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Geprägs A, Bürgin D, Fegert JM, Brähler E, Clemens V. Dealing with the challenges of the pandemic - results of a population-based survey during the second year of the COVID-19 pandemic contrasting benefits and burden. BMC Public Health 2024; 24:1941. [PMID: 39030540 PMCID: PMC11264980 DOI: 10.1186/s12889-024-19203-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 06/19/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND The pandemic and the associated consequences have been ongoing stressors with severe impacts on the population and particularly on families. Research focusing on groups dealing well with the challenges of the pandemic is scarce. Here, we aimed to identify groups being well-adjusted during the pandemic and associated predictors. METHODS A representative sample of the German population (N = 2,515, 51.6% women, 50.09 years), and a subsample of persons with children or adolescents under the age of 18 (N = 453, 60.3% women, 40.08 years) was assessed from July to October 2021. As huge differences in coping with the pandemic are seen, cluster analysis was performed. RESULTS Persons in the "well-adjusted cluster" were characterized by higher quality of life, better coping with the pandemic and lower burden of the pandemic. The family subsample well-adjusted cluster was characterized by lower pandemic-associated burden, lower parental stress compared to before the pandemic and a better relationship with the child. Fewer mental health symptoms and less pandemic-associated negative impact on career predicted membership of the well-adjusted cluster in both samples. An interaction between mental health symptoms and the negative impact of COVID-19 on the career was found. CONCLUSIONS Our results underscore the importance of mental health and work-related factors for coping with the pandemic.
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Affiliation(s)
- Alina Geprägs
- Hospital of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - David Bürgin
- Child and Adolescent Psychiatric Research Department (UPKKJ), Psychiatric University Hospitals, University of Basel, Basel, Switzerland
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Jörg M Fegert
- Hospital of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Elmar Brähler
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center of Johannes, Gutenberg University of Mainz, Mainz, Germany
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Unit, Department of Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
| | - Vera Clemens
- Hospital of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany.
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Radulovic D, Masic S, Stanisavljevic D, Bokonjic D, Radevic S, Rajovic N, Milić NV, Simic Vukomanovic I, Mijovic B, Vukovic M, Dubravac Tanaskovic M, Jojic M, Vladicic Masic J, Spaic D, Milic NM. A Complex Relationship between Quality of Life, Anxiety, and Depression among General Population during Second Year of COVID-19 Pandemic: A Population-Based Study. J Clin Med 2024; 13:3874. [PMID: 38999440 PMCID: PMC11242713 DOI: 10.3390/jcm13133874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/14/2024] Open
Abstract
Background: The COVID-19 pandemic has had a significant impact on the global economy and public health, disrupting various aspects of daily life. Apart from its direct effects on physical health, it has also significantly affected the overall quality of life and mental health. This study employed a path analysis to explore the complex association among multiple factors associated with quality of life, anxiety, and depression in the general population of the Republic of Srpska during the pandemic's second year. Method: A cross-sectional study was conducted on a nationally representative sample (n = 1382) of the general population (adults aged 20+) during the second year of the COVID-19 pandemic in the Republic of Srpska, Bosnia, and Herzegovina. Assessment tools included the DASS-21 scale for depression, anxiety, and stress, along with the Brief COPE scale, Quality of Life Scale (QOLS), and Oslo Social Support Scale (OSSS-3). Sociodemographic factors and comorbidities were also assessed. Structural equation modeling was used to identify the direct and indirect links of various characteristics to quality of life, anxiety, and depression. Results: This study revealed a considerable prevalence of anxiety and depression symptoms (27.5% and 20.9%, respectively), with quality of life playing a significant mediating role. The constructed path model accounted for 33.1% of moderate to severe depression and 79.5% of anxiety. Negative coping was directly linked to anxiety and indirectly to depression via anxiety, while the absence of positive coping had both direct and indirect paths (through quality of life) on depression. Among variables that directly affected depression, anxiety had the highest effect. However, the bidirectional paths between anxiety and depression were also suggested by the model. Conclusions: Pandemic response strategies should be modified to effectively reduce the adverse effects on public mental health. Further research is necessary to assess the long-term effects of the pandemic on mental health and to analyze the contributing factors of anxiety and depression in the post-COVID period.
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Affiliation(s)
- Danijela Radulovic
- Department of Primary Health Care and Public Health, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
| | - Srdjan Masic
- Department of Primary Health Care and Public Health, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
| | - Dejana Stanisavljevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Dejan Bokonjic
- Department of Pediatrics, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
| | - Svetlana Radevic
- Department of Primary Health Care and Public Health, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Nina Rajovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Nikola V. Milić
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivana Simic Vukomanovic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Biljana Mijovic
- Department of Primary Health Care and Public Health, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
| | - Maja Vukovic
- Department of Primary Health Care and Public Health, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
| | - Milena Dubravac Tanaskovic
- Department of Primary Health Care and Public Health, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
| | - Mirka Jojic
- Department of Primary Health Care and Public Health, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
| | - Jelena Vladicic Masic
- Department of Internal Medicine, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
| | - Dragan Spaic
- Department of Primary Health Care and Public Health, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
| | - Natasa M. Milic
- Department of Primary Health Care and Public Health, Faculty of Medicine Foca, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55902, USA
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Coskun AK, Aydin A, Tosun S, To U, Rubman S, Schilsky ML, Zimbrean PC. Wilson Disease and the COVID-19 pandemic: exploring patients' mental health and vaccination attitudes in a longitudinal study. Front Psychol 2024; 15:1326802. [PMID: 38803830 PMCID: PMC11129684 DOI: 10.3389/fpsyg.2024.1326802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction The COVID-19 pandemic significantly impacted the mental health of individuals with chronic conditions such as Wilson's Disease (WD). This study investigates stress, anxiety, depression, quality of life, cognitive function, vaccination rates, infection rates, and perceptions related to the pandemic and vaccines among WD patients. Methods The study analyzed COVID-19 perceptions and vaccine attitudes of 62 adult WD patients enrolled in the international multisite WD Registry. A subgroup of 33 participants completed a series of mental health scales. The effect of working essentially, income loss, wellness activity initiation, and infection of COVID-19 during the pandemic was observed. Results Results indicate that, overall, the pandemic did not exacerbate anxiety or cognitive function in WD patients but did lead to increased depression among essential workers. Patients experiencing income loss exhibited higher levels of stress and anxiety. Despite these challenges, WD patients showed high vaccination rates and positive attitudes towards vaccines. Discussion The findings underscore the significant impact of the pandemic on the mental health of WD patients.
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Affiliation(s)
- Ayse K. Coskun
- Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Adem Aydin
- Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Sumeyra Tosun
- Medgar Evers College, CUNY, Brooklyn, NY, United States
| | - Uyen To
- Medicine and Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Susan Rubman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Michael L. Schilsky
- Medicine and Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Paula C. Zimbrean
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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Zvolensky MJ, Bakhshaie J, Redmond BY, Smit T, Nikčević AV, Spada MM, Distaso W. Coronavirus Anxiety, COVID Anxiety Syndrome and Mental Health: A Test Among Six Countries During March 2021. Clin Psychol Psychother 2024; 31:e2988. [PMID: 38654488 PMCID: PMC11200194 DOI: 10.1002/cpp.2988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024]
Abstract
The negative impact of the COVID-19 pandemic on mental health outcomes is widely documented. Specifically, individuals experiencing greater degrees of severity in coronavirus anxiety have demonstrated higher levels of generalized anxiety, depression and psychological distress. Yet the pathways in which coronavirus anxiety confers vulnerability are not well known. The present investigation sought to address this gap in the scientific literature by testing the indirect effect of the COVID-19 anxiety syndrome, which centres on the function of detecting and managing the environmental threat of virus exposure and its sequalae. Data were collected during the height of the pandemic (March 2021) and included 5297 adults across six countries. Structural equation modelling techniques revealed that the COVID-19 anxiety syndrome evidenced a statistically significant indirect effect between coronavirus anxiety and generalized anxiety, depression and work/social adjustment. Overall, results suggest there could be public health merit to targeting anxiety related to virus exposure to improve behavioural health for those who are struggling with excessive fear and worry.
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Affiliation(s)
- Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
| | - Jafar Bakhshaie
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brooke Y. Redmond
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Ana V. Nikčević
- Department of Psychology, Kingston University, Kingston upon Thames, UK
| | | | - Walter Distaso
- Imperial College Business School, Imperial College London, London, UK
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Koschollek C, Bartig S, Müters S, Goßner L, Bug M, Goerigk L, Hövener C, Kajikhina K. [People with a history of migration in the COVID-19 pandemic : Associations between life satisfaction and indirect socioeconomic effects of the pandemic]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023:10.1007/s00103-023-03741-0. [PMID: 37474794 PMCID: PMC10371942 DOI: 10.1007/s00103-023-03741-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/21/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION It is not only the risks of SARS-CoV‑2 infection and severe to fatal courses of the disease that are socially unequally distributed, but also job and income losses as a result of the containment measures. People with a history of migration are at increased risk of being affected by such indirect socio-economic effects of the pandemic as well. The aim of this article is to investigate the associations between indirect socio-economic effects of the pandemic and life satisfaction among people with selected citizenships. METHODS We analysed data from the multilingual and multimodal interview survey German Health Update Fokus (Gesundheit in Deutschland aktuell: Fokus; GEDA Fokus), which was conducted from November 2021 to May 2022 among people all over Germany with Croatian, Italian, Polish, Syrian or Turkish citizenship. Using multivariable Poisson regression, we analysed associations between sex, age, education, income, German language proficiency and job as well as income losses and life satisfaction. RESULTS Of the 4114 participants, 64.4% reported a high life satisfaction. While a higher income showed positive associations with life satisfaction, negative associations were found for lower self-assessed German language proficiency and for job and income losses that are anticipated or have already occurred. DISCUSSION This article shows that life satisfaction, which is relevant for multiple health outcomes, is lower among those that are affected by job and income losses. Structural causes of socio-economic disadvantages need to be reduced to address health inequalities and to be better prepared for future crises.
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Affiliation(s)
- Carmen Koschollek
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland.
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Fachgebiet 28 Soziale Determinanten der Gesundheit, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland.
| | - Susanne Bartig
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Stephan Müters
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Laura Goßner
- Institut für Arbeitsmarkt- und Berufsforschung, Nürnberg, Deutschland
| | - Marleen Bug
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Lena Goerigk
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Claudia Hövener
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Katja Kajikhina
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
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6
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Geprägs A, Bürgin D, Fegert JM, Brähler E, Clemens V. Parental stress and physical violence against children during the second year of the COVID-19 pandemic: results of a population-based survey in Germany. Child Adolesc Psychiatry Ment Health 2023; 17:25. [PMID: 36804027 PMCID: PMC9940081 DOI: 10.1186/s13034-023-00571-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/01/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Parents and caregivers belonged to those with the highest burdens during the COVID-pandemic. Considering the close link between parental stress and child maltreatment, identifying families with high parental stress is of utmost importance to prevent violence against children. Within this study, we thus aimed to investigate the interplay of parental stress, changes in parental stress, and physical violence against children during the second year of the COVID-pandemic on an exploratory level. METHODS We conducted a cross-sectional, observational study in Germany from July to October 2021. By using different sampling steps, a representative probability sample of the German population was generated. A subsample of these participants with children under the age of 18 was included for analysis within this study (N = 453, 60.3% females, Mage = 40.08; SD = 8.53). RESULTS Higher parental stress levels were associated with more physical violence against children, higher levels of own experiences of child maltreatment, and mental health symptoms. An increase in parental stress during the pandemic was associated with female sex, the use of physical violence against children, and parental experience of child maltreatment. Parents who have ever used physical violence against their children have been characterized by higher parental stress levels, a stronger increase in parental stress during the pandemic, own experience of child maltreatment, mental health symptoms and sociodemographic characteristics. Higher parental stress levels, a stronger increase of parental stress during the pandemic, having pre-existing psychiatric disorders, and parental experience of child maltreatment predicted an increased use of physical violence against children during the pandemic. CONCLUSIONS Our results underscore the importance of parental stress for the risk of physical violence against children, more so in times of overall increased stress due to the pandemic and underline the need for low threshold support for families at risk in times of crises.
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Affiliation(s)
- Alina Geprägs
- grid.6582.90000 0004 1936 9748Hospital of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - David Bürgin
- grid.6582.90000 0004 1936 9748Hospital of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany ,grid.6612.30000 0004 1937 0642Child and Adolescent Psychiatric Research Department (UPKKJ), Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Jörg M. Fegert
- grid.6582.90000 0004 1936 9748Hospital of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Elmar Brähler
- grid.410607.4Department for Psychosomatic Medicine and Psychotherapy, University Medical Center of Johannes Gutenberg University of Mainz, Mainz, Germany ,grid.9647.c0000 0004 7669 9786Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Unit, Department of Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
| | - Vera Clemens
- Hospital of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany.
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Aveiro-Róbalo TR, Garlisi-Torales LD, Chumán-Sánchez M, Pereira-Victorio CJ, Huaman-Garcia M, Failoc-Rojas VE, Valladares-Garrido MJ. Prevalence and Associated Factors of Depression, Anxiety, and Stress in University Students in Paraguay during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12930. [PMID: 36232228 PMCID: PMC9566452 DOI: 10.3390/ijerph191912930] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 06/01/2023]
Abstract
We aimed to determine the prevalence of depression, anxiety, and stress in university students in Paraguay during the COVID-19 pandemic. A cross-sectional study was conducted among 293 students from four universities in Paraguay in 2021. The DASS-21 mental health scale was used to measure the outcomes (depression, anxiety, and stress) and evaluate their association with socio-educational variables. A total of 77.1% of the participants were women and 136 (46.4%) were between 21 and 25 years old. The prevalence of depression, anxiety, and stress was 74.7%, 87.4%, and 57%, respectively. We found that being a woman and studying at a public university was positively associated with depression, anxiety, and stress. Receiving COVID-19 training increases the prevalence of mental health problems. In conclusion, high levels of anxiety, depression, and stress were found in university students during the COVID-19 pandemic. Being a woman, studying at a public university, and receiving training on COVID-19 were factors associated with a higher prevalence of presenting all the mental health problems evaluated. Furthermore, students aged 31 and over had a higher prevalence of depression and stress.
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Affiliation(s)
| | | | - Marisella Chumán-Sánchez
- Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Escuela de Medicina, Universidad San Martín de Porres, Chiclayo 14012, Peru
| | | | | | - Virgilio E. Failoc-Rojas
- Research Unit for Generation and Synthesis Evidence in Health, Universidad San Ignacio de Loyola, Lima 15024, Peru
| | - Mario J. Valladares-Garrido
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima 15046, Peru
- Epidemiology Office, Hospital Regional Lambayeque, Chiclayo 14012, Peru
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Szemik S, Gajda M, Gładyś A, Kowalska M. The Association between COVID-19 Pandemic and the Quality of Life of Medical Students in Silesian Voivodeship, Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11888. [PMID: 36231191 PMCID: PMC9565595 DOI: 10.3390/ijerph191911888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Since the COVID-19 pandemic spread rapidly in 2020, medical universities have been affected by a particular crisis. Due to the increased risk of SARS CoV-2 transmission, the authorities of medical faculties all over the world, including Poland, started to minimize direct contact between students. The objective of the paper is to identify and assess determinants of the quality of life among medical students in Poland before and during the COVID-19 pandemic. (2) Methods: We analyzed data obtained in a cross-sectional study performed among three groups of students tested in three consecutive research periods: period before the COVID-19 pandemic, the COVID-19 pandemic lockdown period and the COVID-19 pandemic period following lockdown. (3) Results: The total number of participants was 1098. We identified that the research period before the COVID-19 pandemic was the risk factor for lower quality of life in terms of the somatic and environmental domains. It was also confirmed that determinants such as poor financial situation, low frequency of physical activity and bad self-declared health status harmed the QoL scores in all domains. (4) Conclusions: The obtained results confirmed that better financial situation, higher physical activity and better self-declared health status were statistically significant factors improving the quality of life of first-year medical students in Poland. The findings of our study also showed that the declared somatic and environmental domains of QoL among medical students were better during the COVID-19 pandemic period. Our observations confirmed that the immediate implementation of e-learning could protect against the deterioration of mental health and quality of life in first-year medical students during possible future epidemic crises.
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Affiliation(s)
- Szymon Szemik
- Department of Nursing Propaedeutics, School of Health Sciences, Medical University of Silesia, 40-027 Katowice, Poland
| | - Maksymilian Gajda
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Aleksandra Gładyś
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Małgorzata Kowalska
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
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