The Coronavirus Disease 2019 Pandemic in Taiwan: An Online Survey on Worry and Anxiety and Associated Factors

Understanding the mental health impacts of biological disasters: Lessons from Taiwan's experience with COVID-19

Biological disasters pose a growing challenge in the 21st century, significantly impacting global society. Taiwan has experienced such disasters, resulting in long-term consequences like loss of life, trauma, economic decline, and societal disruptions. Post-disaster, mental health issues such as fear, anxiety, depression, post-traumatic stress disorder (PTSD), and stress surge, accompanied by increased suicide rates. The Coronavirus disease 2019 (COVID-19) (also called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) pandemic, recognized as a biological disaster, triggered lockdowns and quarantines in Taiwan, causing lifestyle changes, economic recession, and so on. These shifts may elevate uncertainty about the future, intensifying mental stress and leading to a rise in various mental illnesses. This article reviews mental health studies conducted in Taiwan during the pandemic, emphasizing the need to integrate this research for future preparedness and interventions regarding the mental health impacts of biological disasters, including COVID-19. Further research is essential to explore long-term effects, interventions, and generalizability.

A longitudinal study on the change in sleep across three waves of the COVID-19 outbreaks in Hong Kong

In the year 2020, Hong Kong experienced four COVID-19 epidemic waves. The present study aimed to examine the transition of sleep disturbances and explore its associated factors across the later three epidemic waves. Among the 1138 respondents who participated in an online survey at the second wave (T1, April 2020), 338 and 378 participants also completed a follow-up at the third (T2, August 2020) and fourth waves (T3, December 2020), respectively. Participants completed the Insomnia Severity Index and an investigator-designed questionnaire regarding potential factors associated with sleep change such as perceived risk of being infected, economic stress, and confidence in the government and health care professional. Sample of this study were mainly female (67.7%), married (50.3%), young adults (54.2%) with tertiary education (81.6%). Maintaining normal sleep was the most prevalent trajectory of sleep of all three waves (50.5%), followed by persistent insomnia (17.2%) and remitted insomnia (9.0%). Besides female, older-age and lower education level, the results showed that increment in worry about family being infected (adjusted risk ratio, RR = 1.28), perceived interference of daily lives (adjusted RR = 1.19), and economic distress (adjusted RR = 1.24) were significantly associated with the development of clinical insomnia during the three epidemic waves. These factors were also associated with worsening of other sleep parameters. Insomnia being persistent across the three waves of COVID-19 outbreaks was common. Increasing economic distress, daily interference, and worry about family members being infected were associated with an increasing risk of clinical insomnia across the three COVID-19 outbreaks.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41105-023-00486-w.

Between existential mobility and intimacy 5.0: translocal care in pandemic times

The COVID-19 pandemic has reconfigured every social, political, economic and cultural aspect of modern society. Millions of people have been stuck in lockdown within and across borders, national and regional terrains, in their homes and worse places. At this time of unprecedented change and 'stuckedness', digital communication technologies have served as a lifeline to forge and nurture communication, intimate ties and a sense of continuity and belongingness. But being stuck and simultaneously virtually mobile has brought many difficulties, tensions and paradoxes. In this paper we discuss first insights from a study with 15 members of the older Culturally and Linguistically Diverse (CALD) population in Victoria, Australia to explore experiences of being physically stuck and virtually mobile. We find practices of translocal care - ways of caring for distant others through digital technologies, has been made more complex by the pandemic and shaped by two dynamics: networked collective 'existential mobility', and a quantification of feeling that we call 'intimacy 5.0'.

Prevalence of anxiety during the COVID-19 pandemic: A systematic review and meta-analysis of over 2 million people

INTRODUCTION

Uncertainty, disruptions in daily routines, and concerns for the health and well-being during the COVID-19 pandemic are likely associated with increases in generalized anxiety. The present study aimed to systematically review the literature in order to identify the update prevalence of anxiety in the general population during the COVID-19 pandemic.

METHODS

A systematic review and meta-analysis. It included studies that assessed the prevalence of anxiety among the general population during the COVID-19 pandemic.

RESULTS

In total, we included 194 studies. The general prevalence of anxiety was 35.1 %, affecting approximately 851,000 participants. The prevalence in low and middle-income countries (35.1 %; 95%CI: 29.5 % to 41.0 %) was similar compared to high-income countries (34.7 %; 95%CI: 29.6 % to 40.1 %). In studies that provided the proportion of cases in each level of anxiety disorder, mild-to-moderate anxiety affected one quarter of the participants. One in ten cases with anxiety during the COVID-19 may be living with severe or extremely anxiety disorder. Most instruments estimated similar prevalence of anxiety disorders with notable difference in the prevalence estimated by the Generalized Anxiety Disorder 2-item (GAD-2), Zung Self-Rating Anxiety Scale (SAS), and State-Trait Anxiety Inventory (STAI).

CONCLUSION

One in three adults were living with anxiety disorder during the COVID-19 pandemic worldwide.

Exploring digital natives' mobile addiction syndrome in Taiwan: psychological issues and beyond

Purpose

This study seeks to explore digital natives' mobile usage behaviors and, in turn, develop an analytic framework that helps articulate the underlying components of mobile addiction syndrome (MAS), its severity levels and mobile usage purposes.

Design/methodology/approach

The investigation adopts a survey method and a case study. The results of the former are based on 411 random classroom observations and 205 questionnaire responses, and the insights of the latter are derived from 24 interviews and daily observations.

Findings

The findings validate five distinctive signs that constitute MAS and their significant correlations with each of the Big Five personality traits. Classroom observations confirm the prevalence of addiction tendency among digital natives in the research context. Seven levels of MAS and six different mobile usage purposes further manifest themselves from case analysis. There appears to be a sharp contrast between the addicted and non-addicted groups in their mobile purposes and behavioral patterns. Additionally, family relationships seem influential in shaping non-addictive mobile usage behaviors.

Research limitations/implications

Psychological perspectives on MAS may be important but insufficient. Empirical investigation on a global scale, especially with distinctive cross-cultural comparisons, will be highly encouraged. How MAS evolves over time should also serve as future research interests.

Practical implications

Teaching pedagogy of college education might need certain adjustments to intrigue digital natives' learning interests. Future managers might also need to adopt better performance measurements for digital natives who barely separate work from personal matters in their mobile devices.

Social implications

Parents and healthcare institutions may need to develop response mechanism to tackle this global issue at home and in society. The long-term effects of the COVID-19 pandemic on MAS might also deserve global attention.

Originality/value

The analytic framework developed provides an original mechanism that can be valuable in identifying MAS severity and associated behavioral patterns.

COVID-19 Worry and Mental Health Among the Economically Active Population in Guangdong, China

Background

The rapid spread of the coronavirus disease 2019 (COVID-19) pandemic has caused people to worry, which has affected their mental health. This study aimed to access the impact of COVID-19 worry on the mental health of the economically active population (EAP) in a province of China.

Methods

An online cross-sectional survey study was conducted during an outbreak of COVID-19 in Guangdong, China. The survey used the 12-item General Health Questionnaire (GHQ-12) to evaluate participants' mental health status and was completed by 1,584 of the 1,708 participants (a response rate of 92.74%). Ordinary least squares (OLS) regression models were used to identify the correlation between COVID-19 worry and mental health.

Results

Approximately 42.05% of participants reported that they were very worried or extremely worried about the COVID-19 pandemic. COVID-19 worry was negatively correlated with mental health (p < 0.01) and exhibited a stronger influence on the mental health of participants who were male, younger (aged 16–45), or unemployed than on the mental health of participants who were women, older (aged over 45), or employed.

Conclusion

The findings suggest that COVID-19 worry has generated new inequalities in mental health among the EAP of China. The government should provide more public reassurance and psychological support to the EAP to mitigate the effects of COVID-19 worry and prevent mental health disorders.

Who Is the Most Vulnerable to Anxiety at the Beginning of the COVID-19 Outbreak in China? A Cross-Sectional Nationwide Survey

(1) Background: The COVID-19 pandemic has not only changed people’s health behavior, but also induced a psychological reaction among the public. Research data is needed to develop scientific evidence-driven strategies to reduce adverse mental health effects. The aims of this study are to evaluate the anxiety reaction of Chinese people and the related determinants during the earliest phase of the COVID-19 outbreak in China. Evidence from this survey will contribute to a targeted reference on how to deliver psychological counseling service in the face of outbreaks. (2) Methods: A cross-sectional, population-based online survey was conducted from 28 January to 5 February 2020 using an open online questionnaire for people aged 18 years or above, residing in China and abroad. The socio-demographic information of the respondents was collected, and anxiety scores were calculated. A direct standardization method was used to standardize anxiety scores and a general linear model was used to identify associations between some factors (e.g., sex, age, education, etc.) and anxiety scores. (3) Results: A total of 10,946 eligible participants were recruited in this study, with a completion rate of 98.16% (10,946/11,151). The average anxiety score was 6.46 ± 4.12 (total score = 15); women (6.86 ± 4.11) scored higher than men (5.67 ± 4.04). The age variable was inversely and significantly associated with the anxiety score (β = −2.12, 95% CI: −2.47–−1.78). People possessing higher education (β = 1.15, 95% CI: 0.88–1.41) or a higher awareness of cognitive risk (β = 4.89, 95% CI: 4.33–5.46) reported higher levels of anxiety. There was a close association between poor subjective health and anxiety status (β = 2.83, 95% CI: 2.58–3.09). With the increase of confidence, the anxiety of the population exhibited a gradual decline (β = −2.45, 95% CI: −2.77–−2.13). (4) Conclusion: Most people were vulnerable to anxiety during the earliest phase of the COVID-19 outbreak in China. Younger women, individuals with high education, people with high cognitive risk and subjective poor health were vulnerable to anxiety during the epidemic. In addition, increasing confidence in resisting this pandemic is a protective determinant for individuals to develop anxiety. The findings suggest that policymakers adopt psychosocial interventions to reduce anxiety during the pandemic.

Religiosity, Emotions, Resilience, and Wellness during the COVID-19 Pandemic: A Study of Taiwanese University Students

One hard fact of COVID-19 is the uncertainty of all things. Anchoring on the assumption that the religiosity of an individual has a profound impact on their emotions, resilience, and wellness, this study investigated the levels of the centrality of religiosity, emotions towards God, resilience, and wellness among 399 Taiwanese university students. Data analysis included descriptive statistics, factor analysis, group comparisons, multiple regression, and mediation analysis. Findings showed that most of the participants were religious. Furthermore, the 16 emotions towards God were successfully factored into three distinct sub-groups, namely: pleasant, unpleasant, and moral valence, which were later found to be quite related to Asian religions. More importantly, the results suggested that the resiliency of an individual can be attributed to their belief in the existence of God or the Divine, while the wellness indicators of security and satisfaction were related to one’s religiosity. Lastly, structural equation modeling showed that resilience fully mediated the relationship between the ideology dimension of religiosity and the security and satisfaction component of wellness. In addition to discussing these significant results, this paper also included some implications of the study results, particularly the importance of religiosity and emotions toward God or the Divine in sustaining resilience and promoting wellness, especially in the context of crisis, such as the current COVID-19 pandemic.

Impact of Changed Use of Greenspace during COVID-19 Pandemic on Depression and Anxiety

The COVID-19 pandemic has had devastating consequences for health, social, and economic domains, but what has received far less focus is the effect on people's relationship to vital ecological supports, including access to greenspace. We assessed patterns of greenspace use in relation to individual and environmental factors and their relationship with experiencing psychological symptoms under the pandemic. We conducted an online survey recruiting participants from social media for adults in Korea for September-December 2020. The survey collected data on demographics, patterns of using greenspace during the pandemic, and major depression (MD) and generalized anxiety disorder (GAD) symptoms. The Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder 2-item (GAD-2) were applied to identify probable cases of MD and GAD. A logistic regression model assessed the association decreased visits to greenspace after the outbreak compared to 2019 and probable MD and GAD. Among the 322 survey participants, prevalence of probable MD and GAD were 19.3% and 14.9%, respectively. High rates of probable MD (23.3%) and GAD (19.4%) were found among persons currently having job-related and financial issues. Of the total participants, 64.9% reported decreased visits to greenspace after the COVID-19 outbreak. Persons with decreased visits to greenspace had 2.06 higher odds (95% CI: 0.91, 4.67, significant at p < 0.10) of probable MD at the time of the survey than persons whose visits to greenspace increased or did not change. Decreased visits to greenspace were not significantly associated with GAD (OR = 1.45, 95% CI: 0.63, 3.34). Findings suggest that barriers to greenspace use could deprive people of mental health benefits and affect mental health during pandemic; an alternative explanation is that those experiencing poor mental health may be less likely to visit greenspaces during pandemic. This implies the need of adequate interventions on greenspace uses under an outbreak especially focusing on how low-income populations may be more adversely affected by a pandemic and its policy responses.

Protocol for the Implementation and Assessment of "MoodUP": A Stepped Care Model Assisted by a Digital Platform to Accelerate Access to Mental Health Care for Cancer Patients Amid the COVID-19 Pandemic

The COVID-19 pandemic has important consequences for the mental health of populations. Patients with cancer, already at risk for poor mental health outcomes, are not expected to be spared from these consequences, prompting the need for health services to improve responsiveness. This article presents the research protocol for an implementation study designed to describe the uptake of a well-studied and recognized system for the treatment of depression and anxiety (Stepped-care) during the specific context of a Pandemic in an oncological site. The system set-up will be assisted by a digital platform (MoodUP), where patients undergoing cancer treatment will be screened for anxiety and depressive symptoms, triaged by severity level and algorithm-matched to recommended interventions. Patients undergoing cancer treatment at a cancer clinic in Portugal will be invited to subscribe to the MoodUP platform where they will complete a self-reported questionnaire (Hospital Anxiety and Depression Scale) to screen their anxiety and depressive symptoms. Data will be instantly collected, and an algorithm will activate severity-matched intervention suggestions, through a case manager that will coordinate care. The specific objectives of this study will be to describe the implementation and acceptability of the care system by patients and staff, the barriers to and facilitators of implementation, the proportion of patients accessing the system and their pathways through the various stepped-care interventions, and patient perceptions regarding the feasibility and appropriateness of the eHealth platform. Moreover, exploratory analyses will be conducted to describe patterns of anxiety and depression symptoms variation across all patients, as well as within sociodemographically, clinically and contextually characterized subgroups, to characterize their care needs and access, as well as to explore for whom the MoodUP care system may be more appropriate. This study is expected to improve processes for collaborative mental healthcare in oncology and accelerate the digitalization of services, towards the improvement of mental healthcare access, and management of high-risk patients, during the COVID-19 pandemic.