Global Psychological Implications of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Coronavirus Disease-2019 (COVID-19). What Can Be Learned From Italy. Reflections, Perspectives, Opportunities

A Self-Help Virtual Therapeutic Experience Intervention for Overcoming Psychological Distress Related to the COVID-19 Pandemic: Results From the European Multicentric COVID Feel Good Trial

OBJECTIVE

The general objective of the current study was to investigate the efficacy of a novel self-help virtual therapeutic experience (specifically, the COVID Feel Good intervention) in lowering the psychological burden experienced during the COVID-19 lockdowns in four European countries.

METHODS

We focused on participants recruited from June 2020 to May 2021 in the context of a European multicenter project including four university/academic sites. The total number of participants in the longitudinal studies was 107 (study 1, N = 40; study 2, N = 29; study 3, N = 38). The randomized controlled trial (study 4) included 31 participants in total, 16 in the intervention group and 15 in the control group. Primary outcome measures were depression, anxiety, stress symptoms, perceived stress level, and perceived hopelessness. The secondary outcome was experienced social connectedness.

RESULTS

Using separate linear mixed-effects models, the most consistent result across countries was a reduction in perceived stress after the participation in the COVID Feel Good intervention. By pooling the results of the models using a random-effects meta-analysis, we found that after the COVID Feel Good intervention, participants reported a decrease in perceived general distress (mean standardized effect size for general distress in the treatment groups compared with the control conditions was -0.52 [ p = .008, 95% confidence interval = -0.89 to -0.14]) and an increase in the perceived social connection (mean standardized effect size for social connection using COVID Feel Good compared with the control conditions was 0.50 [ p ≤ .001, 95% confidence interval = 0.25 to 0.76]).

CONCLUSIONS

Findings of this study indicate that a virtual self-help intervention is effective in reducing psychological distress. These results contribute to the growing literature supporting the use of digital psychological therapies to relieve psychological distress among the general population during the COVID-19 pandemic.Trial Registration : ISRCTN63887521.

The effect of COVID-19 restrictions on sleep quality of university students and variables predicting sleep quality

BACKGROUND/AIM

The COVID-19 pandemic has created a long period of stress for people worldwide and has significantly affected sleep duration. The pandemic revealed new stress factors that are likely to affect sleep. Uncertainty is a factor that leads to anxiety and depression, which affects sleep. It should also be noted that reductions in sleep quality rather than sleep duration are associated with negative consequences on mental health. This study aims to investigate online that how this situation affected university students.

MATERIALS AND METHODS

This research, with a descriptive study design, was conducted in Turkey between June 01, 2021 and July 30, 2021. The sample included 604 people who accepted voluntary participation, chosen by the random selection method. In the study, sociodemographic information form, Pittsburgh sleep quality index (PSQI), morningness-eveningness questionnaire scale (MEQ Scale), Beck depression inventory (BDI), and Beck anxiety inventory (BAI) were used as data collection tools. Pearson correlation analysis was utilized to examine the relationship between the scales. Multiple regression analysis was performed to investigate the role of morningness-eveningness, anxiety, depression, and insomnia severity on sleep quality.

RESULTS

Sleep quality was negatively correlated with morningness-eveningness scores (r = -0.32, P < 0.01), and positively and significantly related with anxiety (r = 0.43, P < 0.01), depression (r = 0.40, P < 0.01) and insomnia severity (r = 0.55, P < 0.01). According to regression coefficients, while anxiety (β = 0.041, P < 0.001) and insomnia severity scores (β = 0.226, P < 0.001) positively predicted sleep quality, depression did not predict it significantly (β = 0.009, P > 0.05). A significant difference was found in sleep quality according to morning, evening, and intermediate types (F = 27.401, P < 0.001).

CONCLUSION

Events related to the COVID-19 pandemic are associated with reduced sleep quality in connection with increasing negative moods. Considering the importance of sleep for a healthy life, efforts should be made to raise awareness about this issue and to provide psychological help to affected individuals.

Willingness to Receive COVID-19 Booster Vaccine: Associations between Green-Pass, Social Media Information, Anti-Vax Beliefs, and Emotional Balance

The aims of the present investigation were (i) to determine psychological relapses of COVID-19 booster vaccine; (ii) to identify the determining factors affecting willingness to receive COVID-19 vaccine; and (iii) to study the relationship among emotional characteristics (anxiety, stress, depression, optimism), social media information, and the mandatory political choices (i.e., green-pass) in Croatian people. A cross-sectional online survey was conducted for 1003 participants (median age: 40 years) from Croatia during December 2021. Results showed a significant association between vaccinated and unvaccinated participants in all sociodemographic variables, except for gender (p = 0.905). For psychological variables, significant differences were found only for levels of optimism (p < 0.001). People with a postgraduate degree (OR: 2.25, [1.14−4.46], p = 0.020) and PhD (OR: 1.97, [95% CI: 1.01−3.52], p = 0.021) had higher odds of being vaccinated than participants with high school diplomas. Additionally, participants seeking information on TV and radio (OR: 2.35, [1.71−3.23], p < 0.001) or from general practitioner (OR: 2.53, [1.78−3.61], p < 0.001) had higher odds of being vaccinated. Conversely, participants seeking information on social networks (OR: 0.36, [0.27−0.49], p < 0.001), general internet/blogs forums (OR: 0.34, [0.22−0.52], p < 0.001), and from friends or acquaintances (OR: 0.66, [0.48−0.91], p = 0.011) had lower odds of being vaccinated. Additionally, results showed that information policies have failed to fully convince the population to vaccinate and that depression (p = 0.491), anxiety (p = 0.220), and stress (p = 0.521) were not determining factors leading to the decision to receive COVID-19 vaccine. Most of the vaccinated participants perceived the green-pass as potentially useful. In contrast, most unvaccinated participants believed that the green-pass is a form of discrimination and not useful (88%). Further and broader research into possible reasons for continuing or undertaking vaccination is needed. It is recommended to introduce a measure of conformism that represents a change of attitude, belief, or behavior in a narrower sense.

The long psychological shadow of COVID-19 upon healthcare workers: A global concern for action

INTRODUCTION

The outbreak of COVID-19 has posed unprecedented psychological pressure upon every National Health Service in the world. In Piedmont, one of the most affected areas in Italy, 4550 healthcare workers were assessed online in May-June 2020, after the acute outbreak of March-April 2020, that compelled the Italian government to enforce, what was then, the first total lockdown in the Western world.

METHODS

Socio-demographic information of healthcare workers was gathered along with responses to: General Anxiety Disorder-7, Impact of Event Scale-Revised, Beck Depression Inventory-II, Peritraumatic Dissociative Experiences Questionnaire. Information about the need for psychological support was also gathered.

RESULTS

The regression models predicted the presence of moderate to severe symptoms for all the conditions assessed. Almost half of healthcare workers presented at least one clinically relevant symptom, and among them one in every four expressed the need of receiving psychological support.

CONCLUSIONS

Evidence calls for an increase of psychological services within the National Health System in Italy so as to guarantee for healthcare workers the psychological support necessary to cope with the long shadow of COVID-19, whose long-term impact is likely to reveal itself more strongly the more the acute stage of it is passed.

LIMITATIONS

The assessment of the psychological symptoms was performed without knowing the life and professional situations of the sample, and their medical records. Healthcare workers from only one region in Italy were involved, and some professionals (e.g. self-employed healthcare workers) were not included.

A Virtual Reality-Based Self-Help Intervention for Dealing with the Psychological Distress Associated with the COVID-19 Lockdown: An Effectiveness Study with a Two-Week Follow-Up

The aim of this study is to investigate the effectiveness of a novel self-administered at-home daily virtual reality (VR)-based intervention (COVID Feel Good) for reducing the psychological burden experienced during the COVID-19 lockdown in Italy. A total of 40 individuals who had experienced at least two months of strict social distancing measures followed COVID Feel Good between June and July 2020 for one week. Primary outcome measures were depression, anxiety, and stress symptoms, perceived stress levels, and hopelessness. Secondary outcomes were the experienced social connectedness and the level of fear experienced during the COVID-19 pandemic. Linear mixed-effects models were fitted to evaluate the effectiveness of the intervention. Additionally, we also performed a clinical change analysis on primary outcome measures. As concerning primary outcome measures, participants exhibited improvements from baseline to post-intervention for depression levels, stress levels, general distress, and perceived stress (all p < 0.05) but not for the perceived hopelessness (p = 0.110). Results for the secondary outcomes indicated an increase in social connectedness from T0 to T1 (p = 0.033) but not a significant reduction in the perceived fear of coronavirus (p = 0.412). Among these study variables, these significant improvements were maintained from post-intervention to the 2-week follow-up (p > 0.05). Results indicated that the intervention was associated with good clinical outcomes, low-to-no risks for the treatment, and no adverse effects or risks. Globally, evidence suggests a beneficial effect of the proposed protocol and its current availability in 12 different languages makes COVID Feel Good a free choice for helping individuals worldwide to cope with the psychological distress associated with the COVID-19 crisis, although large scale trials are needed to evaluate its efficacy.

Psychosocial Impact and Role of Resilience on Healthcare Workers during COVID-19 Pandemic

Italy was the first European country to be affected by the 2019 coronavirus epidemic (COVID-19). Several studies have shown the risk of developing depression, anxiety, and post-traumatic stress disorder in medical and paramedical staff. Causes included the high contagiousness of the virus, the fear of contracting it, the lack of adequate personal protective equipment, and physical and psychological fatigue. In this context, resilience represents a protective factor against adversity and stress burden. The aim of this research was to investigate if and how the resilience and personality profile is able to influence the response to stress and anxiety on a sample of Italian healthcare workers, during the COVID-19 outbreak. The sample consisted of 152 frontline healthcare workers, physicians, and paramedical professionals. Participants completed the online questionnaire measuring the Resilience Scale for Adults, the Big Five Inventory-10 Item, the State Anxiety Inventory, and the Perceived Stress Scale. Analyses of data aimed to show differences in the stress of healthcare workers due to gender and professional role, and at finding, by means of multidimensional scaling, the relations among anxiety, stress, resilience, and traits of personality. The findings gave some suggestions for implementing strategies useful to increase the resilience in healthcare workers and support them to cope with stressful events, typical of the pandemic emergency.

Poor Sleep Quality and Its Consequences on Mental Health During the COVID-19 Lockdown in Italy

Background

Coronavirus disease 2019 (COVID-19) seriously affected the whole of Italy. The extreme virulence and the speed of propagation resulted in restrictions and home confinement. This change was immediately perceived by people who found themselves exposed to feelings of uncertainty, fear, anger, stress, and a drastic change in the diurnal but above all nocturnal lifestyle. For these reasons, we aimed to study the quality of sleep and its connection to distress levels and to evaluate how lifestyle changed in the Italian population during the lockdown.

Methods

By means of an Internet survey we recruited 6,519 adults during the whole of the COVID-19 lockdown (from March 10–1st phase to May 4–2nd phase). We investigated the sociodemographic and COVID-19-related information and assessed sleep quality using the Medical Outcomes Study–sleep scale (MOS-SS) and mental health with the short form of Depression, Anxiety, and Stress Scales–21 Items (DASS-21). Multiple logistic regression model was used to evaluate the multivariate association between the dependent variable (good sleeper vs. poor sleeper) and all the variables that were significant in the univariate analysis.

Results

A total of 3,562 (55.32%) participants reported poor sleep quality according to the MOS-Sleep Index II score. The multiple binary logistic regression results of poor sleepers revealed several risk factors during the outbreak restrictions: female gender, living in Central Italy, having someone close who died because of COVID-19, markedly changed sleep–wake rhythms characterized by earlier or postponed habitual bedtime, earlier habitual awakening time and reduced number of afternoon naps, and extremely severe levels of stress, anxiety, and depression.

Conclusion

This is the first study designed to understand sleep quality and sleep habits during the whole of the lockdown period in the Italian population that provides more than 6,000 participants in a survey developed specifically for the health emergency related to COVID-19. Our study found that more than half of the Italian population had impaired sleep quality and sleep habits due to elevated psychological distress during the COVID-19 lockdown containment measures. A multidisciplinary action should be undertaken in order to plan appropriate responses to the current crisis caused by the lockdown for the COVID-19 outbreak.

Rethinking the Role of Affect in Risk Judgment: What We Have Learned From COVID-19 During the First Week of Quarantine in Italy

Due to COVID-19 spreading in Italy, on March 11 the Prime Minister of Italy declared a lockdown and imposed severe restrictive measures impacting citizens’ freedom at several levels. People were required to stay at home and go out only to satisfy basic needs. Several risk models have postulated a link among online searching behavior, affect, anxiety, and complaints by individuals toward government restrictions (GR), which emerged as also related to an increased perception of knowledge toward risk. However, to date, no study has addressed how these key risk-related aspects (i.e., affect, anxiety, perceived knowledge on risk, and risk dimensions) can act jointly to orient online health information-seeking behavior, and people’s complaints toward GR imposed during the lockdown. This study investigated the mechanisms underlying online health information-seeking behavior and people’s complaints toward the government’s restrictions during a COVID-19 emergency in the Italian population. Drawing from the health belief model (HBM), which postulates a link between sociodemographic variables, risk, and affect dimensions in emergency, we assumed risk factors as predictors of affect and anxiety, which, in turn, were posited as mediators between risk dimensions, online health information-seeking behavior, and complaints toward GR. Participants (1,031) were involved during the first week of the quarantine (March 11–18) and completed an online survey composed of (i) an adapted version of the Italian Risk Perception Questionnaire; (ii) the Italian Positive (PA) and Negative Affect (NA) Schedule (PANAS-10); (iii) the State Anxiety Scale (STAI-Y1); (iv) ad hoc personal knowledge measure about novel coronavirus; (v) ad hoc item measuring information search behavior regarding the novel coronavirus; (vi) ad hoc measure of the complains regarding GR; and (vii) sociodemographic questions. General linear models and structural equation modeling (SEM) were carried out to test the model. Sociodemographic and cognitive factors predicted the participants’ affect and anxiety, which, in turn, motivated and fully mediated both information search behavior and complaint toward GR. This research can offer useful suggestions for policy-makers during the COVID-19 emergency, and it advanced the knowledge on the risk–emotion link in emergency situations.