Relationship of Anxiety and Depression with Respiratory Symptoms: Comparison between Depressed and Non-Depressed Smokers in Singapore

Mother's psychopathological conditions and parenting characteristics according to smoke exposure

The study aims to investigate the relationship between maternal smoking and smoke exposure with the mother's parenting attitude and psychopathological conditions in the absence of any health problems in the mother-child pairs. A descriptive form consisting of 27 questions, a "Parental Attitude Scale", and a "Depression, Anxiety, and Stress Scale" was applied by mothers with children aged 2 to 6 years. Of the 450 voluntary mothers included in the study, 107 (23.8%) had environmental smoke exposure and 69 (15.0%) were smokers. The highest quartile of democratic subscores was associated with maternal smoking and smoke exposure when confounding factors were controlled. Compared to non-smokers and unexposed, the adjusted odds ratio of having abnormal anxiety scale subscores was 3.90 [95% CI: 1.69-8.97] for smokers. When parenting types were included, mothers' smoking status and overprotective subscores were found to be associated with anxiety. There is an interaction among mothers' smoking, parenting types, and anxiety scores.

Association between 14 candidate genes, PM2.5, and affective disorders: a study of the Taiwan Biobank

BACKGROUND

Most studies have focused on the risk factors, treatment, and care of affective psychosis, and several have reported a relationship between ambient air quality and this psychosis. Although an association has been reported between psychosis and genes, studies mainly explored the associations between one type of psychosis and one gene; few have identified genes related to affective psychosis. This study investigates the genetic and environmental factors of affective psychosis.

METHODS

In this retrospective longitudinal study, 27 604 participants aged 30-70 were selected from Taiwan Biobank. The participants' propensity scores were calculated based on their demographic information, and propensity score matching was performed to divide the participants into an experimental (i.e., affective psychosis) and control group at a 1:5 ratio. Plink was used to analyze the major and minor types of gene expression related to affective psychosis, and PM2.5 exposure was incorporated into the analyses.

RESULTS

According to the generalized estimating equation analysis results, 8 single nucleotide polymorphisms (SNPs) belonging to the ANK3, BDNF, CACNA1C, and GRID1 genotypes were significantly correlated with depressive disorder (P < .001), with the majority belonging to the ANK3 and CACNA1C. A total of 5 SNPs belonging to the CACNA1C, GRID1, and SIRT1 genotypes were significantly correlated with bipolar disorder (P < .001), with the majority belonging to the CACNA1C. No significant correlation was identified between ambient air pollution and affective psychosis.

CONCLUSIONS

CACNA1C and GRID1 are common SNP genotypes for depressive disorder and bipolar disorder and should be considered associated with affective psychosis.

Entrepreneurial intention and the three stages of entrepreneurial action: a process approach

The relationship between entrepreneurial intention (EI) and entrepreneurial action (EA) is a popular topic in entrepreneurship research, owing to the contribution of these constructs in the process leading to the entrepreneurial activity taking place. There are still countries that are recording high entrepreneurial intention levels in comparison to their corresponding entrepreneurial action levels that are low. This is a global concern to which South Africa (SA) is also not immune. Most of the research tests the relationship between two single constructs: EI and EA. Our study follows a process approach and investigates the effect of this relationship between EI and the three stages of EA. A quantitative method was employed and a survey utilized whereby data was collected among 597 entrepreneurs in South Africa. The data was analyzed through Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM). The EI construct is supported through the Theory of Planned Behavior, in conjunction with the Motivation Opportunity Ability theory. The Discovery Theory, together with the Creative Theory, supports each of the stages of EA, namely: entrepreneurial opportunity discovery (EODI); entrepreneurial opportunity evaluation (EOEV); and entrepreneurial opportunity exploitation (EOEX). Previous research regarding the relationship between EI and EA measured this relationship from a binary point of view. This study contributes to the entrepreneurship field by employing the process approach to determine the impact of EI on the stages of EA. This study reveals that EI is statistically significant in all three stages of EA. However, the strength of this relationship is found to be strong between EI and the EODI and EOEV stages and moderate between EI and the EOEX stage. Therefore, this study reveals that effective training interventions and development are necessary between EI and the EOEX stage of EA.

Effect of body image perception and skin-lightening practices on mental health of Filipino emerging adults: a mixed-methods approach protocol

INTRODUCTION

The rampant distribution of idealised images on the internet may lead the general public to improve their body appearance in a way that is sometimes excessive, compulsive or detrimental to other aspects of their lives. There is a decreasing appreciation of body image among emerging adults and an increasing trend on skin-lightening practices linked with psychological distress. This protocol describes the mixed-method approach to assess the relationships among body image perception, skin-lightening practices and mental well-being of Filipino emerging adults and determine the factors that influence them.

METHODS AND ANALYSIS

An explanatory sequential mixed-method approach will be used. A cross-sectional study design will involve an online self-administered questionnaire of 1258 participants, while a case study design will involve in-depth interviews with 25 participants. Data analysis will use generalised linear models and structural equation modelling with a Bayesian network for the quantitative data. Moreover, the qualitative data will use an inductive approach in thematic analysis. A contiguous narrative approach will integrate the quantitative and qualitative data.

ETHICS AND DISSEMINATION

The University of the Philippines Manila Review Ethics Board has approved this protocol (UPMREB 2022-0407-01). The study results will be disseminated through peer-reviewed articles and conference presentations.

Mental Health Conditions of Chinese International Students and Associated Predictors Amidst the Pandemic

The current study aims to examine the mental health conditions and the associated predictors among Chinese international students. A sample of 256 Chinese international students aged 16 or above living primarily in Canada were asked to complete an online survey. Mental health conditions were assessed with the Depression, Anxiety, and Stress Scale-21 and the Physical and Mental Health Summary Scales. 15.3%, 20.4%, and 10.5% of respondents reported severe to extremely severe depression, anxiety, and stress levels, respectively. Univariate analysis of variance models and multiple linear regression models identified education and financial status as significant sociodemographic predictors while controlling for the effect of physical health status. Higher financial status and lower level of education were associated with better mental health conditions. These findings shed light on our understanding of mental health conditions and the risk factors among Chinese international students during the COVID-19 pandemic.

The Relationship between Job Satisfaction and Depressive Symptoms among Chinese Adults Aged 35-60 Years: The Mediating Role of Subjective Well-Being and Life Satisfaction

The purpose of this study was to assess the serial multiple mediating effects of subjective well-being and life satisfaction between job satisfaction and depressive symptoms among Chinese adults aged 35-60 years. According to the 2018 China Family Panel Study (CFPS), we finally selected 10,609 respondents (5202 females, and 5407 males) aged 35-60 years old as samples for the study. Correlation analysis was carried out to examine the relationship among job satisfaction, subjective well-being, life satisfaction, and depressive symptoms. Linear regression models were established to analyze the relationship between job satisfaction and depressive symptoms. Serial multiple mediation analysis was conducted by the SPSS macro PROCESS program. The results suggested that job satisfaction was negatively correlated with depressive symptoms among Chinese adults aged 35-60 years. Subjective well-being and life satisfaction mediated the relationships between them, respectively. Furthermore, job satisfaction also had indirect impacts on depressive symptoms through the serial mediating effects of subjective well-being and life satisfaction. The findings revealed that increasing job satisfaction could decrease depressive symptoms through promoting subjective well-being and life satisfaction. The study may offer some meaningful implications for improving the mental health and reducing the risk of depressive symptoms among Chinese adults aged 35-60 years.

Psychological challenges and related factors of ordinary residents after "7.20" heavy rainstorm disaster in Zhengzhou: a cross-sectional survey and study

BACKGROUND

In 2021, a once-in-a-century heavy rainstorm suddenly attacked Zhengzhou, an important inland city in northern China. However, there have been no studies on the psychological health of disaster-stricken residents. This study is the first to comprehensively report on the mental health status and related factors of local ordinary residents after the heavy rainstorm.

OBJECTIVE

The purpose of this study is to investigate the mental health status and related influencing factors of local ordinary residents after the flood disaster, and to provide reference for government departments to formulate disaster psychological intervention countermeasures based on evidence-driven strategies.

METHODS

The snowball sampling technique was used in this study, and measurement tools of Rainstorm Exposure Questionnaire, Subjective Perception of Rainstorm, Post-Traumatic Stress Disorder Checklist-Civilian version (PCL-C), Depression, Anxiety and Stress Scale-21 (DAS-21) and Chinese version of Social Support Rating Scale (SSRS) were used to evaluate the rainstorm exposure, subjective perception of the rainstorm, psychological symptoms and social support of the disaster-stricken residents within a week after the rainstorm. Logistic regression analysis was used to examine the psychological status and related factors of local residents after the rainstorm disaster.

RESULTS

A total of 469 valid samples were obtained in this study. All the subjects were in the disaster area and experienced the rainstorm personally, with normal intelligence. The statistical results showed that 25.37% people had experienced at least three rainstorm-related stresses, nearly 20.26% people had post-traumatic stress disorder (PTSD) symptoms, and 39.3%, 53.92% and 65.83% people had depression, anxiety and stress symptoms, respectively. Multivariable logistic regression analyses indicated that female (all p < 0.05), the divorced, agricultural workers/farmers (all p < 0.05), students (all p < 0.05), people experiencing at least three rainstorm-related stresses (p < 0.05 or p < 0.01), people with lower satisfaction at the social flood fighting measures (p < 0.05 or p < 0.01) and people with low social support (p < 0.05 or p < 0.01) were all independent risk factors for poor psychological health, and college education or above (p < 0.05 or p < 0.01), the lower degree of worrying about themselves (all p < 0.01), family members (all p < 0.01) and family property (all p < 0.01) were all related to higher psychological health among flood survivors after the disaster.

CONCLUSIONS

Rainstorm could cause local residents to have various degrees of psychological symptoms. This study identified factors associated with the psychological health of disaster-stricken residents, which could be used to develop psychological interventions in improving psychological health of local residents.

The Pandemic COVID-19 and Its Impact on Indian Agricultural Sectors

The outbreak of COVID-19 has created a major panic among the agricultural sectors as well as the farmers in India owing to its’ transmissions, severity, and a lack of proper treatment methodology. From the cross-sectional study with the help of designed questionnaire relating to the “demographic-information”, ”knowledge, attitudes and practices” of Indian farmers and “DASS-21 variables”, the data from 143 farmers’ were collected and analyzed. Further, by using the "Interpretive Structural Modeling (ISM)" approach, an ISM model was developed followed by MICMAC analysis for possible mitigation measures during this pandemic outbreak. The findings provided the interrelationships among the possible mitigation measures for the farmers as well as for the benefits in Indian agricultures, which can be suitably used in appropriate psychological-interventions preparation for improving the mental-health among the farmers during this pandemic period.

Focal points of preanesthesia evaluations for electroconvulsive therapy in patients with depression: a retrospective analysis of clinical characteristics in nonremission

Background

This study explored the patient clinical characteristics that may affect electroconvulsive therapy (ECT) efficacy to enable improved focus during evaluations and preparation for ECT.

Methods

Patients were enrolled for ECT at the Department of Psychiatry and Anesthesiology of the First Affiliated Hospital of Chongqing Medical University from December 2017 to January 2019. The primary outcome in our study was defined as the development of nonremission. A multivariate logistic analysis was performed to identify the risk factors for nonremission.

Results

In total, 874 depressed patients were included in the study. After the ECT treatment, 255 cases (29.2%) exhibited nonremission. A multivariate logistic regression analysis of the variables was performed, and the results showed that atherosclerosis (OR 8.072, 95% CI 2.442 to 16.675; P = 0.001), COPD (OR 2.919, 95% CI 1.240 to 6.871; P = 0.014), diabetes (OR 2.202, 95% CI 1.115 to 4.348; P = 0.023) and smoking (OR 1.519, 95% CI 1.015 to 2.273; P = 0.042) were independent risk factors for nonremission.

Conclusion

In the retrospective analysis, we found that atherosclerosis, diabetes, COPD and smoking may be high-risk factors for nonremission.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12871-022-01686-6.

Mental health status of married women during COVID-19 pandemic in Bangladesh: A cross-sectional study

Aim

The uncontrolled spread of COVID-19 has demanded unparalleled measures, from the imposition of quarantine to the declaration as a public health emergency of international concern. COVID-19 poses a severe threat to our day-to-day life as well as physical and mental health. This study explores mental health status among married women that remain understudied in Bangladesh during the COVID-19 pandemic.

Methodology

A cross-sectional study was conducted among 597 married women via face-to-face interview, maintaining all safety protocols. A semi-structured questionnaire was assembled that included socio-demographics and the DASS-21 scale. Descriptive analysis and logistic regression were performed to examine the associations between variables.

Result

Almost 35% of the respondents had stress, 20% had anxiety, and 44% had depression ranging from mild to extremely severe. Metropolitan city inhabitants, being housewives, higher educational status, number of children, financial condition, comorbidities, family members assistance in household activities, relocation during COVID-19, social media use, concern about family, infected family members, tendency to get COVID-19 updates had been found significant in multivariable and univariate regression analysis with depression, anxiety, and stress.

Conclusion

In this study, we found high rates of stress, anxiety, and depression among the study participants. These findings provide us with an epidemiological picture of the mental health status of our target population that could be a key benchmark for identifying high-risk groups and developing policies as well. Results could also be used to formulate psychological interventions that might be helpful during the COVID-19 period and later.

Premenopausal Singaporean Women Suffering from Major Depressive Disorder Treated with Selective Serotonin Reuptake Inhibitors Had Similar Bone Mineral Density as Compared with Healthy Controls

The association between selective serotonin reuptake inhibitor (SSRI) treatment and lower bone mineral density (BMD) remains controversial, and further research is required. This study aimed to compare the BMD, levels of bone formation and bone metabolism markers in medicated premenopausal Singaporean women with major depressive disorder (MDD) and matched healthy controls. We examined 45 women with MDD who received SSRI treatment (mean age: 37.64 ± 7) and 45 healthy controls (mean age: 38.1 ± 9.2). BMD at the lumbar spine, total hip and femoral neck were measured using dual-energy X-ray absorptiometry. We also measured bone formation markers, procollagen type 1 N-terminal propeptide (P1NP) and bone metabolism markers, osteoprotegerin (OPG) and receptor activator of nuclear factor-kappa-Β ligand (RANKL). There were no significant differences in the mean BMD in the lumbar spine (healthy controls: 1.04 ± 0.173 vs. MDD patients: 1.024 ± 0.145, p = 0.617, left hip (healthy controls: 0.823 ± 0.117 vs. MDD patients: 0.861 ± 0.146, p = 0.181) and right hip (healthy controls: 0.843 ± 0.117 vs. MDD patients: 0.85 ± 0.135, p = 0.784) between healthy controls and medicated patients with MDD. There were no significant differences in median P1NP (healthy controls: 35.9 vs. MDD patients: 37.3, p = 0.635), OPG (healthy controls: 2.6 vs. MDD patients: 2.7, p = 0.545), RANKL (healthy controls: 23.4 vs. MDD patients: 2178.93, p = 0.279) and RANKL/OPG ratio (healthy controls: 4.1 vs. MDD patients: 741.4, p = 0.279) between healthy controls and medicated patients with MDD. Chronic SSRI treatment might not be associated with low BMD in premenopausal Singaporean women who suffered from MDD. This finding may help female patients with MDD make an informed decision when considering the risks and benefits of SSRI treatment.

A Smartphone App for Attentional Bias Retraining in Smokers: Mixed Methods Pilot Study

BACKGROUND

Smoking is a global health threat. Attentional bias influences smoking behaviors. Although attentional bias retraining has shown benefits and recent advances in technology suggest that attentional bias retraining can be delivered via smartphone apps, there is a paucity of research on this topic.

OBJECTIVE

This study aims to address this gap by exploring the use of attentional bias retraining via a novel smartphone app using a mixed methods pilot study. In the quantitative phase, it is hypothesized that participants in the training group who undertake attentional bias retraining via the app should have decreased levels of attentional bias, subjective craving, and smoking frequency, compared with those in the control group who do not undertake attentional bias retraining. The qualitative phase explores how the participants perceive and experience the novel app.

METHODS

In all, 10 adult smokers (3 females and 7 males) between the ages of 26 and 56 years (mean 34.4 years, SD 9.97 years) were recruited. The participants were randomly allocated to the training and control groups. In weeks 1 and 3, participants from both groups attempted the standard visual probe task and rated their smoking frequency and subjective craving. In week 2, the participants in the training group attempted the modified visual probe task. After week 3, participants from both groups were interviewed about their views and experiences of the novel app.

RESULTS

The results of the quantitative analysis did not support this study's hypothesis. The qualitative data were analyzed using thematic analysis. The results yielded 5 themes: ease, helpfulness, unhelpful aspects, barriers, and refinement.

CONCLUSIONS

Findings from the qualitative study were consistent with those from previous studies on health-related smartphone apps. The qualitative results were helpful in understanding the user perspectives and experiences of the novel app, indicating that future research in this innovative area is necessary.

Smoking and nicotine dependence in relation to depression, anxiety, and stress in Egyptian adults: A cross-sectional study

BACKGROUND

Much research has found that smoking is one of the major risk factors for a variety of physical diseases and mental disorders; however, few studies have been conducted on smoking in Egypt. Furthermore, to the researcher's best knowledge, no study in Egypt has compiled data on smoking prevalence, motives, and levels of nicotine dependency. In order to fill in this gap, the current study has attempted to summarize the situation and construct an accurate picture of smoking in Egypt.

MATERIALS AND METHODS

This cross-sectional study included 2000 Egyptian adults in Fayoum through a multistage cluster sampling technique. For data collection, the Socioeconomic Status Scale was deployed. In addition, Depression, Anxiety, Stress Scale (DASS), the Modified Reasons for Smoking Scale (MRSS), and Fagerstrom Test for Nicotine Dependence (FTND) were used. Data analysis performed using SPSS version 22.0. For qualitative data, Chi-square test was used to determine statistical significance. Bivariate Pearson correlation was used to test for the association between quantitative variables.

RESULTS

Of the total sample of 2000 adults, 40.4% had anxiety and 24.3% had stress, and 19.5% showed severe to extremely severe level of depression. For MRSS, tension reduction or relaxation was found in 46.5% adults while 9.8% had high level of nicotine dependence. There was a statistically significant association between psychometric disorders, on one hand, and both smoking motivation and nicotine dependence, on the other (P < 0.001). The DASS score had a statistically significant correlation with age, smoking duration, nicotine dependence level, and MRSS subscales.

CONCLUSION

Smoking is linked to psychological symptoms and shows a moderate to high level of nicotine dependence, with a higher level of dependency, smoking pleasure, stress reduction/ relaxation, and hand-mouth movement as motives for smoking. Furthermore, there was a correlation between nicotine dependence, on one hand, and depression and stress on the other.

Sociodemographic and COVID-Related Predictors for Mental Health Condition of Mainland Chinese in Canada Amidst the Pandemic

The current study investigates the mental health condition of Mainland Chinese in Canada and identifies the associated sociodemographic and COVID-19-related predictors. A sample of 471 Mainland Chinese aged 18 or older completed an online survey that collected information on demographics, experience, cognition, and behaviours related to the COVID-19 pandemic and mental health condition. Mental health condition was assessed with the Depression, Anxiety, and Stress Scale-21 (DASS-21) for the depression, anxiety, and stress levels of Mainland Chinese during the pandemic. Moderate to severe depression, anxiety, and stress levels were respectively reported by 11.30%, 10.83%, and 5.10% of respondents. Univariate analysis of variance models (ANOVAs) were conducted to assess mental health condition variance as stratified by independent sociodemographic- or COVID-19-related explanatory variables, to identify possible predictors to be entered into the subsequent regression models. The regression models identified age, income level, health status, and perceived discrimination as significant sociodemographic predictors (absolute value of βs = 1.19–7.11, ps < 0.05), whereas self-infection worry, attitude towards Canadian measures, information confusion, food/goods stocking, and room cleaning/sanitizing were identified as significant COVID-19-reltaed predictors (absolute value of βs = 1.33–3.45, ps < 0.05) for mental health outcomes. The results shed light on our understanding of the major factors associated with the mental health condition of Mainland Chinese in Canada during the COVID-19 pandemic.

Effect of the COVID-19 outbreak and lockdown on mental health among post-secondary students in the Grand Est region of France: results of the PIMS-CoV19 study

BACKGROUND

The COVID-19 epidemic has sent students around the world in to lockdown. This study sought to assess the prevalence of impaired self-perceived mental health and identify associated factors among French post-secondary students during the lockdown.

METHODS

A cross-sectional study was conducted among French students living in the Grand Est area in France from May 7 to 17, 2020 during the first lockdown. An online survey was used to collect sociodemographic data, learning and teaching conditions, living conditions, and exposure to COVID-19, and self-perceived mental health was assessed with mental composite score (MCS) of the SF-12.

RESULTS

Overall, 4018 were analyzed. Most participants were female (70.7%), and the mean age was 21.7 years (SD 4.0). The mean MCS score was 44.5 (SD 17.3). Impaired mental health, defined by a MCS < 1st Quartile, was mainly associated with female sex; decreased time for learning; not having access to the outside with a garden, a terrace or a balcony; difficulties with the living situation and having someone in the home affected by the SARS-COV2 requiring hospitalization or not.

CONCLUSIONS

This study showed that living conditions during lockdown had a clear impact on the mental health of French post-secondary students. There is a need to improve prevention and to access distance education as well as an urgent need for measures to develop healthy coping strategies for students. This is significant challenge and will assist in moderating the risk for the development of further distress and mental health concerns.

Characteristics of flavored and non-flavored waterpipe tobacco users: a real-world setting study

We aimed to compare sociodemographic characteristics, smoking patterns, beliefs and perceptions, nicotine dependence, and psychological indicators between flavored waterpipe (WP) tobacco (FWT) and non-flavored WP tobacco (non-FWT) smokers in Iran. A cross-sectional study was conducted in 94 WP-serving venues surrounding Tehran and Ardabil metropolitans in Iran. Convenience sampling was applied to select 900 current WP smokers [508 (56%) FWT-only and 392 (44%) non-FWT-only smokers] aged 18 years and older. Multivariable logistic regression was used to examine the independent characteristics of FWT and non-FWT smokers. Compared to non-FWT smokers, FWT smokers were younger (adjusted odds ratio [AOR]=0.88, 95% confidence interval [CI]: 0.87-0.90) and more likely to have ≥ 1 sibling who smoked WP (AOR=1.54, 95% CI: 1.06-2.24), share WP with others (AOR=2.52, 95% CI: 1.68-3.77), report current cigarette smoking (AOR=2.05, 95% CI: 1.23-3.42), and report confidence in quitting at any time (AOR=3.64, 95% CI: 2.45-5.39). FWT smokers were less likely to have seen (AOR=0.40, 95% CI: 0.27-0.60) or read (AOR=0.44, 95% CI: 0.24-0.80) warning messages on WP tobacco packages relative to non-FTW smokers. The most common self-reported reason for smoking WP was entertainment for both groups, followed by stress relief for non-FWT smokers and the escape from loneliness for FWT smokers. FWT-only smokers differ from non-FWT-only smokers in several aspects including being younger, having more positive beliefs and perceptions regarding WP use, and having higher cigarette smoking prevalence. These findings will help in developing more effective and targeted policies and cessation interventions for WP smokers according to flavor type they use, especially in the Middle East.

Association between Anxiety, Depressive Symptoms, and Quality of Life in Patients Undergoing Diagnostic Flexible Video Bronchoscopy

Bronchoscopy is one of the basic invasive procedures in pulmonology accompanied by patients’ anxiety. This study aimed to find an association between predictors of state anxiety/depression and patient’s quality of life (QOL) with pulmonary symptoms undergoing diagnostic flexible video bronchoscopy (FVB). A total of 125 adult patients before FVB were included in a prospective observational study. The quality of life (QOL) was assessed by WHOQOL-BREF questionnaire, the depression possibility by the Beck’s Depression Inventory-II (BDI-II), and the anxiety level by Spielberger’s State-Trait Anxiety Inventory (STAI-S; STAI-T). Results show that the older patients and patients with more comorbidities showed a significantly higher anxiety level. The previous FVB under deep sedation significantly reduced state anxiety. A significantly positive association was found between the STAI score and total BDI-II score. More severe symptoms of anxiety were especially related to lower QOL (physical health, psychological and environmental domains) in patients. Statistically higher trait anxiety in lower social QOL domain scores was observed. Our findings show that high state and trait anxiety were associated with higher depression scores and lower quality of life in the elderly. It seems that the elderly and patients at risk of depression development require more attention in the clinical setting to minimize the anxiety accompanying the bronchoscopy.

Mental health and social support of caregivers of children and adolescents with ASD and other developmental disorders during COVID-19 pandemic

Background

Previous studies showed that caregivers of children with autism spectrum disorder (ASD) and other developmental disorders had higher levels of parenting stress, anxiety and depression. In the present study, the author examined the caregivers' mental health and investigated the mediating role of social support between symptoms severity and parenting stress during COVID-19.

Methods

During 20 March to 8 April 2020, 1932 caregivers of children and adolescents with ASD and other developmental disorders from China were enrolled to fill in a sociodemographic questionnaire, Depression, Anxiety and Stress Scale and Social Support Rating Scale. The author also collected children's disability severity symptoms and behavioral problems.

Results

The results showed that 46.01% of the caregivers reported symptoms of depression, 44.67% showed anxiety and 44.62% showed stress during COVID-19 pandemic. Fathers were found to get more subjective support than mothers (P < 0.05). Caregivers who had the highest educational attainment had the most social support (P = 0.01). People who had the more household income showed the significantly lower levels of depression and anxiety (P < 0.05). The caregivers' employment status during COVID-19 was found significantly related with their depression, anxiety, stress and social support (P < 0.05).

Limitations

This study has some limitations, such as it did not conduct the longitudinal analysis of variables before COVID-19.

Conclusions

The findings showed that many caregivers experienced mental health problems during COVID-19. The author suggested to promote caregivers' engagement in functional social support and the behavioral interventions for their children to reduce the impact of stress, anxiety and depression.

Estimates of COVID-19 Risk Factors among Social Strata and Predictors for a Vulnerability to the Infection

Coronavirus disease 2019 (COVID-19) has emerged as a potentially severe disease, especially for individuals presenting with certain underlying medical conditions. We analyzed the rates of comorbidities and symptoms to reveal the potential severity of the pandemic in Volos, one of the most air-polluted cities in Greece. Environmental and health-related predictors for SARS-CoV-2 infection were investigated. A web-based questionnaire was disseminated through social media in the first half of March 2021 during a five-month strict lockdown. Sociodemographic data, preexisting medical conditions, frequency of clinical symptoms, and COVID-19 information were recorded. The study population consisted of 2000 responders. Four-fifths of the participants reported comorbidities that could increase vulnerability to severe COVID-19. Respiratory symptoms were reported from the unemployed and from retirees, and cold-related symptoms were reported in the education sector and in undergraduates. Women and younger generations shaped social vulnerability to respiratory infections similar to the elderly. SARS-CoV-2 infection was reported in 3.7% of the study population. Common headache (OR 2; CI 1189-3013; p = 0.007) and prior pneumonia (OR 1.9; CI 1024-2898; p = 0.04) were significant predictors for susceptibility to SARS-CoV-2 infection. The importance of monitoring society through community-based questionnaires is highlighted, for predicting and preventing future widespread transmission of infectious diseases.

Tobacco smoking and nicotine dependence among patients with respiratory diseases in Vietnam: Status and correlated factors

INTRODUCTION

Understanding nicotine dependence can support clinicians in enhancing the effectiveness of treatments for respiratory patients. Our research aimed to assess the severity of nicotine dependence among patients with respiratory diseases in Vietnam and accordingly suggest potential interventions for tobacco cessation.

METHODS

A cross-sectional study was conducted at the Respiratory center of Bach Mai Hospital, Hanoi, for two months of 2016 (October and November). A total of 508 respondents participated in the study Data on socio-economic characteristics and smoking patterns were collected. The Euroqol-5 dimensions-5 levels (EQ-5D-5L) and Fagerström test for nicotine dependence (FTND) were used to evaluate patient's quality of life and the nicotine dependence level, respectively. Kruskal-Wallis and Chi-square tests were used to assess the differences between variables. We applied the multivariate logistic regression and Tobit regression to categorize the association between nicotine dependence level and other factors.

RESULTS

A total of 508 patients enrolled in our study. Former smokers and current smokers accounted for 8.1% and 38.6% of the sample, respectively. Current smokers were more likely to be male, work as free lancers, and report anxiety/depression. Higher level of nicotine dependence among current smokers was associated with the employment status of the patient. The mean number of cigarettes per day was 15.7 (SD = 11.1). The mean score of the FTND was 5.1 (SD = 2.0). Freelancers were more likely to be a current smoker (OR = 2.65, 95% CI = 2.21; 5.79). People who experienced anxiety/depression had a higher likelihood of smoking (OR = 2.21, 95% CI = 1.04; 4.72).

CONCLUSIONS

Current smokers demonstrated a moderate level of nicotine dependence, which predict a difficult quitting and suggest the development of specialized programs to support smoking cessation counseling. Furthermore, the capabilities of physicians in supporting and counseling patients in quitting smoking should be strengthened.

The impact of the COVID-19 pandemic on physical and mental health in the two largest economies in the world: a comparison between the United States and China

The broad impact of the COVID-19 on self-reported daily behaviors and health in Chinese and US samples remains unknown. This study aimed to compare physical and mental health between people from the United States (U.S.) and China, and to correlate mental health parameters with variables relating to physical symptoms, knowledge about COVID-19, and precautionary health behaviors. To minimize risk of exposure, respondents were electronically invited by existing study respondents or by data sourcing software and surveys were completed via online survey platforms. Information was collected on demographics, physical symptoms, contact history, knowledge about COVID-19, psychologic parameters (i.e. IES-R; DASS-21), and health behaviors. The study included a total of 1445 respondents (584 U.S.; 861 China). Overall, Americans reported more physical symptoms, contact history, and perceived likelihood of contracting COVID-19. Americans reported more stress and depressive symptoms, while Chinese reported higher acute-traumatic stress symptoms. Differences were identified regarding face mask use and desires for COVID-19 related health information, with differential mental health implications. Physical symptoms that were possibly COVID-19 related were associated with adverse mental health. Overall, American and Chinese participants reported different mental and physical health parameters, health behaviors, precautionary measures, and knowledge of COVID-19; different risk and protective factors were also identified.

The Impact of the COVID-19 Pandemic on Physical and Mental Health in China and Spain: Cross-sectional Study

BACKGROUND

Differences in physical and mental health impact across continents during the COVID-19 pandemic are unknown.

OBJECTIVE

This study compared the levels of impact of COVID-19 on mental health among people from Spain and China and correlated mental health parameters with variables relating to symptoms similar to COVID-19, COVID-19 knowledge, and precautionary measures.

METHODS

We collected information on demographic data, physical symptoms, contact history with persons with a confirmed COVID-19 diagnosis, COVID-19 knowledge, and precautionary measures. Participants completed the Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety and Stress Scale-21 Items (DASS-21). To analyze the differences in the mental health parameters, the mean scores between Chinese and Spanish respondents were compared using the independent samples t test. The differences in categorical variables between the two samples were analyzed by the chi-square test. Linear regression was used to calculate the univariate associations between the independent variables and mental health parameters for both groups separately, with adjustments made for age, gender, and education.

RESULTS

A total of 1528 participants (Spain: n=687; China: n=841) were recruited. The mean age of the Chinese respondents was 24.73 years (SD 7.60; range 18-65 years), and the mean age of the Spanish respondents was 43.06 years (SD 11.95; range 18-76 years). Spanish participants reported significantly more symptoms similar to COVID-19 infection (eg, fever, sore throat, and breathing difficulties), contact history with COVID-19, higher perceived risk of contracting COVID-19, frequent use of medical services, and less confidence in medical services compared with their Chinese counterparts (P<.001). Spanish participants reported significantly higher DASS-21 stress and depression scores, while Chinese participants reported significantly higher IES-R scores (P<.001). Chinese participants encountered more discrimination from other countries (P<.001). Significantly more Chinese participants reported using face masks than Spanish ones (P<.001). More exposure to health information was associated with adverse mental health in Spain (depression: P=.02; anxiety: P=.02; stress: P=.001).

CONCLUSIONS

Our study found that Spanish respondents reported higher levels of stress and depression as well as more symptoms and use of medical services. In preparation for the next pandemic, Spain needs to establish a prompt policy to implement rapid response and enhance medical services to safeguard physical and mental health.

Prevalence and predictors of psychological response during immediate COVID-19 pandemic

AIM

COVID-19 pandemic has created a serious psychological impact worldwide since it has been declared. This study aims to investigate the level of psychological impacts of the COVID-19 pandemic on the Turkish population and to determine related factors.

METHODS

The study was carried out by an online questionnaire using the virtual snowball sampling method. The sociodemographic data were collected on the following subjects: participants' experience on any signs of infection within the last month, the history of COVID-19 contact-treatment-quarantine, level of compliance with precautionary measures, the sources of information and level of knowledge about the pandemic process and their belief levels on the knowledge they acquire. Besides, the questions that take place in the Depression, Anxiety and Stress Scale-21 (DASS-21), and Impact of Events Scale-Revised (IES-R) were asked to participants.

RESULTS

Of the 3549 participants, anxiety was found in 15.8%, depression in 22.6%, stress in 12.9%, and psychological trauma in 20.29% based on moderate and above levels. Female gender, young age, higher education level, being single, high monthly income, presence of psychiatric illness, a large number of people living together, having any signs of infection, and contact history with COVID-19 infected person or contaminated object are identified as risk factors that may increase psychological impact. Compliance with the rules was found to reduce the risk of psychological response.

CONCLUSIONS

The risk factors for the psychological impact of the COVID-19 pandemic, and acknowledging these factors can help to formulate the interventions to reduce the stress levels of the population.

A chain mediation model on COVID-19 symptoms and mental health outcomes in Americans, Asians and Europeans

The novel Coronavirus-2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) in March 2020, impacting the lifestyles, economy, physical and mental health of individuals globally. This study aimed to test the model triggered by physical symptoms resembling COVID-19 infection, in which the need for health information and perceived impact of the pandemic mediated the path sequentially, leading to adverse mental health outcomes. A cross-sectional research design with chain mediation model involving 4612 participants from participating 8 countries selected via a respondent-driven sampling strategy was used. Participants completed online questionnaires on physical symptoms, the need for health information, the Impact of Event Scale-Revised (IES-R) questionnaire and Depression, Anxiety and Stress Scale (DASS-21). The results showed that Poland and the Philippines were the two countries with the highest levels of anxiety, depression and stress; conversely, Vietnam had the lowest mean scores in these areas. Chain mediation model showed the need for health information, and the perceived impact of the pandemic were sequential mediators between physical symptoms resembling COVID-19 infection (predictor) and consequent mental health status (outcome). Excessive and contradictory health information might increase the perceived impact of the pandemic. Rapid COVID-19 testing should be implemented to minimize the psychological burden associated with physical symptoms, whilst public mental health interventions could target adverse mental outcomes associated with the pandemic.

Mental Health of the General Population during the 2019 Coronavirus Disease (COVID-19) Pandemic: A Tale of Two Developing Countries

Background: This study aimed to compare the severity of psychological impact, anxiety and depression between people from two developing countries, Iran and China, and to correlate mental health parameters with variables relating to the COVID-19 pandemic. Although China and Iran are developing countries based on the World Bank’s criteria, these two countries are different in access to resources and health care systems. We hypothesized that Iranians would show higher levels of depression, anxiety and stress as compared to Chinese. Methods: This study collected information related to the COVID-19 pandemic including physical health, precautionary measures and knowledge about the pandemic. We also used validated questionnaires such as the Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety and Stress Scale (DASS-21) to assess the mental health status. Results: There were a total of 1411 respondents (550 from Iran; 861 from China). The mean IES-R scores of respondents from both countries were above the cut-off for post-traumatic stress disorder (PTSD) symptoms. Iranians had significantly higher levels of anxiety and depression (p < 0.01). Significantly more Iranians believed COVID-19 was transmitted via contact, practised hand hygiene, were unsatisfied with health information and expressed less confidence in their doctors, but were less likely to wear a facemask (p < 0.001). Significantly more Iranians received health information related to COVID-19 via television while Chinese preferred the Internet (p < 0.001). Conclusions: This cross-country study found that Iranians had significantly higher levels of anxiety and depression as compared to Chinese. The difference in reported measures between respondents from Iran and China were due to differences in access to healthcare services and governments’ responses to the pandemic.

The impact of COVID-19 pandemic on physical and mental health of Asians: A study of seven middle-income countries in Asia

The coronavirus disease (COVID-19) pandemic has impacted the economy, livelihood, and physical and mental well-being of people worldwide. This study aimed to compare the mental health status during the pandemic in the general population of seven middle income countries (MICs) in Asia (China, Iran, Malaysia, Pakistan, Philippines, Thailand, and Vietnam). All the countries used the Impact of Event Scale–Revised (IES-R) and Depression, Anxiety and Stress Scale (DASS-21) to measure mental health. There were 4479 Asians completed the questionnaire with demographic characteristics, physical symptoms and health service utilization, contact history, knowledge and concern, precautionary measure, and rated their mental health with the IES-R and DASS-21. Descriptive statistics, One-Way analysis of variance (ANOVA), and linear regression were used to identify protective and risk factors associated with mental health parameters. There were significant differences in IES-R and DASS-21 scores between 7 MICs (p<0.05). Thailand had all the highest scores of IES-R, DASS-21 stress, anxiety, and depression scores whereas Vietnam had all the lowest scores. The risk factors for adverse mental health during the COVID-19 pandemic include age <30 years, high education background, single and separated status, discrimination by other countries and contact with people with COVID-19 (p<0.05). The protective factors for mental health include male gender, staying with children or more than 6 people in the same household, employment, confidence in doctors, high perceived likelihood of survival, and spending less time on health information (p<0.05). This comparative study among 7 MICs enhanced the understanding of metal health in the general population during the COVID-19 pandemic.

Correlation between emotional intelligence and negative emotions of front-line nurses during the COVID-19 epidemic: A cross-sectional study

AIMS AND OBJECTIVES

The purpose of this study was to understand the emotional intelligence level (EI) and negative emotional status of the front-line nurses in the epidemic situation and to further explore the relationship between them.

BACKGROUND

During the COVID-19 epidemic, under the influence of multiple factors, nurses were vulnerable to negative emotions. While previous studies have explored, the role of emotional intelligence in negative emotions, the relationship between the two has not been sufficiently discussed in the context of COVID-19.

DESIGN

The study carried out a cross-sectional survey. The STROBE was selected as the checklist in this study.

METHODS

202 nurses from Wuhan makeshift hospital participated in the questionnaire survey. Data collection tools included a general data questionnaire designed by the researchers, Chinese version of EI scale (WLEIS-C) and Chinese version of Depression Anxiety Stress Scale (DASS-21). Descriptive statistics, single factor analysis and correlation analysis were used to analyse the data.

RESULTS

The emotional intelligence of the front-line nurses was in the upper middle range. Among the negative emotions, anxiety was the most prominent symptom.

CONCLUSIONS

Managers should pay attention to the negative emotional problems of front-line nurses, improve their EI level and promote mental health and the progress of epidemic prevention.

RELEVANCE TO CLINICAL PRACTICE

Improving the level of emotional intelligence can reduce the frequency and intensity of negative emotions. In clinical work, emotional intelligence can be used as a skill to carry out relevant training, which is conducive to playing a positive role in future emergencies.

Assessment of Psychological Distress and Associated Factors among Hospitalized Patients During the COVID-19 Pandemic at Selected Hospitals in Southwest Ethiopia

BACKGROUND

The aim of this study was to assess the prevalence of psychological distress and associated factors among hospitalized patients during the COVID-19 pandemic at three selected hospitals in southwest Ethiopia.

METHODS

An institution-based cross-sectional study design was conducted among hospitalized patients during the COVID-19 pandemic at Mizan-Tepi University Teaching Hospital, Tepi General Hospital, and Gebre Tsadik Shawo General Hospital, southwest Ethiopia from May 10 to August 10, 2020. Sample size was computed using a single-proportion formula, and systematic sampling was employed to recruit study participants. Data were collected using a structured interviewer-administered questionnaire. Psychological distress was assessed with the Kessler Psychological Distress Scale, which has been validated in Ethiopia. SPSS 21.0 was used for analysis. Descriptive statistics were calculated to characteristize the study population. Predictors of psychological distress were identified by logistic regression analyses.

RESULTS

Among the 337 study participants enrolled, about 41% were aged 25-34 years. The overall prevalence of psychological distress was 57.9% (95% CI 52.8%-63.5%). Being female (AOR 3.69, 95% CI 2.08-6.55), having high (AOR 5.45, 95% CI 2.35-12.66) and medium perceived life threat (AOR 3.37, 95% CI 1.75-6.48), poor (AOR 3.97, 95% CI 1.70-9.29) and moderate social support (AOR 3.17, 95% CI 1.36-7.41), and current khat use (AOR 4.16, 95% CI 1.67-10.35) were statistically associated with psychological distress during the COVID-19 pandemic at P value <0.05.

CONCLUSION

The prevalence of psychological distress was high among hospitalized patients during the COVID-19 pandemic. The study findings highlight the need to develop psychological support strategies to improve mental health and psychological resilience.

Prevalence of Depression, Anxiety, and Stress among the General Population in Saudi Arabia during Covid-19 Pandemic

Coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on public mental health. Our objective was to assess prevalence of depression, anxiety, and stress among the general population in Saudi Arabia during this pandemic. A descriptive cross-sectional approach was used targeting all accessible populations in Saudi Arabia. Data were collected from participants using an electronic pre-structured questionnaire. Psychological impact was assessed using the Arabic version of Depression, Anxiety, and Stress Scale (DASS-21). A total of 1597 participants completed the survey. In total, 17.1% reported moderate to severe depressive symptoms; 10% reported moderate to severe anxiety symptoms; and 12% reported moderate to severe stress levels. Depression, anxiety, and stress were significantly higher among females, younger respondents, and health care providers. Depression was higher among smokers, singles, and non-working respondents. Anxiety was higher among those reporting contacts with COVID-19 positive cases, previously quarantined and those with chronic health problems. Our findings reaffirm the importance of providing appropriate knowledge and specialized interventions to promote the mental well-being of the Saudi population, paying particular attention to high-risk groups.

Change in Compliance of Staff at 4 Vietnam Universities after the Enactment of Smoke-free Environment Decree

BACKGROUND

The Tobacco Control Law in Vietnam was adopted in 2012 and came into force from May 2013, followed by a number of guiding sub-law legal documents. Smoke-free campus policy in university is considered an important measure to protect people from secondhand smoking as well as staffs and students will be in favour of the policy. Furthermore, there has been evidence suggested that smoke-free policy had positive impact on active smoking as well as anti-smoking attitude.

METHODS

A cross-sectional self-administered study of staff at 4 universities were conducted in 2 phases, Phase 1 as early introduction of the Law (n = 900) and Phase 2 as 1-year post (n = 885). Demographics, tobacco consumption, compliance status and compliance with awareness towards the campus smoking regulations were assessed in both phases.

RESULTS

Daily smoking prevalence decreased significantly (P < .05) 1 year after implementing the smoke-free policy, while a significant increase in occasional smoking (P < .01). Compliance of staff to the regulation the campus should be indoor smoke-free was significantly increase at Phase 2 compared to Phase 1, however participants reported there would be places on campus that smokers frequently violated the smoke-free regulations.

CONCLUSIONS

The study indicated a significant positive change in compliance of staff at the 4 universities after the implementation of the Tobacco Control Law, included the smoke-free policy. Although the prevalence of tobacco smoking in this study was low, the proportion of respondents who reported to reduce infringement the smoke-free policy suggests support for staff smokers would be beneficial. Raising awareness and enforcement is likely to enhance the long-term outcomes of the implementation of smoke-free environment.

The Psychological Impact of the COVID-19 Pandemic on Teenagers in China

PURPOSE

The 2019 COVID-19 pandemic poses a challenge to adolescent psychological health. The aim of this study was to survey junior high and high school students in China to better understand the psychological consequences, such as anxiety, depression, and stress, of the COVID-19 pandemic.

METHODS

A cross-sectional online survey using structural questionnaires was conducted from April 7, 2020, to April 24, 2020. Demographic information and general information related to the pandemic were collected. Psychological consequences were assessed by the Impact of Event Scale-Revised and the Depression, Anxiety and Stress Scale. Influencing factors were assessed by the Brief Resilience Scale and Coping Style Questionnaire.

RESULTS

Our sample comprised 493 junior high school students (male = 239, mean age = 13.93 years) and 532 high school students (male = 289, mean age = 17.08 years). Resilience and positive coping were protective factors for the occurrence of depressive, anxiety, and stress symptoms in junior high and high school students (p < .05). Positive coping was a protective factor for trauma-related distress in junior high school students (p < .05). Negative coping is a risk factor for depression, anxiety, stress symptoms, and trauma-related distress in junior high and high school students (p < .05).

CONCLUSIONS

During the COVID-19 pandemic in China, more than one fifth of junior high and high school students' mental health was affected. Our findings suggested that resilience and positive coping lead to better psychological and mental health status among students. In contrast, negative coping is a risk factor for mental health.

The Effect of Brief Crisis Intervention Package on Improving Quality of Life and Mental Health in Patients with COVID-19

Objective: COVID 19 is having a devastating effect on mankind’s life. Individuals with COVID-19 will experience high levels of stress, depression, anxiety, and low quality of life. The goals the of present study were to investigate the effect of brief crisis intervention package on stress, depression, anxiety, and quality of life in patient with COVID-19.

Method: In this randomized controlled clinical trial, 30 patients were randomly selected and divided into control and experimental groups. The experimental group was examined in four 60-minute sessions for one month. During this period, the control group received only routine treatment and therapy. Before and after the intervention, DASS21, the Symptom Checklist (SCL-25), and WHO-QOL were used to measure and record patient mental health and quality of life. Finally, data were analyzed using SPSS 24 software.

Results: The average mental health score was assessed with WHO-QOL, DASS21, and SCL-25 before intervention and was not statistically significant (P = > 0.05), and the mean score of stress, anxiety, depression, WHO-QOL, SCL-25 after intervention was statistically significant (P < 0.001). Therefore, results showed the brief crisis intervention package was effective in improving the quality of life (P < 0.05) and mental illnesses (P < 0.05) in patients with COVID-19.

Conclusion: The brief crisis intervention package can reduce the negative effect of patients with COVID-19. Therefore, this intervention can be used as a beneficial treatment to improve mental disorder symptoms and to improve the condition of people who suffer from COVID-19.

A quantitative and qualitative study on the neuropsychiatric sequelae of acutely ill COVID-19 inpatients in isolation facilities

This study examined the neuropsychiatric sequelae of acutely ill patients with coronavirus disease 2019 (COVID-19) infection who received treatment in hospital isolation wards during the COVID-19 pandemic. Ten COVID-19 patients who received treatment in various hospitals in Chongqing, China; 10 age- and gender-matched psychiatric patients; and 10 healthy control participants residing in the same city were recruited. All participants completed a survey that collected information on demographic data, physical symptoms in the past 14 days and psychological parameters. Face-to-face interviews with COVID-19 patients were also performed using semi-structured questions. Among the COVID-19 patients, 40% had abnormal findings on the chest computed topography scan, 20% had dysosmia, 10% had dysgeusia, and 80% had repeated positivity on COVID-19 reverse-transcription polymerase chain reaction testing. COVID-19 and psychiatric patients were significantly more worried about their health than healthy controls (p = 0.019). A greater proportion of COVID-19 patients experienced impulsivity (p = 0.016) and insomnia (p = 0.039) than psychiatric patients and healthy controls. COVID-19 patients reported a higher psychological impact of the outbreak than psychiatric patients and healthy controls, with half of them having clinically significant symptoms of posttraumatic stress disorder. COVID-19 and psychiatric patients had higher levels of depression, anxiety and stress than healthy controls. Three themes emerged from the interviews with COVID-19 patients: (i) The emotions experienced by patients after COVID-19 infection (i.e., shock, fear, despair, hope, and boredom); (ii) the external factors that affected patients' mood (i.e., discrimination, medical expenses, care by healthcare workers); and (iii) coping and self-help behavior (i.e., distraction, problem-solving and online support). The future direction in COVID-19 management involves the development of a holistic inpatient service to promote immune and psychological resilience.

Psychological State and Associated Factors During the 2019 Coronavirus Disease (COVID-19) Pandemic Among Filipinos with Rheumatoid Arthritis or Systemic Lupus Erythematosus

BACKGROUND

Patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are perceived to be more vulnerable to worse COVID-19 infection outcome. Furthermore, severe shortage in hydroxychloroquine supply was experienced.

OBJECTIVE

We presented the psychological responses of Filipino SLE and RA patients to the COVID-19 pandemic and shortage of hydroxychloroquine supply.

METHODS

A total of 512 completed online surveys from SLE and RA patients were gathered from May 19 to 26, 2020. The online survey collected data on socio-demographics, health status, contact history, health service utilization, use of hydroxychloroquine, COVID-19 knowledge and concerns, precautionary measures, information needs, the validated Impact of Events Scale-Revised (IES-R) and Depression, Anxiety and Stress Scales (DASS-21) ratings.

RESULTS

The psychological impact of COVID-19 outbreak was at least moderate in 20%. The mean IES-R score was higher among SLE (22.34, SD=14.39) than RA (18.85, SD=13.24) patients. Stress, anxiety and depression were moderate to severe in 12.3%, 38.7%, and 27.7% of respondents. The mean stress subscale score was 10.11 (SD=7.95), mean anxiety subscale score was 6.79 (SD=6.57) and mean depression subscale score was 9.03 (SD=8.77). The risk factors for adverse mental health during the COVID-19 pandemic include the presence of comorbidity of hypertension and asthma; being a healthcare worker; and presence of specific symptoms of myalgia, cough, breathing difficulty, dizziness and sore throat. The protective factors for mental health during the pandemic include satisfaction with available health information and wearing of face masks.

CONCLUSION

In the third month of the pandemic in the Philippines, 20% of the respondents with lupus and RA experienced moderate to severe psychological impact. There was moderate to severe anxiety in 38.7% and moderate to severe depression in 27%. Identification of factors that affect mental health in lupus and RA is useful in implementation of effective psychological support strategies.

Depression, anxiety and stress in different subgroups of first-year university students from 4-year cohort data

BACKGROUND

Limited studies have been conducted to investigate the mental health status of subgroups of university students. This study hypothesized that there would be differences among student subgroups in the prevalence of depression, anxiety and stress; and association of age, gender, academic performance and mental health status.

METHODS

This was a cross-sectional survey study. Since 2014, first-year university students in a university in Hong Kong were invited to complete the Depression Anxiety Stress Scale (DASS-21) before the commencement of their study. These DASS data were then merged with objectively measured data from university records. 9,479 students completed the DASS survey, this being 56.5% of the total student population in the records. Kruskal-Wallis Tests were applied to compare the differences among student subgroups.

RESULTS

Community college transfer (CCT) students were the highest-risk group for depression, anxiety and stress, and their study load was the highest as well. Unexpectedly, mainstream students ranked after the CCT students in the prevalence and levels of depression, anxiety and stress. Student athletes had the highest prevalence of depression. Although there were declining trends for depression, anxiety and stress, it was only a slight drop. Overall, age, gender, study load and academic performance were associated with the mental health profile (p<0.05).

LIMITATIONS

After admission, students' mental health conditions could have changed. Further studies are needed to measure mental health during their study.

CONCLUSIONS

Mental health problems were not distributed evenly across different student subgroups, psychological support should be designed according to the needs of each student subgroup.

Variety, frequency, and type of Internet use and its association with risk of depression in middle- and older-aged Chinese: A cross-sectional study

BACKGROUND

Internet use is beneficial to mental health has been acknowledged, but its specific patterns await further investigation in China's context of urban-rural disparity. Therefore, we aimed to understand the patterns of Internet use and measure their associations with risk of depression in China from three dimensions: variety, frequency and type.

METHODS

We selected 18,492 urban and rural Chinses respondents aged 45 years and older from China Health and Retirement Longitudinal Study (CHARLS) 2015 dataset. Risk of depression was measured by 10-item Centre for Epidemiologic Studies (CES-D 10). Internet use was measured from three dimensions: variety, frequency and type, whereas its relationship with risk of depression was examined by multivariate logistic regression model.

RESULTS

In the whole sample, 67.2% of respondents had no risk of depression, and approximately 7% used Internet, which was inversely associated with risk of depression (AOR=0.617, 95% CI=0.444, 0.858). Rural respondents had higher risk of depression (37.1% VS 26.2%) and lower prevalence of Internet use (2.6% VS 13%). Among rural respondents, using Internet occasionally (AOR=0.338; 95% CI=0.130, 0.881), using one type of device (AOR=0.293; 95% CI=0.113, 0.760), especially mobile phone (AOR=0.427; 95% CI=0.187, 0.978) were associated with lower odds of depression. No significant associations were observed in urban respondents.

LIMITATIONS

The causal relationship between variables awaits further investigation with a longitudinal design.

CONCLUSION

Internet use was negatively associated with risks of depression, especially in rural but not in urban participants. Rural-urban disparities should be considered when designing strategies to encourage moderate Internet use.

Prevalence of depressive symptoms among nurses in China: A systematic review and meta-analysis

BACKGROUND

Depression is one of the most common mental disorders, profoundly impacting an individual's performance and quality of life. Due to their unique working conditions, nursing is counted among the occupational groups at high risk for developing depression. Because of the shortage of nursing resources in China, Chinese nurses suffer from heavy daily workloads more than those in many other countries. Therefore, this study aimed to evaluate the overall prevalence of depressive symptoms and analyse the potential risk factors of depressive symptoms in Chinese nurses.

METHODS

A systematic literature search in PubMed, EMBASE, Web of Science, the Chinese BioMedical Literature Database (CBM), the China National Knowledge Infrastructure (CNKI), and the Weipu and Wanfang databases up to Dec 31st, 2019 was performed regarding the prevalence of depressive symptoms in Chinese nurses. Eligibility assessment and data extraction were performed independently by 2 researchers, and meta-analysis was used to synthesize the data. Heterogeneity was evaluated using Cochran's Q test and quantified using the I2 statistic. To explore the potential source of heterogeneity, subgroup analyses were also performed. In addition, both funnel plot and Egger's tests were adopted to assess publication bias.

RESULTS

A total of 102 studies published from 1996 to 2019 covering 22 provinces were included for further analysis. The total number of participants was 52,592, with a range of 46 to 7205 per study. The overall prevalence of depressive symptoms in Chinese nurses was 43.83% (95%CI: 40.26%-47.42%), and 31.12% (95%CI: 27.30%-35.07%) were classified as mild degrees of depressive symptoms. The prevalence of depressive symptoms may be significantly affected by region, province or municipality and department marital status. Moreover, an increasing trend in the prevalence of depressive symptoms was observed in recent years.

CONCLUSION

The results presented a high prevalence of depressive symptoms among Chinese nurses, which suggests interventional programmes by health decision-makers to improving the mental state of nurses is needed urgently, especially in nurses with high risk factors for depressive symptoms. Furthermore, the nationwide investigation of depressive symptoms prevalence should be performed with a standard diagnostic tool, which may be more useful for policy makers and planners.

Is returning to work during the COVID-19 pandemic stressful? A study on immediate mental health status and psychoneuroimmunity prevention measures of Chinese workforce

This study aimed to quantify the immediate psychological effects and psychoneuroimmunity prevention measures of a workforce returning to work during the COVID-19 epidemic. Workforce returning to work was invited to complete an online questionnaire regarding their attitude toward the COVID-19 epidemic and return-to-work along with psychological parameters including the Impact of Event Scale-Revised, Depression, Anxiety, Stress Scale- 21 (DASS-21) and Insomnia Severity Index (ISI). Psychoneuroimmunity prevention measures include precautions at personal and organization levels. From 673 valid questionnaires, we found that 10.8% of respondents met the diagnosis of post-traumatic stress disorder (PTSD) after returning to work. The respondents reported a low prevalence of anxiety (3.8%), depression (3.7%), stress (1.5%) and insomnia (2.3%). There were no significant differences in the severity of psychiatric symptoms between workers/technicians and executives/managers. >95% reported psychoneuroimmunity prevention measures including good ventilation in the workplace and wore a face mask as protective. Factors that were associated with the severity of psychiatric symptoms in the workforce were marital status, presence of physical symptom, poor physical health and viewing return to work as a health hazard (p < 0.05). In contrast, personal psychoneuroimmunity prevention measures including hand hygiene and wearing face masks as well as organizational measures including significant improvement of workplace hygiene and concerns from the company were associated with less severe psychiatric symptoms (p < 0.05). Contrary to expectations, returning to work had not caused a high level of psychiatric symptoms in the workforce. The low prevalence of psychiatric symptoms could be due to confidence instilled by psychoneuroimmunity prevention measures before the resumption of work. Our findings would provide information for other countries during the COVID-19 pandemic.

Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A case-control study with service and research implications for immunopsychiatry

This study aimed to assess and compare the immediate stress and psychological impact experienced by people with and without psychiatric illnesses during the peak of 2019 coronavirus disease (COVID-19) epidemic with strict lockdown measures. Seventy-six psychiatric patients and 109 healthy control subjects were recruited from Chongqing, China and completed a survey on demographic data, physical symptoms during the past 14 days and a range of psychiatric symptoms using the Impact of Event Scale-Revised (IES-R), Depression, Anxiety and Stress Scale (DASS-21) and Insomnia Severity Index (ISI). IES-R measures PTSD symptoms in survivorship after an event. DASS-21 is based on tripartite model of psychopathology that comprise a general distress construct with distinct characteristics. The mean IES-R, DASS-21 anxiety, depression and stress subscale and ISI scores were higher in psychiatric patients than healthy controls (p < 0.001). Serious worries about their physical health, anger and impulsivity and intense suicidal ideation were significantly higher in psychiatric patients than healthy controls (p < 0.05). More than one-third of psychiatric patients might fulfil the diagnostic criteria post-traumatic stress disorder (PTSD). More than one-quarter of psychiatric patients suffered from moderately severe to severe insomnia. Respondents who reported no change, poor or worse physical health status and had a psychiatric illness were significantly more likely to have higher mean IES-R, DASS depression, anxiety and stress subscale scores and ISI scores (p < 0.05). This study confirms the severity of negative psychological impact on psychiatric patients during the COVID-19 epidemic with strict lockdown measures. Understanding the psychological impact on psychiatric patients during the COVID-19 pandemic has the potential to provide insight into how to develop a new immunopsychiatry service. Further research is required to compare pro-inflammatory cytokines between psychiatric patients and healthy controls during the pandemic.

A Nationwide Survey of Psychological Distress among Italian People during the COVID-19 Pandemic: Immediate Psychological Responses and Associated Factors

The uncontrolled spread of the coronavirus disease 2019 (COVID-19) has called for unprecedented measures, to the extent that the Italian government has imposed a quarantine on the entire country. Quarantine has a huge impact and can cause considerable psychological strain. The present study aims to establish the prevalence of psychiatric symptoms and identify risk and protective factors for psychological distress in the general population. An online survey was administered from 18–22 March 2020 to 2766 participants. Multivariate ordinal logistic regression models were constructed to examine the associations between sociodemographic variables; personality traits; depression, anxiety, and stress. Female gender, negative affect, and detachment were associated with higher levels of depression, anxiety, and stress. Having an acquaintance infected was associated with increased levels of both depression and stress, whereas a history of stressful situations and medical problems was associated with higher levels of depression and anxiety. Finally, those with a family member infected and young person who had to work outside their domicile presented higher levels of anxiety and stress, respectively. This epidemiological picture is an important benchmark for identifying persons at greater risk of suffering from psychological distress and the results are useful for tailoring psychological interventions targeting the post-traumatic nature of the distress.

Obsessive-compulsive symptoms and cigarette smoking: an initial cross-sectional test of mechanisms of co-occurrence

Tobacco addiction and obsessive-compulsive symptoms (OCS; intrusive thoughts or impulses that cause distress and rituals) are both mediated by compulsivity and negative reinforcement. Little evidence exists to guide theory, research, treatment, and population-based prevention of this co-occurrence. We propose a conceptual model of OCS-smoking co-occurrence in which smokers with elevated OCS capitalize on smoking to assuage OCS. This secondary analysis examined associations between OCS levels and self-reported smoking motives that are model-concordant: i) negative reinforcement-smoking for relief; ii) sensorimotor-benefits of behaviors and sensations of the tobacco self-administration ritual; and iii) habitual-smoking without conscious control. A community sample of cigarette smokers enrolled in a cessation trial (N = 458; 47.2% female; M _age = 36.9; SD = 13.6) completed pre-quit self-report measures of OCS levels and smoking motives. Regression models adjusted for sociodemographic covariates and non-OCS psychopathologies indicated that OCS level was positively associated with each model-concordant motive. OCS level was also correlated with tobacco dependence severity and greater withdrawal symptom severity experienced during previous quit attempts. Those with higher OCS report greater motivation to smoke for negative reinforcement, sensorimotor behavioral-ritualistic, habit/automaticity, and stimulation reasons. Further examination of the proposed model of OCS-smoking co-occurrence is warranted to guide theory and intervention for this population.

Influence of Family Environment and Tobacco Addiction: A Short Report from a Post-Graduate Teaching Hospital, India

Background: The initiation of tobacco addiction is complex, and several factors contribute to the onset of this behavior. It is presumed that the influence of family environment may pose a key factor in tobacco addiction. Tobacco-use has been highly observed in the Jamnagar district of Saurashtra region of Gujarat, India. No earlier study has focused on determining the pervasiveness of tobacco-use in families of tobacco users and non-users in this geographical area. Thus, this study aimed to assess the practice and pattern of tobacco-use (smoking and/or tobacco-chewing) in the families of tobacco-user patients. Methods: We studied the families of 65 tobacco-user patients (Group 1) who visited an outpatient clinic of an Ayurvedic post-graduate hospital with complaints of cough were studied and compared with age and gender-matched non-tobacco users (Group 2). The prevalence of tobacco use among the parents, siblings, and children of both groups was analyzed and compared. Results: The findings revealed that tobacco use among parents, siblings, and children in Group 1 was higher than Group 2 (p < 0.001). This meant that the problems of tobacco addiction are not always related to the individual, and therefore, tobacco-prevention strategies should focus on the entire family. Conclusions: These findings offer further insight into the promotion of smoking prevention interventions. Nevertheless, further research is warranted.

Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.

Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.

Nutritional Factors, Physical Health and Immigrant Status Are Associated with Anxiety Disorders among Middle-Aged and Older Adults: Findings from Baseline Data of The Canadian Longitudinal Study on Aging (CLSA)

The main purpose of this study was to compare the lifetime prevalence of anxiety disorders among foreign-born and Canadian-born adults in middle and later life. Using baseline data of the Canadian Longitudinal Study on Aging (2010–2015), multivariable binary logistic regression was conducted to investigate anxiety diagnosis and immigrant status, while controlling for socio-economic, health-related, and nutrition covariates. Of 26,991 participants (49.3% men, 82.5% Canadian born, 58.5% aged 45–65 years), the overall prevalence of self-reported physician diagnosis of anxiety disorders was 8.5%, with immigrants being lower than Canadian-born respondents (6.4% vs. 9.3%, p < 0.001). After accounting for all covariates, the adjusted odds ratio (aOR) for anxiety disorders was lower among immigrants (aOR = 0.77, 95% CI: 0.67–0.88) compared to those who were Canadian born. Identified risk factors included: younger age (aORs = 1.79–3.52), being a woman (aOR = 1.25, 95% CI: 1.07–1.46), single status (aOR = 1.27, 95% CI: 1.09–1.48), lower income (aORs = 1.28–2.68), multi-morbidities (aORs = 2.73–5.13), chronic pain (aOR = 1.31, 95% CI: 1.18–1.44), lifetime smoking ≥ 100 cigarettes (aOR = 1.35, 95% CI: 1.23–1.48), BMI < 18.5 (aOR = 1.87, 95% CI: 1.20–2.92), body fat ≥ 26% (aORs = 1.28–1.79), fruit and vegetable intake (<3/day; aORs = 1.24–1.26), and pastry consumption (>1/day; aOR = 1.55, 95% CI: 1.12–1.15) (p < 0.05). Targeting socio-economic and nutritional risk factors may reduce the burden of anxiety disorders in middle and late adulthood.

Gender differences in depression, anxiety, and stress among college students: A longitudinal study from China

BACKGROUND

The objective of this longitudinal study was to examine the gender differences in college students' depression, anxiety, and stress over the four academic years, and to explore possible anxiety-related factors among first year students.

METHODS

The study analyzed 1892 undergraduate students from 15 universities in China, with 898 females and 994 males. The students have been followed for four years and completed a survey containing the Depression Anxiety Stress Scale-21 questionnaire, students' socio-demographic information, and their educational background, etc. RESULTS: (1) On average, both female and male college students suffered from mild anxiety in the first three years. Female students scored significantly higher in anxiety than males in the first and second years, and there was no significant gender difference in students' average depression and stress levels. (2) A significantly larger proportion of female students experienced anxiety above the normal threshold, whereas a higher percentage of male students endured different degrees of depression; no significant gender differences were found in stress problems. (3) Anxiety had a significant positive correlation with introversion. Female freshmen's anxiety levels were also associated with their body image, drinking habits, and academic performance.

LIMITATIONS

Response bias may exist considering that self-reported data was used. Due to data unavailability, we only explored the anxiety-related factors in freshman year, which cannot sufficiently reflect the consistency of correlations over time.

CONCLUSIONS

Anxiety turned out to be the most prevalent and serious issue for college students, especially for female students; while a growing prevalence of depression was found among male students during college. It is of great significance to adopt collegiate policies reflecting the gender differentials.

Impact of the COVID-19 Pandemic on Physical and Mental Health in Lower and Upper Middle-Income Asian Countries: A Comparison Between the Philippines and China

Objective: The differences between the physical and mental health of people living in a lower-middle-income country (LMIC) and upper-middle-income country (UMIC) during the COVID-19 pandemic was unknown. This study aimed to compare the levels of psychological impact and mental health between people from the Philippines (LMIC) and China (UMIC) and correlate mental health parameters with variables relating to physical symptoms and knowledge about COVID-19. Methods: The survey collected information on demographic data, physical symptoms, contact history, and knowledge about COVID-19. The psychological impact was assessed using the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety, and Stress Scale (DASS-21). Findings: The study population included 849 participants from 71 cities in the Philippines and 861 participants from 159 cities in China. Filipino (LMIC) respondents reported significantly higher levels of depression, anxiety, and stress than Chinese (UMIC) during the COVID-19 (p < 0.01) while only Chinese respondents' IES-R scores were above the cut-off for PTSD symptoms. Filipino respondents were more likely to report physical symptoms resembling COVID-19 infection (p < 0.05), recent use of but with lower confidence on medical services (p < 0.01), recent direct and indirect contact with COVID (p < 0.01), concerns about family members contracting COVID-19 (p < 0.001), dissatisfaction with health information (p < 0.001). In contrast, Chinese respondents requested more health information about COVID-19. For the Philippines, student status, low confidence in doctors, dissatisfaction with health information, long daily duration spent on health information, worries about family members contracting COVID-19, ostracization, and unnecessary worries about COVID-19 were associated with adverse mental health. Physical symptoms and poor self-rated health were associated with adverse mental health in both countries (p < 0.05). Conclusion: The findings of this study suggest the need for widely available COVID-19 testing in MIC to alleviate the adverse mental health in people who present with symptoms. A health education and literacy campaign is required in the Philippines to enhance the satisfaction of health information.