suppressive ERQ strategies and ANPS SADNESS scores appeared as relevant risk factors, which predicted higher Global Severity Index (GSI) scores during lockdown. (4) Conclusions: The lockdown appears to have activated PLAY and CARE as protective systems, but has detuned the ability to positively reinterpret the situation.

Caring for Mothers: A Narrative Review on Interpersonal Violence and Peripartum Mental Health

Interpersonal violence in the perinatal period is frequent and should be considered a prominent health issue due to the risk of escalation of violence and the significant impact on mothers' parenting after childbirth. Domestic violence during pregnancy can be associated with fatal and non-fatal adverse health outcomes due to the direct trauma to a pregnant woman's body and to the effect of stress on fetal growth and development. Emotional violence is a risk factor for prenatal and/or postpartum depression. Recent studies focusing on abusive situations during peripartum and possible preventive strategies were identified in PubMed/Medline, Scopus, Embase, and ScienceDirect. All of the available literature was retrospectively reviewed with a special attention to peer-reviewed publications from the last ten years. Results of the present narrative review suggest that perinatal health care professionals (general practitioners, gynecologists, obstetricians, psychologists, psychiatrists) should promptly detect interpersonal violence during and after pregnancy and provide health care for pregnant women. It seems pivotal to guarantee psychological care for abused women before, during, and after pregnancy in order to prevent the risk of depressive symptoms, other mental or physical sequelae, and mother-to-infant bonding failure. There is an urgent need for multifaceted interventions: programs should focus on several risk factors and should design tailored care pathways fitted to the specific needs of women and finalized to support them across the lifespan.

Exercise and Use of Enhancement Drugs at the Time of the COVID-19 Pandemic: A Multicultural Study on Coping Strategies During Self-Isolation and Related Risks

Introduction: Little is known about the impact of restrictive measures during the COVID-19 pandemic on self-image and engagement in exercise and other coping strategies alongside the use of image and performance-enhancing drugs (IPEDs) to boost performance and appearance. Objectives: To assess the role of anxiety about appearance and self-compassion on the practice of physical exercise and use of IPEDs during lockdown. Methods: An international online questionnaire was carried out using the Exercise Addiction Inventory (EAI), the Appearance Anxiety Inventory (AAI), and the Self-Compassion Scale (SCS) in addition to questions on the use of IPEDs. Results: The sample consisted of 3,161 (65% female) adults from Italy (41.1%), Spain (15.7%), the United Kingdom (UK) (12.0%), Lithuania (11.6%), Portugal (10.5%), Japan (5.5%), and Hungary (3.5%). The mean age was 35.05 years (SD = 12.10). Overall, 4.3% of the participants were found to engage in excessive or problematic exercise with peaks registered in the UK (11.0%) and Spain (5.4%). The sample reported the use of a wide range of drugs and medicines to boost image and performance (28%) and maintained use during the lockdown, mostly in Hungary (56.6%), Japan (46.8%), and the UK (33.8%), with 6.4% who started to use a new drug. Significant appearance anxiety levels were found across the sample, with 18.1% in Italy, 16.9% in Japan, and 16.7% in Portugal. Logistic regression models revealed a strong association between physical exercise and IPED use. Anxiety about appearance also significantly increased the probability of using IPEDs. However, self-compassion did not significantly predict such behavior. Anxiety about appearance and self-compassion were non-significant predictors associated with engaging in physical exercise. Discussion and Conclusion: This study identified risks of problematic exercising and appearance anxiety among the general population during the COVID-19 lockdown period across all the participating countries with significant gender differences. Such behaviors were positively associated with the unsupervised use of IPEDs, although no interaction between physical exercise and appearance anxiety was observed. Further considerations are needed to explore the impact of socially restrictive measures among vulnerable groups, and the implementation of more targeted responses.

A Community Participation Initiative During COVID-19 Pandemic: A Case Study From India

BACKGROUND

A community participation initiative of stitching personal protective equipment (PPE), masks, and face shields for healthcare professionals working in the hospital during the COVID-19 pandemic was conducted using a case study design.

METHODS

The hospital tailoring unit was used to cater to the in-house demand for stitching safety gear kits for healthcare professionals. A transect walk was conducted to survey hospitals for selecting material for stitching the safety gears and to draw up a plan to meet future demand. The psychiatric social worker induced a community participatory initiative using the method of social work of community organization. A flyer was prepared to invite participants with prior experience in tailoring for this initiative. All participants were trained by the master trainers of the tailoring unit. The participants were also interviewed about their views on this initiative in an informal interview.

RESULTS

A total of 83 participants, including 26 individuals (8 volunteers and 18 who received an honorarium), 2 boutiques (n = 12), and 1 government organization, participated in the activity (n = 45). A total of 1700 complete PPE kits and 13,000 masks were stitched during this period. The participants reported that the benefit of being a part of this initiative was reduced boredom, sense of purpose and satisfaction, and improved mental health due to structured activity.

CONCLUSIONS

A community participation initiative using the principles of community organization, a method of social work, can help produce desired outputs and improve the well-being of the participants.

Consequences of COVID19-pandemic lockdown on Italian occupational physicians' psychosocial health

COVID-19 was declared a pandemic on March 12, 2020. Italy has been the most affected country in the world, right after China. Healthcare workers (HCWs) were among the hardest hit by this event from both a working and psychological point of view. The aim of this web-based cross-sectional study is to assess the consequences of the COVID-19 pandemic on Italian Occupational Physicians' well-being and psychological distress, in relation to demographic and occupational characteristic, lifestyle and habits during the lockdown period. We conducted a web-based cross-sectional survey questionnaire from April 1 to April 21st, 2020. To evaluate the level of psychological distress and the level of well-being, the general Health Questionnaire-12 (GHQ-12) and the WHO-5 Wellbeing Index were utilized. Since the statistical assumptions were respected, we proceeded with an analysis of variance (ANOVA) to ascertain the differences between the averages of the scores of the GHQ-12. Doctors who live in the most affected regions have a prevalence of psychological distress higher than their colleagues from the rest of Italy. ANOVA shows significant differences relating to the female gender, and to the life changes provoked by the lockdown for example not feeling sheltered at home or suffering from loneliness. This study showed a high prevalence of psychological distress in occupational physicians. To prevent the occurrence of mental disorders among Occupational Physicians, it is urgent to put in place policies of psychological support and well-being preservation.

Loneliness, Emotion Dysregulation, and Internalizing Symptoms During Coronavirus Disease 2019: A Structural Equation Modeling Approach

Background: Our study aimed to test the hypotheses that an increased level of loneliness experienced during coronavirus disease 2019 (COVID-19) confinement was predictive of internalizing symptoms and that this pathway was mediated by emotion dysregulation levels. Methods: To reach this aim, we performed an online longitudinal survey recruiting 1,330 participants at Time 1 (at the beginning of the lockdown) and 308 participants at Time 2 (few days before the end of the lockdown). All filled out a set of questionnaires: demographic data, University of California, Los Angeles Loneliness scale, Difficulties in Emotion Regulation Scale-18 items, and Depression Anxiety and Stress Scale-21 items. Hypotheses were tested using structural equation modeling in two steps and controlling for age. First, hypotheses were tested on cross-sectional data. Then, a cross-lagged panel analysis was performed on longitudinal data. Results: Models obtained a good fit and evidenced the predictive role of loneliness levels on the three outcomes (i.e., depression, anxiety, and stress). Moreover, we found that emotion dysregulation levels partially mediated the longitudinal relationship between loneliness and both depression and stress but not between loneliness and anxiety levels. Conclusions: This study points out that a central goal of clinical intervention could be the ability to regulate negative emotional states.

The Impact of Coping Strategies and Perceived Family Support on Depressive and Anxious Symptomatology During the Coronavirus Pandemic (COVID-19) Lockdown

The coronavirus pandemic represents a severe global crisis, affecting physical, and psychological health. Lockdown rules imposed to counteract the rapid growth of COVID-19, mainly social restrictions, have represented a risk factor for developing depressive and anxious symptoms. The research aims are to explore the effect of coping strategies and perceived social support on depressive and anxious symptomatology during the COVID-19 pandemic. Ninety-six healthy people (46 males, mean age = 39.3; SD = 16.6) completed through on-line platform: Socio-demographic questionnaire, Coping Inventory for Stressful Situations (CISS), Multidimensional Scale of Perceived Social Support (MSPSS) and Symptom Checklist-90-Revised (SCL-90-R), 3 weeks after the imposition of lockdown restrictions. SCL-90-R Depression scores showed significant positive correlation with CISS Emotion (r = 0.85; p = 0.001) and Avoidant (r = 0.34; p = 0.018), a significant negative correlation with MSPSS Family support (r = -0.43; p = 0.003). SCL-90-R Anxiety scores showed a significant positive correlation with CISS Emotion (r = 0.72; p = 0.001) and Avoidant (r = 0.35; p = 0.016). No significant correlations between both CISS Emotion and Avoidant scales with social support emerged. Two Multiple Linear Regression analysis were performed using, respectively, SCL-90-R Depression and Anxiety scores as dependent variables, and the CISS and MSPSS scales, age, and gender as predictors. The first regression model (R 2 = 0.78; adjusted R 2 = 0.75) revealed CISS Emotion (β = 0.83; p = 0.001) and MSPSS Family support (β = -0.24; p = 0.004) had a predictive effect on SCL-90-R Depression scores. The second regression model (R 2 = 0.52; adjusted R 2 = 0.472) revealed that only CISS Emotion (β = 0.71; p = 0.001) predicted the SCL-90-R Anxiety scores. In conclusion, during the COVID-19 pandemic lockdowns, coping focus on emotions seemed to increase anxious and depressive symptoms, probably due to the uncontrollable nature of the stressful event and the high emotional response. Family support which reduces the sense of loneliness had an exclusive role in mitigating depressive symptoms. These results highlight the importance of promoting psychological strategies to improve emotional regulation skills, reducing isolation from family, to prevent mood symptomatology in healthy citizens during large-scale health crises.

Risk factors associated with mental illness in hospital discharged patients infected with COVID-19 in Wuhan, China

The coronavirus disease 2019 (COVID-19) pandemic can have a profound impact on the mental health of patients who survived the illness. However, little is known about the prevalence rate of mental health disorders among hospital discharged COVID-19 patients and its associated factors. A cross-sectional survey of hospital discharged patients was conducted April 11-22, 2020 in Wuhan, China (where the pandemic began). 675 participants completed the survey, including 90 (13.3%) medical staff (physicians and nurses who had been ill). We used Fisher's exact test and multivariable logistic regression methods to explore the risk factors associated with mental health problems (anxiety, depression, and PTSD symptoms associated with COVID-19 hospitalization). Adverse mental health effects of COVID-19 are evident after discharge from the hospital, with sleep difficulties highlighted as a central issue. As we found that perceived discrimination was a central predictor of mental illness, preventing and addressing social stigma associated with COVID-19 may be crucial for improving mental health for recovered patients.

Psychopathological Burden and Quality of Life in Substance Users During the COVID-19 Lockdown Period in Italy

BACKGROUND

Following the development of the COVID-19 pandemic, a rigid public health strategy of reduced social contact and shelter-in-place has been adopted by the Italian Government to reduce the spread of the virus. In this paper, we aim at evaluating the impact that the COVID-19 pandemic, and the relative containment measures, have had on a real-life sample of patients suffering from substance use disorders (SUDs) and/or behavioral addictions.

METHODS

An anonymous questionnaire was filled out by 153 addicted patients, both outpatients and residential inpatients, recruited across Italy and highly representative of the current Italian population suffering from addictions. Psychopathological burden (anxiety and depressive symptomatology, somatization, irritability, and post-traumatic symptoms), quality of life, and craving changes in daily habits were assessed.

RESULTS

In our sample, we found moderate rates of depression (22.9%), anxiety (30.1%), irritability (31.6%), and post-traumatic stress (5.4%) symptoms. Psychopathological burden was globally higher among residential patients. Reported levels of craving were generally low.

DISCUSSION

This study is the first attempt to collect Italian data regarding the effects of the rigid quarantine period, during the COVID-19 pandemic, on patients suffering from a SUD and/or behavioral addictions. The presence of a moderate psychopathological burden correlated to poor quality of life and low craving scores represented the main outcomes. Long-term studies, with follow-up after the end of the restrictive measures, should be considered to implement our findings.