Self-Perceived Mental Health Status, Digital Activity, and Physical Distancing in the Context of Lockdown Versus Not-in-Lockdown Measures in Italy and Croatia: Cross-Sectional Study in the Early Ascending Phase of the COVID-19 Pandemic in March 2020

War, emotions, mental health, and artificial intelligence

During the war time dysregulation of negative emotions such as fear, anger, hatred, frustration, sadness, humiliation, and hopelessness can overrule normal societal values, culture, and endanger global peace and security, and mental health in affected societies. Therefore, it is understandable that the range and power of negative emotions may play important roles in consideration of human behavior in any armed conflict. The estimation and assessment of dominant negative emotions during war time are crucial but are challenged by the complexity of emotions' neuro-psycho-physiology. Currently available natural language processing (NLP) tools have comprehensive computational methods to analyze and understand the emotional content of related textual data in war-inflicted societies. Innovative AI-driven technologies incorporating machine learning, neuro-linguistic programming, cloud infrastructure, and novel digital therapeutic tools and applications present an immense potential to enhance mental health care worldwide. This advancement could make mental health services more cost-effective and readily accessible. Due to the inadequate number of psychiatrists and limited psychiatric resources in coping with mental health consequences of war and traumas, new digital therapeutic wearable devices supported by AI tools and means might be promising approach in psychiatry of future. Transformation of negative dominant emotional maps might be undertaken by the simultaneous combination of online cognitive behavioral therapy (CBT) on individual level, as well as usage of emotionally based strategic communications (EBSC) on a public level. The proposed positive emotional transformation by means of CBT and EBSC may provide important leverage in efforts to protect mental health of civil population in war-inflicted societies. AI-based tools that can be applied in design of EBSC stimuli, like Open AI Chat GPT or Google Gemini may have great potential to significantly enhance emotionally based strategic communications by more comprehensive understanding of semantic and linguistic analysis of available text datasets of war-traumatized society. Human in the loop enhanced by Chat GPT and Gemini can aid in design and development of emotionally annotated messages that resonate among targeted population, amplifying the impact of strategic communications in shaping human dominant emotional maps into a more positive by CBT and EBCS.

Perspectives on the COVID-19 Vaccination Rollout in 17 Countries: Reflexive Thematic and Frequency Analysis Based on the Strengths, Weaknesses, Opportunities, and Threats (SWOT) Framework

BACKGROUND

As the SARS-CoV-2 virus created a global pandemic and rapidly became an imminent threat to the health and lives of people worldwide, the need for a vaccine and its quick distribution among the population was evident. Due to the urgency, and on the back of international collaboration, vaccines were developed rapidly. However, vaccination rollouts showed different success rates in different countries and some also led to increased vaccine hesitancy.

OBJECTIVE

The aim of this study was to identify the role of information sharing and context sensitivity in various vaccination programs throughout the initial COVID-19 vaccination rollout in different countries. Moreover, we aimed to identify factors in national vaccination programs related to COVID-19 vaccine hesitancy, safety, and effectiveness. Toward this end, multidisciplinary and multinational opinions from members of the Navigating Knowledge Landscape (NKL) network were analyzed.

METHODS

From May to July 2021, 25 completed questionnaires from 27 NKL network members were collected. These contributors were from 17 different countries. The responses reflected the contributors' subjective viewpoints on the status and details of the COVID-19 vaccination rollout in their countries. Contributors were asked to identify strengths, weaknesses, opportunities, and threats (ie, SWOT) of the respective vaccination programs. The responses were analyzed using reflexive thematic analysis, followed by frequency analysis of identified themes according to the represented countries.

RESULTS

The perspectives of NKL network members showed a link between organizational elements of the vaccination rollout and the accompanying societal response, both of which were related to strengths and weaknesses of the process. External sociocultural variables, improved public communication around vaccination-related issues, ethical controversies, and the spread of disinformation were the dominant themes related to opportunities and challenges. In the SWOT 2×2 matrix, Availability and Barriers emerged as internal categories, whereas Transparent communication and promotion and Societal divide emerged as key external categories.

CONCLUSIONS

Inventory of themes and categories inspired by elements of the SWOT framework provides an informative multidisciplinary perspective for effective implementation of public health strategies in the battle against COVID-19 or any future pandemics of a similar nature.

Psychosocial Factors of Subjective Well-Being in Women with Eating Disorders

Eating disorders are known as the most lethal mental health conditions, and lately there has been a significant increase in the prevalence of these disorders. The aim of this research was to determine the perceived quality of professional support, the relationship between subjective well-being, loneliness, resilience, and the quality of family functioning, and the possibility of predicting subjective well-being based on knowledge of psychosocial factors in people with eating disorders. Eighty-six women with a diagnosed eating disorder participated in the online survey. The Diener Subjective Well-Being Scale, the UCLA Loneliness Scale, the Brief Resilience Scale, and the Self-Report Family Inventory were used to measure the constructs. Questions were constructed to collect information about the perceived quality and availability of professional support. Results showed lower levels of life satisfaction and flourishing and more frequent negative experiences. Reports of medium levels of loneliness, lower levels of flourishing, and lower perceived quality of family functioning were also obtained. Significant predictors of subjective well-being were loneliness and resilience, while family cohesion was significant in predicting positive and negative experiences and flourishing. These findings can contribute to the recognition of aspects existent prior to the development of the disorder, based on which experts can determine what to focus on in the treatment process.

The Role of Emotional Skills (Competence) and Coping Strategies in Adolescent Depression

Depression is a state of low mood that can lead to several negative outcomes on thoughts, emotions, behaviors, and even physical state. With that in mind, it is important to detect individuals at risk of developing depressive symptoms early and identify protective factors. During the COVID-19 pandemic, adolescents emerged as one of the most vulnerable groups, with deteriorated anxiety and depression due to imposed social isolation, reduced social activities, and concerns over household status, health, and peer support. Distance learning through public service broadcasts and online tools lasted for several months, posing the need for adjustment. This study aimed to assess emotional competence and coping styles as predictors of depression in a sample of adolescents. The study was conducted in-person on a sample of 142 high school students. A high percentage of participants reported above-average levels of depression (21.1% severely depressed). On average, girls reported higher levels of depression than boys (t = 3.86, p < 0.01). Gender differences were also found in emotion-focused coping and avoidance, with girls scoring higher on both (p < 0.05). However, there were no gender differences in problem-focused coping or emotional competence. Hierarchical regression analysis concluded that perceiving and understanding emotions, expressing and naming emotions, regulating emotions, and avoidance were significant predictors of depression. This regression model explained 53% of depression variance, with the regulation of emotions being the most powerful predictor (p < 0.01). No mediating effect of coping styles on the relationship between emotional competence and depression was found in this study.

Assessment of Perceived Health Status and Access to Health Service during the COVID-19 Pandemic: Cross-Sectional Survey in Italy

(1) Background: The aims of this survey were to assess the perceived health status and to evaluate the use of healthcare services during the pandemic period. (2) Methods: This cross-sectional survey was conducted from May to October 2021 in the Campania and Calabria regions, Southern Italy. The sample was selected among 655 subjects attending vaccination or primary care physician clinics. (3) Results: More than half (57.2%) of the respondents were female, the mean age was 49 years (range 19-97), and 61.3% had at least one chronic disease. Among the respondents, 56.3% declared that they had accessed healthcare at least once during the pandemic and, among all respondents who did not access healthcare, 23.2% gave reasons related to the COVID-19 pandemic. The two scores obtained from the Short-Form-12 Health Survey (SF-12), physical health summary (PCS) and mental health summary (MCS), had a means of 48.4 and 45.9, respectively. Among the respondents, 2.3% of respondents considered their health poor, 43.1% good and 6.4% excellent. (4) Conclusions: Our results suggest the need to ensure, in similar health emergency situations, a quick response from the National Health System so that ordinary medical assistance activities can be guaranteed in full safety, avoiding the risk of missed access or lack of assistance.

Influencing factors of anxiety and depression of discharged COVID-19 patients in Wuhan, China

Objectives

This study is intended to assess the prevalence of depression and anxiety in individuals who had recovered from COVID-19 and been discharged from hospital (RD hereafter) in Wuhan, China, and to explore the factors associated with these mental disorders.

Methods

Participants of this study were the RD who were infected at the beginning of the outbreak from 13 communities in Jianghan District of Wuhan City, Hubei Province, China by convenience sampling in mid-2021. The Generalized Anxiety Disorder Questionnaire, the Patient Health Questionnaire, the Short Version of COVID-19 Stigma Scale, the Peace of Mind Scale, the Resilience Style Questionnaire, and the Perceived Social Support Questionnaire were used to collect relevant information of the participants. Descriptive analyses, Pearson correlation analysis, and logistic regression analysis were used to describe and analyze the data and to examine the factors associated with the mental health status of this population.

Results

In total, we recruited 1601 participants from 3059 COVID-19 patients, and 1541 participants completed the questionnaire survey, with a response rate of 96.25%. Finally, 1297 participants met the inclusion and exclusion criteria in this study, of whom 28.8% and 37.9% reported mild to severe levels of anxiety and depression symptoms. Perceived better mental health status during hospitalization, higher frequency of alcohol use per week, peace of mind, higher education level, and resilience were negatively associated with anxiety, while stigma and history of psychological or emotional counseling before infection was positively associated with anxiety. More severe clinical classification of COVID-19 and stigma (AOR = 1.057, P<0.001) were both positively associated with depression, while perceived better mental health status during hospitalization (AOR = 0.564, P<0.001), higher frequency of alcohol use per week (AOR = 0.462, P = 0.004), peace of mind (AOR = 0.857, P<0.001), and social support (AOR = 0.972, P = 0.034) were negatively associated with depression.

Conclusions

Tailored interventions on reducing stigma, enhancing mindfulness and social support should be taken into account to alleviate anxiety and depression among RD.

The effect of different degrees of lockdown and self-identified gender on anxiety, depression and suicidality during the COVID-19 pandemic: Data from the international COMET-G study

INTRODUCTION

During the COVID-19 pandemic various degrees of lockdown were applied by countries around the world. It is considered that such measures have an adverse effect on mental health but the relationship of measure intensity with the mental health effect has not been thoroughly studied. Here we report data from the larger COMET-G study pertaining to this question.

MATERIAL AND METHODS

During the COVID-19 pandemic, data were gathered with an online questionnaire from 55,589 participants from 40 countries (64.85% females aged 35.80 ± 13.61; 34.05% males aged 34.90±13.29 and 1.10% other aged 31.64±13.15). Anxiety was measured with the STAI, depression with the CES-D and suicidality with the RASS. Distress and probable depression were identified with the use of a previously developed cut-off and algorithm respectively.

STATISTICAL ANALYSIS

It included the calculation of Relative Risk (RR), Factorial ANOVA and Multiple backwards stepwise linear regression analysis RESULTS: Approximately two-thirds were currently living under significant restrictions due to lockdown. For both males and females the risk to develop clinical depression correlated significantly with each and every level of increasing lockdown degree (RR 1.72 and 1.90 respectively). The combined lockdown and psychiatric history increased RR to 6.88 The overall relationship of lockdown with severity of depression, though significant was small.

CONCLUSIONS

The current study is the first which reports an almost linear relationship between lockdown degree and effect in mental health. Our findings, support previous suggestions concerning the need for a proactive targeted intervention to protect mental health more specifically in vulnerable groups.

The Evolution of Psychological and Behavioral Consequences of Self-Isolation During Lockdown: A Longitudinal Study Across United Kingdom and Italy

Introduction

Several countries imposed nationwide or partial lockdowns to limit the spread of COVID-19 and avoid overwhelming hospitals and intensive care units. Lockdown may involve restriction of movement, stay-at-home orders and self-isolation, which may have dramatic consequences on mental health. Recent studies demonstrated that the negative impact of lockdown restrictions depends on a wide range of psychological and socio-demographic factors.

Aims

This longitudinal study aimed to understand how internal factors such as personality and mindfulness traits, and external factors, such as daily habits and house features, affect anxiety, depression and general wellbeing indicators, as well as cognitive functions, during the course of a lockdown.

Methods

To address these questions, 96 participants in Italy and the United Kingdom filled out a survey, once a week for 4 weeks, during the first-wave lockdowns. The survey included questions related to their habits and features of the house, as well as validated questionnaires to measure personality traits, mindful attitude and post-traumatic symptoms. Indicators of wellbeing were the affective state, anxiety, stress and psychopathological indices. We also measured the emotional impact of the pandemic on cognitive ability by using two online behavioral tasks [emotional Stroop task (EST) and visual search].

Results

We found that internal factors influenced participants' wellbeing during the first week of the study, while external factors affected participants in the last weeks. In the first week, internal variables such as openness, conscientiousness and being non-judgmental toward one's own thoughts and emotions were positively associated with wellbeing; instead, neuroticism and the tendency to observe and describe one's own thoughts and emotions had detrimental effects on wellbeing. Toward the end of the study, external variables such as watching television and movies, browsing the internet, walking the dog, and having a balcony showed a protective value, while social networking and engaging in video calls predicted lower values of wellbeing. We did not find any effects of wellbeing on cognitive functioning.

Conclusion

Recognizing specific traits and habits affecting individuals' wellbeing (in both short and long terms) during social isolation is crucial to identify people at risk of developing psychological distress and help refine current guidelines to alleviate the psychological consequences of prolonged lockdowns.

Noor N, Mat Ludin AF, Shahar S, Abdul Manaf MR. The Challenges and Strategies towards Healthy Eating during COVID-19 Home Confinement Period among Working Adults with BMI ≥ 25 kg/m2 Enrolled in a Weight Loss Program: Qualitative Findings

The COVID-19 pandemic has been affecting our lifestyles, such as work, living, and health. In Malaysia, the Restriction of Movement Order (RMO) was first announced in March 2020 to curb the spread of the virus. Since then, many Malaysians have been confined to their own home. This new lifestyle can cause a change of eating habits where healthy eating may be a challenge. Hence, our qualitative study explored the challenges and strategies for healthy eating during the first wave of the COVID-19 home confinement period among working adults overweight and obese in Malaysia. Eleven participants were individually interviewed through phone calls. The interviews were audio-recorded, transcribed verbatim, and then coded with NVIVO 12 based on thematic analysis. We found that social pressure, changes in the social setting, more free time to access food, and extra stock of unhealthy foods at home were among the challenges to healthy eating. Some participants countered these perceived challenges by reducing unhealthy food stock, limiting kitchen visits, and utilizing self-monitoring apps to monitor their calorie intake. Social media was not consistently perceived to influence their eating behavior during this period. We conclude that COVID-19 home confinement has created challenges to healthy eating habits among overweight and obese adults with overweight and obesity. Our study provides evidence that vulnerable groups such as overweight and obese individuals require specific nutritional support during pandemic-related confinement to enhance eating self-efficacy.

Educators' Psychosocial Burdens Due to the COVID-19 Pandemic and Predictive Factors: A Cross-Sectional Survey of the Relationship with Sense of Coherence and Social Capital

This study aims to identify the social and psychological burdens placed on educators during the third wave of the COVID-19 pandemic in Japan and to propose an optimal form of support. We investigated educators' perceptions of psychological and socioeconomic anxieties and burdens, sense of coherence, and social capital using a questionnaire survey of 1000 educators in January 2021. Multivariate regression analyses were conducted to analyze the associations between the variables. Results: Approximately 80% of the respondents considered COVID-19 a formidable, life-threatening illness. Our results revealed that the higher the social capital, the greater the fear of COVID-19, and the higher the sense of coherence, the lower this fear. Conclusions: The anxiety burden of implementing infection prevention was higher than the anxiety burden associated with distance learning. The predictive factors for educators' perceptions of burden included sense of coherence, gender, and age. Our findings suggest the importance of having the government and educational institutions provide multidimensional assistance that matches educators' individual characteristics.

Effects of Pandemic on Feelings of Depression in Italy: The Role of Age, Gender, and Individual Experiences During the First Lockdown

The restrictions to physical contacts that have been imposed in different countries to deal with the coronavirus disease 2019 (COVID-19) pandemic may have contributed to an increase in feelings of depression on top of other negative consequences of the pandemic. This study examines the consequences of the COVID-19 pandemic on feelings of depression using original data collected in Italy between April 14 and 24, 2020. Quota sampling (N = 3,026) was performed to target the population of 18+ and, together with post-stratification weights, permitted obtaining a representative sample of the Italian population with respect to key sociodemographic factors. We find that 47% of the respondents have increased depressive feelings during the Covid-19 lockdown. Adopting a life-course perspective, we revealed great heterogeneity in feelings of depression consequences by age, gender, and difficulties experienced during the first national lockdown. Identifying groups of population at higher risk of suffering from feelings of depression as a result of COVID-19 is crucial to limit indirect long-term consequences of the pandemic.

BIOMEDICAL RESEARCHERS CONFRONTING THE COVID-19 PANDEMIC

The COVID-19 pandemic represents a global challenge to be confronted by the biomedical community. This article aimed to explore how knowledgeable and competent researchers may contribute to fighting the pandemic, and to discuss the ethics and impact of this endeavor. Many medical researchers and in particular clinical practitioners are engaged in collecting new evidence and creating new knowledge by undertaking pandemic-related research. This research is frequently unplanned, and subsequently numerous obstacles to starting new but necessary studies must be overcome. To contribute research evidence in hard times represents a highly ethical move. Moreover, these new studies need ethical approvals, financial resources, and institutional frameworks. Another pandemic-related challenge is how to generate expert opinions during the period when solid evidence is missing. Unlike research studies providing necessary scientific evidence, expert opinions do not need ethical approvals or disclosures of competing interests. The apparent contrast of evidence-based versus opinion-based decision-making during the pandemic reconfirms that quality research studies have no alternatives at all times.