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Bernardo ABI, Ramos SDA. Culturalizing theory and research on cognitive models of hope. Front Psychol 2024; 15:1457725. [PMID: 39184941 PMCID: PMC11341373 DOI: 10.3389/fpsyg.2024.1457725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 07/25/2024] [Indexed: 08/27/2024] Open
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Ma HY, Chiang NT, Kao RH, Lee CY. Health Workers' Mindfulness-Based Stress Reduction and Resilience During COVID-19 Pandemic. J Multidiscip Healthc 2024; 17:3691-3713. [PMID: 39114858 PMCID: PMC11303674 DOI: 10.2147/jmdh.s464285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/25/2024] [Indexed: 08/10/2024] Open
Abstract
Background Research indicates that a significant number of healthcare workers accounted for all confirmed Coronavirus disease 2019 (COVID-19) cases, and many of the infected healthcare workers were asymptomatic. During the COVID-19 outbreak, a considerable number of people in Taiwan contracted the disease. Therefore, health workers in Taiwan often experienced lack of medical resources, and this problem is worse for outer island areas. In terms of stress and mental health, this study investigated the effect of poor healthcare capacity and high workload on health workers during the COVID-19 pandemic. This study also explored mindfulness-based stress reduction and resilience in health workers. Methods This study conducted an in-depth interview to investigate stress perceived by health workers in a hospital located on an outer island of Taiwan as well as their mental health and stress relieving strategies. Results It was found that during the COVID-19 outbreak, some common sources of stress for health workers included exposure to infectious diseases, heavy workloads, facing ethical dilemma in clinical decision-making, and unfamiliar problems from the pandemic. These types of stress cause worries, anxiety, and depression in health workers, which affects their mental and physical health as well as their patient-care performance. Conclusion This study proposed that mindfulness-based stress reduction and protecting mental health are important for health workers.
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Affiliation(s)
- Hsiang-Yu Ma
- Department of Ocean and Border Management, National Quemoy University, Kinmen, Taiwan
| | - Nein-Tsu Chiang
- Department of Ocean and Border Management, National Quemoy University, Kinmen, Taiwan
| | - Rui-Hsin Kao
- Department of Ocean and Border Management, National Quemoy University, Kinmen, Taiwan
| | - Chih-Ying Lee
- Department of Ocean and Border Management, National Quemoy University, Kinmen, Taiwan
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Wang G, Yi X, Fan H, Cheng H. Anxiety and sleep quality in patients receiving maintenance hemodialysis: multiple mediating roles of hope and family function. Sci Rep 2024; 14:15073. [PMID: 38956144 PMCID: PMC11219716 DOI: 10.1038/s41598-024-65901-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 06/25/2024] [Indexed: 07/04/2024] Open
Abstract
The objective of this cross-sectional study was to examine the extent of sleep quality among individuals undergoing maintenance hemodialysis (MHD) and to scrutinize whether hope and family function serve as mediators in the association between anxiety and sleep quality in this cohort. A convenience sampling method was used to recruit 227 patients receiving maintenance hemodialysis from two tertiary hospitals in Wuhan. Participants completed several self-report questionnaires, including the Sociodemographic questionnaire, Hospital Anxiety and Depression Scale, Athens Insomnia Scale, Herth Hope Index, and Family APGAR Index. As per the findings of the chain mediation analysis, it was observed that the sleep quality scores were directly predicted by anxiety. Moreover, anxiety positively predicted sleep quality scores through hope and family function as mediators. The observed types of mediation were partial mediation. The total indirect effect value was 0.354, indicating the mediating effect of hope and family function, while the total effect value was 0.481, representing the overall effect of anxiety on sleep quality. The total effect size was 73.60% (0.354/0.481), indicating that the mediation accounted for a significant portion of the relationship. This study established the chain mediating effect of hope and family function between anxiety and sleep quality in patients receiving maintenance hemodialysis. The findings highlight the importance of addressing anxiety and promoting hope and family function to improve sleep quality in this population. The findings suggest that healthcare professionals should be attentive to the anxiety levels of these patients and implement targeted interventions to help alleviate anxiety, enhance hope, and improve family functioning, with the ultimate goal of improving sleep quality in this population.
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Affiliation(s)
- Guoqing Wang
- Hemodialysis Center, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Xiang Yi
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Hui Fan
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China.
| | - Huiling Cheng
- Hemodialysis Center, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China.
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Acoba EF. Social support and mental health: the mediating role of perceived stress. Front Psychol 2024; 15:1330720. [PMID: 38449744 PMCID: PMC10915202 DOI: 10.3389/fpsyg.2024.1330720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/31/2024] [Indexed: 03/08/2024] Open
Abstract
Social support has been associated with improved mental health; however, the mechanisms underlying this relationship remain unclear. This study aimed to explore whether perceived stress mediate the relationship between social support and positive affect, anxiety, and depression. Drawing from Lazarus and Folkman's stress and coping theory, the study emphasized the influential role of social support in appraising stressful events. A cross-sectional survey was conducted online among 426 Filipino adults during the peak of the COVID-19 pandemic. Participants completed measures including the Multidimensional Scale of Perceived Social Support (MSPSS), the Perceived Stress Scale-10 (PSS-10), the Positive Affect subscale of PANAS, and the Depression and Anxiety subscales of DASS-21. The hypotheses of the study were tested using mediation analysis. Consistent with the hypotheses, perceived stress significantly mediated the relationship between family and significant other support with positive affect, anxiety, and depression. Family and significant other support decreased perceived stress, increasing positive affect, and decreasing anxiety and depression. On the other hand, perceived stress did not mediate the relationship between friend support and positive affect, anxiety, and depression. Implications and future research directions are discussed.
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Affiliation(s)
- Evelyn F. Acoba
- Psychology, Central Luzon State University, Munoz, Philippines
- Department of Psychology, De La Salle University, Manila, Philippines
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Tao Y, Cheng Z, Wang C, Liu T, Yan M, Huang X, Jian S, Sun L, Chen Z. Perceived stress and psychological disorders in healthcare professionals: a multiple chain mediating model of effort-reward imbalance and resilience. Front Public Health 2023; 11:1320411. [PMID: 38155891 PMCID: PMC10753578 DOI: 10.3389/fpubh.2023.1320411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/01/2023] [Indexed: 12/30/2023] Open
Abstract
Background Healthcare professionals have shown more psychological disorders such as anxiety and depression due to the nature of work, which can cause job burnout, decrease the quality of medical services, and even endanger medical safety. The aim of the study is to explore the serial multiple mediating role of effort- reward imbalance and resilience between perceived stress and psychological disorders among healthcare professionals. Methods A cross-sectional study was conducted in China from February to April 2023. A total of 2098 healthcare professionals at a tertiary general hospital was investigated by the following self-reported questionnaires: Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), The Effort-Reward Imbalance (ERI), Healthcare professionals Resilience Scale (MSRS). Results Anxiety and depression are interrelated (r = 0.362, p < 0.01), and they were positively related to perceived stress (r = 0.640/0.607, p < 0.01) and ERI (r = 0.422/0.383, p < 0.01), and negatively related to resilience (r = -0.343/-0.320, p < 0.01). After controlling demographic factors, the variance in anxiety and depression was explained by perceived stress was 37.7 and 35.0%. Bootstrap analyses examining the pathway of perceived stress-ERI-resilience-anxiety revealed significant direct effects [B = 0.560, 95%CI (0.528, 0.591)], as well as indirect effects mediated independently by ERI [B = 0.045, 95%CI (0.029, 0.060)], resilience [B = 0.031, 95%CI (0.017, 0.047)], or a combination of both [B = 0.004, 95%CI (0.002, 0.007)]. Similarly, in the path of perceived stress-ERI-resilience-anxiety-depression, significant direct effects were found [B = -0.310, 95%CI(0.265, 0.351)], along with indirect effects mediated individually by ERI [B = 0.033, 95%CI(0.013, 0.052)], resilience [B = 0.014, 95%CI (0.001, 0.028)], and anxiety [B = 0.218, 95%CI (0.190, 0.246)], or by both or three together (B = 0.032). Conclusion This study proved the hypothesis that ERI and resilience played a mediating role in perceived stress and psychological disorders, revealed the potential mechanism of anxiety in stress and depression, and proposed a solution for perceived stress to psychological distress, which can provide a basis for the intervention of healthcare professionals in the face of mental health crisis.
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Affiliation(s)
- Yuanling Tao
- Health Management Centre, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zhen Cheng
- Health Management Centre, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Chenxi Wang
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Ting Liu
- Health Management Centre, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Mi Yan
- Health Management Centre, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Xiaohong Huang
- Health Management Centre, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Shasha Jian
- Health Management Centre, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Li Sun
- Health Management Centre, First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zongtao Chen
- Health Management Centre, First Affiliated Hospital of Army Medical University, Chongqing, China
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Chen G, Zhang Y, Wei Z, Zhang X, Liu J, Peng J, Xu Z, Yu C, Zhang J. The mediating role of anxiety and depression in the relationship between coping styles and life satisfaction among frontline medical workers during the COVID-19 pandemic: A cross-sectional study. IBRAIN 2023; 9:390-401. [PMID: 38680510 PMCID: PMC11045195 DOI: 10.1002/ibra.12133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/25/2023] [Accepted: 09/03/2023] [Indexed: 05/01/2024]
Abstract
This study aimed to examine the mediating role of anxiety and depression in the relationship between coping styles and life satisfaction among frontline medical workers during the COVID-19 pandemic. Five hundred and fourteen frontline medical workers from Zunyi were recruited to complete questionnaires, including the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Satisfaction with Life Scale (SWLS), and Simplified Coping Style Questionnaire (SCSQ). SPSS 24.0 was used to measure the characteristics of anxiety, depression, life satisfaction, and coping styles. We found that the prevalence rates of anxiety and depression among study participants were 22.57% and 18.29%, respectively. Besides, anxiety was positively correlated with depression; anxiety and depression were positively correlated with passive coping style but negatively correlated with life satisfaction and active coping style; life satisfaction was positively correlated with active coping style and negatively correlated with passive coping style (all p < 0.001). Moreover, anxiety and depression mediated the relationship between coping styles and life satisfaction. Anxiety accounted for 18.6% of the effect of active coping style and 35.48% of the effect of passive coping style on life satisfaction. Depression accounted for 48.84% of the effect of active coping style and 67.74% of the effect of passive coping style on life satisfaction. The present study provides novel insights into the effect of subclinical anxiety and depression on frontline medical workers in the pandemic area. Anxiety and depression yielded a mediating effect on the relationship between coping styles and life satisfaction.
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Affiliation(s)
- Gui‐Fang Chen
- Department of PsychiatryZunyi Medical UniversityZunyiGuizhouChina
| | - Ye‐Ping Zhang
- Department of PsychiatryZunyi Medical UniversityZunyiGuizhouChina
| | - Zhi‐Jie Wei
- Department of PsychiatryZunyi Medical UniversityZunyiGuizhouChina
| | - Xin‐Lan Zhang
- Department of PsychiatryZunyi Medical UniversityZunyiGuizhouChina
| | - Jun Liu
- Department of PsychiatryZunyi Medical UniversityZunyiGuizhouChina
| | - Juan Peng
- Department of PsychiatryZunyi Medical UniversityZunyiGuizhouChina
| | - Zu‐Cai Xu
- Department of NeurologyZunyi Medical UniversityZunyiGuizhouChina
| | - Chang‐Yin Yu
- Department of NeurologyZunyi Medical UniversityZunyiGuizhouChina
| | - Jun Zhang
- Department of PsychiatryZunyi Medical UniversityZunyiGuizhouChina
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Mehrotra S, Roy S. Hope, Belief in Just World and Trust in Government: An Interaction Amidst Covid-19 Pandemic in India. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231177852. [PMID: 37211995 DOI: 10.1177/00302228231177852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The outbreak of COVID 19 has brought about changes in all spheres of human life. In the present times of pandemic, human life has suffered not only from physical stresses but also encountered and endured several mental stresses. In recent times people adopted several measures to bring positivity to their life. The present study explores the relationship between- Hope, Belief in Just World, Covid -19, and Trust in the Government in India, during the Covid-19 Pandemic. Data was collected online from young adults, via Google forms, using the tools- Adult Hope scale, Covid Anxiety scale, Belief in Just world scale, and Trust in Government. Results showed a significant correlation between the three variables. Hope, Belief in Just World, and Trust in government. Regression analysis found these three variables to significantly impact Covid anxiety. Further, Belief in Just World was found to mediate the relationship between Hope and Covid anxiety. During challenging times, it is important to boost mental health in the right direction. Implications have been further discussed in the article.
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Affiliation(s)
- Sheetal Mehrotra
- Department of Applied Psychology, Pondicherry University, Pondicherry, India
| | - Shreyasi Roy
- Department of Psychology, Christ (Deemed to Be University), Bengaluru, India
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Wen J, Zou L, Wang Y, Liu Y, Li W, Liu Z, Ma Q, Fei Y, Mao J, Fu W. The relationship between personal-job fit and physical and mental health among medical staff during the two years after COVID-19 pandemic: Emotional labor and burnout as mediators. J Affect Disord 2023; 327:416-424. [PMID: 36758870 PMCID: PMC9907793 DOI: 10.1016/j.jad.2023.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND In the context of the Corona Virus Disease 2019 (COVID-19) pandemic, research on personal-job fit and physical and mental health was inadequate. We aimed to explore the relationship between personal-job fit and physical and mental health among medical staff during the two years after COVID-19 pandemic and verify emotional labor and burnout as mediators. METHODS A total of 2868 medical staff from two general hospitals, were included from July 3 to July 27, 2022, in Wuhan, China. SPSS was used for statistical description, and AMOS was used for structural equation modeling (SEM) to analyze the mediating effect of emotional labor and burnout. RESULTS In the SEM, the total effect of personal-job fit on physical and mental health was significant (β = 0.855, 95 % CI: 0.748-0.972). The mediating effect of surface acting between personal-job fit and physical and mental health was significant (β = 0.078, 95 % CI: 0.053-0.110). The mediating effect of burnout was significant (β = 0.220, 95 % CI: 0.175-0.274), but the mediating effect of deep acting was not significant (β = 0.006, 95 % CI: -0.013-0.025). The chain mediating effect of surface acting or deep acting and burnout between personal-job fit and physical and mental health was significant (β = 0.082, 95 % CI: 0.059-0.108; β = 0.049, 95 % CI: 0.038-0.063). LIMITATIONS Owing to the cross-sectional study, causal relationship, and direction of effects among variables could not be determined. CONCLUSIONS Personal-job fit has significant direct and indirect effects on physical and mental health. Monitoring and intervening in personal-job fit, emotional labor, and burnout might be effective ways to promoting physical and mental health among medical staff during the COVID-19 pandemic.
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Affiliation(s)
- Jing Wen
- School of nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Li Zou
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Ying Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yifang Liu
- School of nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wenjing Li
- School of nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zewei Liu
- School of nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Qian Ma
- School of nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yang Fei
- School of nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jing Mao
- School of nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Wenning Fu
- School of nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Dela Cruz IC, Agpaoa DCM, Archeta MBB, Paris JGH, Simon PD. Hope and depression among pandemic graduates. ASIA PACIFIC JOURNAL OF COUNSELLING AND PSYCHOTHERAPY 2023. [DOI: 10.1080/21507686.2023.2192952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Kotera Y, Liu G, Colman R, Young H, Ozaki A, Miyatake H, Kosaka M, Tanimoto T. A longitudinal study of mental health in healthcare workers in Japan during the initial phase of COVID-19 pandemic: comparison with the general population. CURRENT PSYCHOLOGY 2023:1-4. [PMID: 37359617 PMCID: PMC9999062 DOI: 10.1007/s12144-023-04444-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/12/2023]
Abstract
The COVID-19 pandemic negatively impacted the mental health of people in Japan. Healthcare workers (HCWs) especially suffered from poor mental health, engaging with COVID-19 patients while protecting themselves from infection. However, a long-term assessment of their mental health in comparison to the general population remains to be conducted. This study evaluated and compared changes in mental health between these two populations over a six-month period. Measures of mental health, loneliness, hope and self-compassion were completed at baseline and at six-month follow-up. Two-way MANOVA (Time x Group) identified that no interaction effects were present. However, at baseline, HCWs had higher levels of mental health problems and loneliness, and lower levels of hope and self-compassion than the general population. Furthermore, a higher level of loneliness was found in HCWs at six months. These findings highlight strong feelings of loneliness in HCWs in Japan. Interventions such as digital social prescribing are recommended.
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Affiliation(s)
- Yasuhiro Kotera
- Faculty of Medicine & Health Sciences, University of Nottingham, NG7 2TU Nottingham, UK
| | - Gillian Liu
- College of Health, Psychology & Social Care, University of Derby, DE22 1GB Derby, UK
| | - Rory Colman
- College of Health, Psychology & Social Care, University of Derby, DE22 1GB Derby, UK
| | - Holly Young
- College of Health, Psychology & Social Care, University of Derby, DE22 1GB Derby, UK
| | - Akihiko Ozaki
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, 972-8322 Iwaki, Japan
- Medical Governance Research Institute, 108-0074 Tokyo, Japan
| | | | | | - Tetsuya Tanimoto
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, 972-8322 Iwaki, Japan
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Dizon JIWT, Mendoza NB, Nalipay MJN. Anxiety and well-being amidst the COVID-19 outbreak and the moderating role of locus-of-hope: Evidence from a large sample in the Philippines. JOURNAL OF PACIFIC RIM PSYCHOLOGY 2023. [DOI: 10.1177/18344909231156532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
The COVID-19 pandemic has placed a heavy psychological burden on the lives of many individuals and created a rise in the prevalence of anxiety, which could be detrimental to people's well-being. Nevertheless, there have also been reports about having hope in overcoming the challenges brought about by the pandemic. The study intended to find out whether the different locus-of-hope dimensions (internal, family, peers, and spiritual locus-of-hope) would moderate the impact of anxiety symptoms on well-being (psychological, social, and emotional well-being). A nationwide survey was conducted among Filipino adults ( N = 10,529). Results showed that anxiety symptoms were negatively associated with psychological, social, and emotional well-being. Moderation analyses show that internal, family, and spiritual locus-of-hope buffered the negative effect of anxiety symptoms on specific well-being outcomes, whereas peer locus-of hope did not. The study demonstrates the importance of hope as a viable resource in facilitating an individual's well-being amid adverse and uncertain circumstances, such as the COVID-19 pandemic.
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Subjective sleep alterations in healthy subjects worldwide during COVID-19 pandemic: A systematic review, meta-analysis and meta-regression. Sleep Med 2022; 100:89-102. [PMID: 36029756 PMCID: PMC9364714 DOI: 10.1016/j.sleep.2022.07.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/04/2022] [Accepted: 07/18/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE We conducted a systematic review and meta-analysis to provide an update on sleep quality in different world areas and better characterize subjective sleep alterations during the COVID-19 pandemic. Considering gender distribution and specific pandemic-related parameters, we also intend to identify significant predictors of sleep problems. METHODS Six electronic databases were searched from December 2019 to November 2021 for studies investigating sleep during COVID-19 employing the Pittsburgh Sleep Quality Index, the Medical Outcomes Study Sleep, the Insomnia Severity Index or the Epworth Sleepiness Scale. Random-effects models were implemented to estimate the pooled raw means of subjective sleep alterations. Also, we considered the role of several pandemic-related parameters (i.e., days from the first COVID-19 case, government stringency index, new cases for a million people, new deaths for a million people) by means of meta-regression analyses. RESULTS A total of 139 studies were selected. The pooled mean of the global Pittsburgh Sleep Quality Index score (PSQIgen) was 6.73 (95% CI, 6.61-6.85). The insomnia severity index score was reported from 50 studies with a pooled mean of 8.44 (95% CI, 7.53-9.26). Subgroup analyses confirmed that most subcategories had poor sleep quality and subclinical insomnia. Meta-regressions showed that PSQIgen was predicted by days from the first COVID-19 case and government restrictions with a negative slope and by female gender with a positive slope. The government stringency index was positively correlated with the direct subjective evaluation of sleep quality. CONCLUSIONS We found an overall impaired sleep and widespread subthreshold insomnia during the COVID-19 pandemic. The female percentage seems to be the best predictor of impaired sleep quality, consistently to the available literature. Noteworthy, sleep alterations were inversely associated with governmental restrictions and decreased during the pandemic. Our results give a contribution to critically orienting further studies on sleep since COVID-19 pandemic.
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Makhfudli M, Machin A, Nasir A, Wahyudi AS, Harianto S, Rindayati R, Muhalla HI, Sulpat E, Okviasanti F, Susanto J, Ilkafah I, Kartini Y. Understanding Patients with COVID in the Isolation Rooms from the Perspective of Care: A Qualitative Study. J Multidiscip Healthc 2022; 15:2539-2551. [PMID: 36388629 PMCID: PMC9642087 DOI: 10.2147/jmdh.s386066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/17/2022] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Being treated in isolation rooms for people infected with COVID-19, creates various perceptions of uncertainty, especially when strict "health protocols" are applied. This study aims to determine the understanding patients with COVID in the intensive care unit from the perspective of care. MATERIALS AND METHODS The research design used phenomenological qualitative with in-depth interviews. Purposive sampling was used with interpretive phenomenological analysis. Participants were 25 patients who had been exposed to COVID-19, consisting of 10 men and 15 women. RESULTS This study resulted in the theme of the perception of COVID-19 sufferers while undergoing treatment in isolation rooms, with four themes, namely, 1) mental attacks, 2) feel like fighting alone, 3) expecting Concern, 4) positive attitude. CONCLUSION This analysis shows that various perceptions of uncertainty that are felt while being treated in the isolation room due to suffering from COVID-19 disease can be anticipated by increasing the awareness of nurses to be closer to patients through caring-based nursing practices by emphasizing meaningful interpersonal relationships.
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Affiliation(s)
| | - Abdulloh Machin
- Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Abd Nasir
- Faculty of Nursing, Airlangga University, Surabaya, Indonesia
- Faculty of Vocational, Airlangga University, Surabaya, Indonesia
| | | | - Susilo Harianto
- Faculty of Nursing, Airlangga University, Surabaya, Indonesia
- Faculty of Vocational, Airlangga University, Surabaya, Indonesia
| | - Rindayati Rindayati
- Faculty of Nursing, Airlangga University, Surabaya, Indonesia
- Faculty of Vocational, Airlangga University, Surabaya, Indonesia
| | - Hafna Ilmy Muhalla
- Faculty of Nursing, Airlangga University, Surabaya, Indonesia
- Faculty of Vocational, Airlangga University, Surabaya, Indonesia
| | - Emuliana Sulpat
- Faculty of Nursing, Airlangga University, Surabaya, Indonesia
- Faculty of Vocational, Airlangga University, Surabaya, Indonesia
| | - Fanni Okviasanti
- Faculty of Nursing, Airlangga University, Surabaya, Indonesia
- Faculty of Vocational, Airlangga University, Surabaya, Indonesia
| | - Joko Susanto
- Faculty of Nursing, Airlangga University, Surabaya, Indonesia
- Faculty of Vocational, Airlangga University, Surabaya, Indonesia
| | - Ilkafah Ilkafah
- Faculty of Vocational, Airlangga University, Surabaya, Indonesia
| | - Yanis Kartini
- Department of Nursing, and Midwifery Faculty, Universitas Nahdlatul Ulama Surabaya, East Java, Indonesia
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Tee EYJ, Shah RIABRR, Ramis T, Jia-Qi LC. Bent, But Not Broken: Locus-of-Hope and Well-Being Among Malaysians Facing Economic Challenges Amidst the COVID-19 Pandemic. PSYCHOLOGICAL STUDIES 2022; 67:304-316. [PMID: 35601659 PMCID: PMC9110276 DOI: 10.1007/s12646-022-00653-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 02/17/2022] [Indexed: 11/30/2022] Open
Abstract
Hope is conceptualized as a cognitive set that has often been studied in the context of adversity. No studies, however, directly examine how locus-of-hope (LOH) influences psychological outcomes among vulnerable populations within collectivist cultural contexts. We address this gap by assessing the relationships between LOH and well-being among Malaysians facing financial struggles during the COVID-19 pandemic. We hypothesized that LOH will predict well-being but that external LOH will more strongly predict well-being than internal LOH. One-hundred and fifty-two (152) Malaysians (63 men, 89 women, average age 29.69 years old) who have (1) experienced loss of employment status (2) decrease in salary earnings or (3) earn below the lower 40% threshold of national household incomes completed a series of questionnaires assessing their LOH and well-being. Results indicate that controlling for age, perceptions of government efforts and trait optimism, LOH significantly predict well-being. Findings also show that internal LOH and LOH-family were the strongest predictors of well-being. Theoretical and practical implications are discussed in light of these findings.
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Affiliation(s)
- Eugene Y. J. Tee
- Department of Psychology, Faculty of Behavioural Sciences, Languages, and Education, HELP University, Kuala Lumpur, Malaysia
| | | | - TamilSelvan Ramis
- Centre for American Education, Sunway University, Petaling Jaya, Malaysia
| | - Lauren Chai Jia-Qi
- Department of Psychology, Faculty of Behavioural Sciences, Languages, and Education, HELP University, Kuala Lumpur, Malaysia
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Jahrami HA, Alhaj OA, Humood AM, Alenezi AF, Fekih-Romdhane F, AlRasheed MM, Saif ZQ, Bragazzi NL, Pandi-Perumal SR, BaHammam AS, Vitiello MV. Sleep disturbances during the COVID-19 pandemic: A systematic review, meta-analysis, and meta-regression. Sleep Med Rev 2022; 62:101591. [PMID: 35131664 PMCID: PMC8782754 DOI: 10.1016/j.smrv.2022.101591] [Citation(s) in RCA: 147] [Impact Index Per Article: 73.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/15/2021] [Accepted: 01/11/2022] [Indexed: 02/07/2023]
Abstract
This systematic review and meta-analysis evaluated the extent of sleep disturbances during the COVID-19 pandemic. Eleven databases and six preprint repositories were searched for the period from November 1, 2019, to July 15, 2021. The DerSimonian and Laird method was used to develop random-effect meta-analyses. Two hundred and fifty studies comprising 493,475 participants from 49 countries were included. During COVID-19, the estimated global prevalence of sleep disturbances was 40.49% [37.56; 43.48%]. Bayesian meta-analysis revealed an odds of 0.68 [0.59; 0.77] which translates to a rate of approximately 41%. This provides reassurance that the estimated rate using classical meta-analysis is robust. Six major populations were identified; the estimated prevalence of sleep problem was 52.39% [41.69; 62.88%] among patients infected with COVID-19, 45.96% [36.90; 55.30%] among children and adolescents, 42.47% [37.95; 47.12%] among healthcare workers, 41.50% [32.98; 50.56%] among special populations with healthcare needs, 41.16% [28.76; 54.79%] among university students, and 36.73% [32.32; 41.38%] among the general population. Sleep disturbances were higher during lockdown compared to no lockdown, 42.49% versus 37.97%. Four in every ten individuals reported a sleep problem during the COVID-19 pandemic. Patients infected with the disease, children, and adolescents appeared to be the most affected groups.
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Affiliation(s)
- Haitham A Jahrami
- Ministry of Health, Bahrain; College of Medicine and Medical Sciences, Arabian Gulf University, Bahrain.
| | - Omar A Alhaj
- Department of Nutrition, Faculty of Pharmacy and Medical Science, University of Petra, Amman, Jordan
| | - Ali M Humood
- College of Medicine and Medical Sciences, Arabian Gulf University, Bahrain
| | - Ahmad F Alenezi
- College of Medicine and Medical Sciences, Arabian Gulf University, Bahrain
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Psychiatry Department "Ibn Omrane", Tunisia; Tunis El Manar University, Faculty of Medicine of Tunis, Tunisia
| | - Maha M AlRasheed
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | | | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, Canada
| | - Seithikurippu R Pandi-Perumal
- Somnogen Canada Inc., College Street, Toronto, Canada; Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India
| | - Ahmed S BaHammam
- Department of Medicine, College of Medicine, University Sleep Disorders Center, King Saud University, Saudi Arabia; The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
| | - Michael V Vitiello
- Psychiatry & Behavioral Sciences, Gerontology & Geriatric Medicine, and Biobehavioral Nursing, University of Washington, Seattle, WA 98195-6560, United States
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Zhang M, Wu Y, Ji C, Wu J. The Role of Perceived Social Support and Stress in the Relationship between Hope and Depression among Chinese Shadow Education Tutors: A Serial Mediation Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3348. [PMID: 35329036 PMCID: PMC8951324 DOI: 10.3390/ijerph19063348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 02/06/2023]
Abstract
The association between hope and depression has been studied, leaving the underlying mechanism of how hope might predict depression unexplored. With a cross-sectional design, this study investigated two possible mediating factors in the relationship between hope and depression among Chinese shadow education tutors, who confront a high turnover rate and are at high risk for depression. Altogether, 221 tutors participated in the survey, and reported their dispositional hope, perceived social support (PSS), perceived stress (PS), and depression. Results indicated that both PSS and PS mediated the relationship between hope and depression. Results also supported the hypothesized serial mediating effect. In other words, hope as a positive disposition may promote PSS, which can mitigate PS. The reduced PS, in turn, alleviates depression. This finding not only shed light on the independent and accumulative mediating effects of PSS and PS, but also has implications for preventive interventions among Chinese shadow education tutors experiencing the enormous pressure of instability. This serial mediation model should be confirmed by further longitudinal study.
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Affiliation(s)
- Mohan Zhang
- Jing Hengyi School of Education, Hangzhou Normal University, Hangzhou 311121, China; (M.Z.); (J.W.)
| | - Yunpeng Wu
- School of Teacher Education, Dezhou University, Dezhou 253023, China
| | - Chengjun Ji
- Jing Hengyi School of Education, Hangzhou Normal University, Hangzhou 311121, China; (M.Z.); (J.W.)
| | - Jianfen Wu
- Jing Hengyi School of Education, Hangzhou Normal University, Hangzhou 311121, China; (M.Z.); (J.W.)
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Ramos SDA, Bernardo ABI. Unboxing the therapeutic community for addictions: a locus-of-hope theory perspective. THERAPEUTIC COMMUNITIES 2022. [DOI: 10.1108/tc-03-2021-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The therapeutic community (TC) is a widely used treatment approach for substance use disorders. Several psychological theories have been used to explain its processes but have put less emphasis on the specific contributions of the person’s cognitive resources. This paper aims to offer a theoretical conceptualization using the locus-of-hope theory which expounds on the person’s goal-directed thinking and how it bolsters the TC process.
Design/methodology/approach
This paper reviewed contemporary theoretical perspectives on TCs and studies on locus-of-hope theory to provide arguments for locus-of-hope’s utility in understanding TCs. From this review, this paper discusses a formal conceptualization of TCs using the locus-of-hope model.
Findings
In this conceptualization, the authors explained that the TC becomes a co-agent in the person’s goal-pursuit by strengthening the individual’s beliefs regarding one’s capability to develop goals together with the will and strategies to attain these important recovery goals. The person’s hopeful thinking boosts the TC protocols in a dynamic fashion.
Originality/value
This paper offers a locus-of-hope perspective that considers the person’s contributions in bolstering the TC process. Reflections on clinical and research implications were provided. This paper aids further in unboxing of the TC.
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E. Kalaitzaki A, Tsouvelas G, Tamiolaki A, Konstantakopoulos G. Post-traumatic stress symptoms during the first and second COVID-19 lockdown in Greece: Rates, risk, and protective factors. Int J Ment Health Nurs 2022; 31:153-166. [PMID: 34658113 PMCID: PMC8652774 DOI: 10.1111/inm.12945] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/24/2021] [Accepted: 10/05/2021] [Indexed: 01/25/2023]
Abstract
The aim was to (i) compare the rates of perceived stress, post-traumatic stress symptoms (PTSS) and other potential correlates (i.e., resilience, social support, coping strategies, and loneliness) in the general population between the two COVID-19 lockdowns in Greece and (ii) explore risk and protective factors of PTSS. Online data were collected amid the first (timepoint 1-T1) and second lockdown (timepoint 2-T2) by 1009 and 352 participants, respectively. The PTSD Checklist for DSM-5 and the Perceived Stress Scale measured levels of PTSS and perceived stress. The Brief Resilience Scale, the COPE, the revised UCLA Loneliness Scale, and the ENRICHD Social Support Instrument measured resilience, coping strategies, loneliness, and social support, respectively. Higher levels of PTSS and perceived stress were reported during T2, compared to T1. Clinically significant levels of PTSS were presented by 26.1% and 35.5% of the participants during T1 and T2, respectively. Higher levels of loneliness and use of maladaptive coping strategies and lower levels of social support, resilience and use of adaptive coping strategies were also found. During both lockdowns, PTSS were predicted by perceived stress, loneliness, reduced resilience and the coping strategies of denial and self-blame. PTSS were associated with younger age, female gender, being single, not having children, and the evaluation of the pandemic as a crisis. The findings highlight the significant public mental health concerns during the COVID-19 lockdowns. Understanding the risk and protective factors against PTSS and focusing on vulnerable populations should be prioritized by the governments worldwide in the development of evidence-based interventions.
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Affiliation(s)
- Argyroula E. Kalaitzaki
- Department of Social WorkLaboratory of Interdisciplinary Approaches to the Enhancement of Quality of LifeHealth Sciences FacultyUniversity Research Centre ‘Institute of AgriFood and Life Sciences’Hellenic Mediterranean UniversityHeraklionGreece
| | - George Tsouvelas
- Department of NursingUniversity of West AtticaAigaleoGreece
- Laboratory of Interdisciplinary Approaches for the Enhancement of Quality of LifeHellenic Mediterranean UniversityHeraklionGreece
| | - Alexandra Tamiolaki
- Department of Social WorkLaboratory of Interdisciplinary Approaches to the Enhancement of Quality of LifeHealth Sciences FacultyHellenic Mediterranean UniversityHeraklionGreece
| | - George Konstantakopoulos
- Department of PsychiatryNational and Kapodistrian University of AthensEginition HospitalAthensGreece
- Department of Clinical, Education and Health PsychologyUniversity College LondonLondonUK
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Sánchez-Sánchez E, Díaz-Jimenez J, Rosety I, Alférez MJM, Díaz AJ, Rosety MA, Ordonez FJ, Rosety-Rodriguez M. Perceived Stress and Increased Food Consumption during the 'Third Wave' of the COVID-19 Pandemic in Spain. Nutrients 2021; 13:2380. [PMID: 34371889 PMCID: PMC8308749 DOI: 10.3390/nu13072380] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 12/11/2022] Open
Abstract
The COVID-19 pandemic has impacted the mental health of people worldwide. An increase in perceived stress can lead to unhealthy behaviors such as increased food consumption. The aim of this study was to find the level of perceived stress and its relationship with increased food consumption during the "third wave" of the COVID-19 pandemic in Spain. This was a cross-sectional study that employed anonline self-reported frequency of consumption questionnaire and the Perceived Stress Scale-10. A total of 637 subjects participated and 83.6% of respondents had moderate or high stress-more prevalent in the female and young respondents. Moreover, 36.1% of respondents reported that they had increased the frequency of consumption of some foods, mainly nuts, snacks, and jellybeans, along with coffee, tea, cocoa, and soft drinks. Eating between meals was more pronounced in those with high stress (65.1%) than in those with moderate stress (40.4%) and low stress (20.2%). Furthermore, the respondents with high stress reported greater weight gain. Thus, the results show that the level of perceived stress during the 'third wave' of this pandemic increased food consumption.
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Affiliation(s)
- Eduardo Sánchez-Sánchez
- Internal Medicine Department, Punta de Europa Hospital, Algeciras, 11207 Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Hospital Universitario Puerta del Mar, Universidad de Cádiz, 11009 Cádiz, Spain
| | - Jara Díaz-Jimenez
- Campus Cádiz, Doctoral School of the University of Cádiz (EDUCA), Edificio Hospital Real (PrimeraPlanta), Plaza Falla 8, 11003 Cádiz, Spain;
| | - Ignacio Rosety
- Human Anatomy, School of Medicine, University of Cádiz, Plaza Fragela, s/n, 11003 Cadiz, Spain; (I.R.); (F.J.O.)
| | - Maria José M. Alférez
- Department of Physiology, Faculty of Pharmacy, Campus Universitario de Cartuja, University of Granada, 18011 Granada, Spain;
| | - Antonio Jesús Díaz
- Medicine Department, School of Nursing, University of Cadiz, Plaza Fragela, s/n, 11003 Cadiz, Spain;
| | - Miguel Angel Rosety
- Move-It Research Group, Biomedical Research and Innovation Institute of Cadiz, Puerta del Mar University Hospital, University of Cádiz, Plaza Fragela, s/n, 11003 Cadiz, Spain;
| | - Francisco Javier Ordonez
- Human Anatomy, School of Medicine, University of Cádiz, Plaza Fragela, s/n, 11003 Cadiz, Spain; (I.R.); (F.J.O.)
| | - Manuel Rosety-Rodriguez
- Medicine Department, School of Medicine, University of Cádiz, Plaza Fragela, s/n, 11003 Cadiz, Spain;
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Alimoradi Z, Broström A, Tsang HW, Griffiths MD, Haghayegh S, Ohayon MM, Lin CY, Pakpour AH. Sleep problems during COVID-19 pandemic and its' association to psychological distress: A systematic review and meta-analysis. EClinicalMedicine 2021; 36:100916. [PMID: 34131640 PMCID: PMC8192091 DOI: 10.1016/j.eclinm.2021.100916] [Citation(s) in RCA: 191] [Impact Index Per Article: 63.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The emerging novel coronavirus disease 2019 (COVID-19) has become one of the leading cause of deaths worldwide in 2020. The present systematic review and meta-analysis estimated the magnitude of sleep problems during the COVID-19 pandemic and its relationship with psychological distress. METHODS Five academic databases (Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, and Embase) were searched. Observational studies including case-control studies and cross-sectional studies were included if relevant data relationships were reported (i.e., sleep assessed utilizing the Pittsburgh Sleep Quality Index or Insomnia Severity Index). All the studies were English, peer-reviewed papers published between December 2019 and February 2021. PROSPERO registration number: CRD42020181644. FINDINGS 168 cross-sectional, four case-control, and five longitudinal design papers comprising 345,270 participants from 39 countries were identified. The corrected pooled estimated prevalence of sleep problems were 31% among healthcare professionals, 18% among the general population, and 57% among COVID-19 patients (all p-values < 0.05). Sleep problems were associated with depression among healthcare professionals, the general population, and COVID-19 patients, with Fisher's Z scores of -0.28, -0.30, and -0.36, respectively. Sleep problems were positively (and moderately) associated with anxiety among healthcare professionals, the general population, and COVID-19 patients, with Fisher's z scores of 0.55, 0.48, and 0.49, respectively. INTERPRETATION Sleep problems appear to have been common during the ongoing COVID-19 pandemic. Moreover, sleep problems were found to be associated with higher levels of psychological distress. With the use of effective programs treating sleep problems, psychological distress may be reduced. Vice versa, the use of effective programs treating psychological distress, sleep problems may be reduced. FUNDING The present study received no funding.
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Affiliation(s)
- Zainab Alimoradi
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Anders Broström
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
| | - Hector W.H. Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Mark D. Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Shahab Haghayegh
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Maurice M. Ohayon
- Stanford Sleep Epidemiology Research Center (SSERC), School of Medicine, Stanford University, CA, USA
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University
| | - Amir H. Pakpour
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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