The effects of COVID-19 stay-at-home order on sleep, health, and working patterns: a survey study of US health care workers

Practice and Challenges of Bangladeshi Occupational Therapists during COVID-19: A Cross-Sectional Survey

This descriptive study describes the practice and challenges of occupational therapists in Bangladesh during the COVID-19 pandemic using an online survey. Eighty-four participants who are practising in both clinical and community settings anonymously participated in the study between January - March 2021. About a third (38.5%) of participants continued hands-on service, 29.5% started working from home, 19.2% worked in both methods, and 12.8% stopped working and almost 12% commenced telerehabilitation service as a new practice. This paper describes the practice as well as the different challenges. Implications of the results are explored as well as future needs.

Differentiating the relationships between traditional and new media use and sleep quality during the COVID-19 pandemic: roles of psychological distress and age

Background

Numerous studies have consistently demonstrated a decline in sleep quality during the COVID-19 pandemic. The primary objective of this study is to explore the impact of engaging with pertinent epidemic information through the media amid the COVID-19 crisis on individuals' sleep quality and the underlying mechanisms through which this influence operates.

Methods

An online cross-sectional study design was employed. A total of 1,063 British adults (36.2% males; M age = 38.85, SD age = 13.36, ranging from 18 to 77 years old) participated in the study and completed our questionnaires, which included media usage frequency during the pandemic, the 10-item Kessler Psychological Distress Scale (K10), the Insomnia Severity Index (ISI), and the Ten-item Personality Inventory (TIPI).

Results

Pearson's correlation analyses indicated that there was no significant correlation between COVID-19-related traditional media use (television, radio, newspaper) and psychological distress or sleep quality. However, exposure to information related to COVID-19 through new media use (Facebook, Tik Tok, Twitter) was correlated with greater psychological distress and poorer sleep quality. A moderated mediation analysis showed that psychological distress fully mediated the relationship between new media use and poor sleep, which was moderated by age, with the association between psychological distress and poor sleep quality being stronger among older adults.

Conclusion

Exposure to information of COVID-19 via new (but not traditional) media use deteriorated sleep quality through greater psychological distress, and this relationship was stronger among older adults.

How teleworking adoption is changing the labor market and workforce dynamics?

This article investigates how teleworking adoption influenced the labor market and workforce dynamic using bibliometric methods to overview 86 years of teleworking research [1936-2022]. By grouping the retrieved articles available on the Web of Science (WOS) core collection database, we revealed a holistic and topical view of teleworking literature using clustering and visualization techniques. Our results reflect the situation where the adoption of teleworking in the last three years was accelerated by the pandemic and facilitated by innovation in remote work technologies. We discussed the factors influencing one's decision to join the workforce or a specific company, besides the unintended consequences of the rapid adoption of teleworking. The study can aid organizations in developing adequate teleworking arrangements, enhancing employee outcomes, and improving retention rates. Furthermore, it can help policymakers design more effective policies to support employees, improve labor force participation rates, and improve societal well-being.

Poor sleep quality and its associated factors among working adults during COVID-19 pandemic in Malaysia

Background

In Malaysia, a nationwide movement control order (MCO), implemented to curb the COVID-19 spread, impacted on the lives of the working population which could impair sleep quality.

Objective

This study aims to find the sleep quality status and its association with the socioeconomic, employment and lifestyle factors of working adults during the MCO period.

Methods

A cross-sectional study was conducted among 500 eligible working adults. Data were collected using a structured questionnaire consisting of the Pittsburg Sleep Quality Index.

Results

The proportion of poor sleep quality is found to be 59.4%. Analysis shows that the use of electronic devices before sleep (OR = 2.33, 95% CI = 1.02-5.35, p-value = 0.046), increased amount of workload (OR = 0.45, p-value = 0.005), decreased in amount of workload (OR = 0.48, p-value = 0.003) and distracted while working (OR = 0.57, p-value = 0.014) are the factors significantly associated with and are predictors of poor sleep quality.

Conclusion

During crisis, there is a need for public health interventions for the working population to adopt a healthy lifestyle. Employers are recommended to support employees' well-being and to provide a healthy workplace during challenging times. Policy recommendations are also made to implement flexible working arrangements, workload management, workplace mental health support and legal protections on reasonable working hours, rest breaks and time off during crises.

The early-stage impacts of shock events on adult sleep: Lessons from the COVID-19 pandemic

The present study aims to estimate the early-stage association of the coronavirus disease 2019 (COVID-19) pandemic with sleep duration, 4 months after the initial outbreak, at a national level. Using the China Family Panel Studies in 2018 and its follow-up in 2020, 16,563 adult participants were analyzed in our study. The first wave transmissibility of the COVID-19 pandemic in mainland China was used as a quasi-natural experiment. The difference in difference method was employed to compare variations across participants interviewed before or after the pandemic and between groups from provinces with different COVID-19 severity. The study observed a decline in workday sleep duration among adults, regardless of their employment status. Specifically, working adults experienced a significant decrease in sleep duration on work days (-1.54, 95% confidence interval -2.16 to -0.92), alongside an increase on work-free days (2.41, 1.56-3.24), leading to a wider sleep discrepancy in sleep patterns (3.95, 3.31-4.59). Noteworthy, working-age adults (-2.00, -2.79 to -1.22) and males (-3.31, -4.31 to -2.30) exhibited greater sleep decreases on work days, whereas females exhibited a more pronounced disparity in sleep patterns (6.18, 4.73-7.63) between work and work-free days. The pandemic is significantly associated with prolonged changes in adults' sleep duration, including sleep decreases on work days and catch-up sleep on work-free days for working adults. To prepare for future global emergencies, the government may need to promote resilience to mitigate the pandemic's adverse impacts on the working population. Guaranteeing adequate sleep among working adults and reducing sleep debt should be prioritized in such efforts.

Organizational and occupational health issues with working remotely during the pandemic: a scoping review of remote work and health

BACKGROUND

Stay-at-home orders during the COVID-19 global pandemic created unprecedented challenges for workers whose work was transferred to the home setting. Little is presently known about the benefits and the challenges associated with global remote work on well-being and mental health, work-life balance, job satisfaction, productivity, home office adaptability, and gender equality.

METHODS

A scoping review of PubMed/Medline was undertaken in October 2021 to better understand these broad dimensions associated with remote worker health, well-being, and the home office workspace. The review focused on white-collar workers who undertook remote work during each of the lockdown waves from March 2020 to 2021.

RESULTS

A total of 62 studies were included in the review, which spanned Asia, North America, South America, and Europe. Overall, workers seemed to enjoy remote work, but productivity varied. The main setbacks associated with remote work included feelings of isolation and loneliness, which negatively influenced well-being. Social support from management and contact with colleagues mitigated this. Leadership style also influenced remote worker well-being. Overall, women suffered from lower levels of remote work well-being and productivity, especially if they had children. The home office and its adaptability were integral for successful remote work. Work-life balance was affected in some workers who struggled with heavier workloads or family duties.

CONCLUSIONS

To promote well-being and successful remote work, isolation and loneliness should be reduced through greater contact with colleagues and managers. Managers should promote family friendly policies that may support work-life balance and reduce gender inequities in remote work.

The impact of COVID-19 on nurse alcohol consumption: A qualitative exploration

AIMS AND OBJECTIVES

To explore the long-term impact of the COVID-19 pandemic on nurse alcohol consumption.

BACKGROUND

The COVID-19 pandemic has caused immense disruption to healthcare services worldwide, and nurses have not been immune, experiencing burnout, declining mental health and ultimately, attrition from the profession. Increases in alcohol consumption have been reported across subsections of society, including those with pre-existing mental ill health and experiencing high stress, and exploring this phenomenon in nurses is essential for workforce well-being and sustainability.

DESIGN

Qualitative descriptive study design.

METHODS

Secondary analysis of individual, semi-structured interviews with nurses (N = 42) from diverse settings across Australia, including community, primary and hospital settings, conducted in July and August 2021. Data were analysed using structural coding and reported in accordance with the CORE-Q guidelines.

FINDINGS

Two key themes were found after analysis of the data: (1) factors influencing alcohol consumption (subthemes: workplace factors and external factors), and (2) the pandemic's influence on alcohol consumption (subthemes: increased consumption, moderation of consumption and alcohol as a reward).

CONCLUSIONS

Several participants described increased alcohol consumption because of the COVID-19 pandemic, particularly due to the stress of working in an environment where resources were scarce. Workplace factors such as overtime, missed breaks and heightened workload were all described as driving stress, and in turn increased alcohol consumption.

RELEVANCE TO CLINICAL PRACTICE

Increased alcohol consumption has been associated with burnout, absenteeism and intention to leave. The nursing profession is currently undergoing significant continuing stress providing care and management to patients with the SARS-CoV-2 virus, and increased alcohol consumption is a significant threat to personal and workforce well-being, workforce sustainability and quality nursing care.

Changes in self-reported cannabis use during the COVID-19 pandemic: a scoping review

BACKGROUND

The COVID-19 pandemic is affecting mental health and substance use (MHSU) issues worldwide. The purpose of this study was to characterize the literature on changes in cannabis use during the pandemic and the factors associated with such changes.

METHODS

We conducted a scoping review by searching peer-reviewed databases and grey literature from January 2020 to May 2022 using the Arksey and O'Malley Framework. Two independent reviewers screened a total of 4235 documents. We extracted data from 129 documents onto a data extraction form and collated results using content analytical techniques.

RESULTS

Nearly half (48%) of the studies reported an increase/initiation of cannabis use, while 36% studies reported no change, and 16% reported a decrease/cessation of cannabis use during the pandemic. Factors associated with increased cannabis use included socio-demographic factors (e.g., younger age), health related factors (e.g., increased symptom burden), MHSU factors (e.g., anxiety, depression), pandemic-specific reactions (e.g., stress, boredom, social isolation), cannabis-related factors (e.g., dependence), and policy-related factors (e.g., legalization of medical/recreational cannabis).

CONCLUSION

Public health emergencies like the COVID-19 pandemic have the potential to significantly impact cannabis use. The pandemic has placed urgency on improving coping mechanisms and supports that help populations adapt to major and sudden life changes. To better prepare health care systems for future pandemics, wide-reaching education on how pandemic-related change impacts cannabis use is needed.

Poor Sleep Quality and Working From Home Influence the Prevalence of Leisure Time Physical Inactivity During the COVID-19 Pandemic: COVID-Inconfidentes Study

OBJECTIVE

The aim of the study is to explore possible associations according to quality of sleep and work from home (WFH) with physical inactivity (PI) during the COVID-19 pandemic.

METHODS

This is a cross-sectional study in two Brazilian cities (>18 years), by probability sampling. Leisure-time physical activity was self-reported and classified according to guidelines. Sleep was by applying the Pittsburgh Sleep Quality Index. Work from home was classified as: total WFH or no WFH.

RESULTS

A total of 1750 adults were analyzed, 69.1% were physically inactive, 51.9% had poor sleep quality, and 79.8% were not in WFH. PI was associated with poor sleep quality and non-WFH. Compared with those who reported WFH and good sleep quality, those who reported non-WFH and poor sleep quality had 4 times the prevalence of PI.

CONCLUSIONS

Poor sleep quality, and not WFH, is associated with leisure PI. These factors combined increase the probability of PI.

A longitudinal study of how women's prenatal and postnatal concerns related to the COVID-19 pandemic predicts their infants' social-emotional development

Infant social-emotional development may be impacted by the COVID-19 pandemic. This study investigated associations between maternal pre- and postnatal pandemic-related concerns and social-emotional developmental risk. Data, collected in 2020-2021, came from 220 mothers (87% white, 6% Hispanic, 1% Black, 3% Asian, 1% American Indian, Mage  = 32.46 years), and infants (53.18% male, Mage  = 12.98 months) in the United States. Maternal postnatal pandemic-related concerns were associated with total risk scores (B = 6.09, p-value <.001) and offspring risk of scoring positive for problems related to inflexibility (B = 4.07, p-value = .006). The total score association was moderated by self-reported social support. Infants may be detrimentally impacted by the pandemic via maternal pandemic-related concerns. Maternal social support may buffer infants.

Combined effect of work from home and work during nonwork time on sleep disturbance

Background

Owing to the coronavirus disease 2019 pandemic, being exposed to work from home and work during nonwork time simultaneously can lead to sleep disturbance; however, their combined effect is unclear. We aimed to investigate the combined effect of work from home and work during nonwork time on sleep disturbance.

Methods

This study used data from the Sixth Korean Working Condition Survey and included 27,473 paid workers. Logistic regression analysis was conducted to investigate the relationship between work from home, work during nonwork time, and sleep disturbance according to sex. We re-classified participants into 4 groups based on their working from home (No/Yes) and working during nonwork time (No/Yes). The relative excess risk due to interaction was calculated to examine the effect of exposure to both telecommuting and non-regular work hours on sleep disturbance.

Results

Workers exposed to work from home and work during nonwork time had significantly higher risks of sleep disturbance for all, men, and women workers (OR [95% CI]: 1.71 [1.46-2.02], 1.79 [1.43-2.23], and 1.64 [1.29-2.08] for work from home and 3.04 [2.70-3.42], 3.61 [3.09-4.22], and 2.41 [2.01-2.90] for work during nonwork time, respectively). Compared to those who were not exposed to both factors, when workers had both job factors, the ORs (95% CI) of sleep disturbance for all, men, and women were 3.93 (2.80-5.53), 5.08 (3.21-8.03), and 2.91 (1.74-4.87), respectively. The relative excess risk due to interaction of work from home and work during nonwork time was not significant for sleep disturbance.

Conclusions

Work from home and work during nonwork time were each associated with sleep disturbance, but the interaction between the two factors on sleep disturbance was not observed in both men and women.

Staying Home, Tweeting Hope: Mixed Methods Study of Twitter Sentiment Geographical Index During US Stay-At-Home Orders

BACKGROUND

Stay-at-home orders were one of the controversial interventions to curb the spread of COVID-19 in the United States. The stay-at-home orders, implemented in 51 states and territories between March 7 and June 30, 2020, impacted the lives of individuals and communities and accelerated the heavy usage of web-based social networking sites. Twitter sentiment analysis can provide valuable insight into public health emergency response measures and allow for better formulation and timing of future public health measures to be released in response to future public health emergencies.

OBJECTIVE

This study evaluated how stay-at-home orders affect Twitter sentiment in the United States. Furthermore, this study aimed to understand the feedback on stay-at-home orders from groups with different circumstances and backgrounds. In addition, we particularly focused on vulnerable groups, including older people groups with underlying medical conditions, small and medium enterprises, and low-income groups.

METHODS

We constructed a multiperiod difference-in-differences regression model based on the Twitter sentiment geographical index quantified from 7.4 billion geo-tagged tweets data to analyze the dynamics of sentiment feedback on stay-at-home orders across the United States. In addition, we used moderated effects analysis to assess differential feedback from vulnerable groups.

RESULTS

We combed through the implementation of stay-at-home orders, Twitter sentiment geographical index, and the number of confirmed cases and deaths in 51 US states and territories. We identified trend changes in public sentiment before and after the stay-at-home orders. Regression results showed that stay-at-home orders generated a positive response, contributing to a recovery in Twitter sentiment. However, vulnerable groups faced greater shocks and hardships during the COVID-19 pandemic. In addition, economic and demographic characteristics had a significant moderating effect.

CONCLUSIONS

This study showed a clear positive shift in public opinion about COVID-19, with this positive impact occurring primarily after stay-at-home orders. However, this positive sentiment is time-limited, with 14 days later allowing people to be more influenced by the status quo and trends, so feedback on the stay-at-home orders is no longer positively significant. In particular, negative sentiment is more likely to be generated in states with a large proportion of vulnerable groups, and the policy plays a limited role. The pandemic hit older people, those with underlying diseases, and small and medium enterprises directly but hurt states with cross-cutting economic situations and more complex demographics over time. Based on large-scale Twitter data, this sociological perspective allows us to monitor the evolution of public opinion more directly, assess the impact of social events on public opinion, and understand the heterogeneity in the face of pandemic shocks.

Increased Incidence of Suspected Smoke Inhalation During the Coronavirus Disease 2019 Pandemic: A National Database Study

The COVID-19 pandemic has forced many Americans to adapt their daily routines. In 2020, there was a significant increase in house fires according to the National Fire Prevention Association (NFPA). The objective of this study was to characterize the changes in suspected smoke inhalations (SSIs) during the first year of the pandemic in the National Emergency Medical Services Information System (NEMSIS). The NEMSIS database was queried for all EMS transports captured between 2017 and 2020. Differences in the incidences of SSIs and fire dispatches in 2020 were estimated using Poisson regression models. There was a 13.4% increase in the incidence of fire dispatches and a 15% increase in SSIs transported in 2020 compared to the previous 3 years. The incidence rate ratio of both fire dispatches (1.271; 95% CI: 1.254-1.288; P < .001) and SSI (1.152; 95% CI: 1.070-1.241; P < .001) was significantly elevated in 2020. The increases in fire dispatches and SSIs observed in the NEMSIS database are in concordance with other literature indicating the increase in fire incidence and morbidity observed during the pandemic. These results should inform fire prevention outreach efforts and resource allocation in burn centers in the event of future pandemic.

Onsite versus home-office: differences in sleep patterns according to workplace

Background and objective

This study aimed to evaluate the sleep patterns of students and employees working onsite versus those working from home during the COVID-19 pandemic using actigraphy.

Methods

A total of 75 students/employees (onsite: N = 40, home-office: N = 35; age range: 19-56 years; 32% male; 42.7% students, 49.3% employees) were studied between December 2020 and January 2022 using actigraphy, a sleep diary, and an online questionnaire assessing sociodemographics and morningness-eveningness. Independent-sample t-tests, paired-sample tests, and a multivariate general linear model adjusting for age (fixed factors: sex and work environment) were applied.

Results

Overall, onsite workers had significantly earlier rise times (7:05 [SD: 1:11] versus 7:44 [1:08] hours) and midpoints of sleep (2:57 [0:58] versus 3:33 [0:58] hours) on weekdays compared to home-office workers. Sleep efficiency, sleep duration, variability of sleep timing, and social jetlag did not differ between the groups.

Discussion

Home-office workers showed a delay in sleep timing that did not affect any other sleep parameters such as sleep efficiency or nighttime sleep duration. The work environment had only marginal impact on sleep patterns and thus sleep health in this sample. Sleep timing variability did not differ between groups.

Supplementary Information

The online version of this article (10.1007/s11818-023-00408-5) contains supplementary material 1 and 2, which is available to authorized users.

Machine learning-based analytics of the impact of the Covid-19 pandemic on alcohol consumption habit changes among United States healthcare workers

The COVID-19 pandemic is a global health concern that has spread around the globe. Machine Learning is promising in the fight against the COVID-19 pandemic. Machine learning and artificial intelligence have been employed by various healthcare providers, scientists, and clinicians in medical industries in the fight against COVID-19 disease. In this paper, we discuss the impact of the Covid-19 pandemic on alcohol consumption habit changes among healthcare workers in the United States during the first wave of the Covid-19 pandemic. We utilize multiple supervised and unsupervised machine learning methods and models such as decision trees, logistic regression, support vector machines, multilayer perceptron, XGBoost, CatBoost, LightGBM, AdaBoost, Chi-Squared Test, mutual information, KModes clustering and the synthetic minority oversampling technique on a mental health survey data obtained from the University of Michigan Inter-University Consortium for Political and Social Research to investigate the links between COVID-19-related deleterious effects and changes in alcohol consumption habits among healthcare workers. Through the interpretation of the supervised and unsupervised methods, we have concluded that healthcare workers whose children stayed home during the first wave in the US consumed more alcohol. We also found that the work schedule changes due to the Covid-19 pandemic led to a change in alcohol use habits. Changes in food consumption, age, gender, geographical characteristics, changes in sleep habits, the amount of news consumption, and screen time are also important predictors of an increase in alcohol use among healthcare workers in the United States.

Work from home and the association with sedentary behaviors, leisure-time and domestic physical activity in the ELSA-Brasil study

BACKGROUND

Work from home (WFH) can impact workers´ sedentary behaviors and levels of physical activity. The aim of this study was to estimate the association between WFH and workers´ sedentary behaviors, leisure-time and domestic physical activities during the COVID-19 pandemic and verify whether age and sex may act as effect modifiers.

METHODS

We conducted a cross-sectional study of 2544 participants in the supplementary study on COVID-19 in the Longitudinal Study of Adult Health (ELSA-Brasil) from July 2020 to February 2021. We assessed screen time (≤ 8 h/day versus > 8 h/day), accumulated sitting time (≤ 8 h/day versus > 8 h/day) as sedentary behaviors on a typical day, and leisure-time (active versus inactive, according to World Health Organization recommendations) and domestic (low versus high, according to median) physical activity, using the International Physical Activity Questionnaire (IPAQ), before and during social distancing. Logistic regression models were used.

RESULTS

Participants that were working from home during social distancing showed increased odds of screen time and sitting time greater than 8 h/day (OR = 3.12; 95%CI: 2.32-4.20 and OR = 2.68; 95%CI: 2.02-3.56, respectively) and higher odds of high domestic physical activity (OR = 1.29; 95%CI: 0.99-1.67) when compared to those not working from home. There was no association between WFH and leisure-time physical activity (OR = 0.99, 95%CI: 0.75,1.31). Age was an effect modifier in the association between WFH and leisure-time physical activity and domestic activity. Older people working from home showed higher odds of physical inactivity (OR = 1.84, 95%CI: 1.07,3.16) and high domestic physical activity (OR = 1.92, 95%CI: 1.12,3.27) compared to older people not working from home.

CONCLUSION

WFH was associated with sedentary behavior > 8 h/day and high domestic physical activity. In the older people, WFH was associated with physical inactivity and high domestic physical activity. As sedentary behavior and physical inactivity are consistently negatively associated with health, it is important to discuss policies to manage WFH that allow pauses from physical activities and performance of hours of work within preestablished limits to reduce sedentary behavior. In addition, individuals working from home, especially the older people, should be encouraged to engage in leisure-time physical activity as a form of health promotion.

Helping the Helpers: Adaptation and Evaluation of Stress First Aid for Healthcare Workers in the Veterans Health Administration During the COVID-19 Pandemic

BACKGROUND

Early interventions are needed to support the behavioral health of healthcare staff in the context of the COVID-19 pandemic. Stress First Aid (SFA) is a self-care and peer support model for reducing burnout and stress that is designed for use in high-stress occupations.

METHODS

We conducted a mixed-methods evaluation of an SFA program in the Veterans Health Administration (VHA). This brief, multi-session, didactic program was adapted for hospital workgroups. Program attendees completed a survey assessing implementation outcomes, burnout, stress, mood, and SFA skills at the beginning (N = 246) and end (n = 94) of the SFA program and a subgroup (n = 11) completed qualitative feedback interviews.

FINDINGS

Program acceptability, appropriateness, and feasibility were rated highly. From pre- to post-SFA, the impact of the pandemic on stress and anxiety, as well as proficiency in supporting peers increased. Qualitative findings suggest the program provided a shared language to discuss stress, normalized stress reactions, met a need for stress management tools, and helped staff feel valued, empowered, connected with each other. Staff reported being more aware of their stress, but SFA was insufficient to address many of the systemic sources of burnout and stress.

CONCLUSIONS AND APPLICATIONS TO PRACTICE

While the SFA program was well received, the impact of brief programs is likely to be modest when implemented in the middle of an ongoing pandemic and when burnout arises from chiefly from systemic sources. Lessons learned during the program implementation that may guide future efforts are discussed.

Working-from-home persistently influences sleep and physical activity 2 years after the Covid-19 pandemic onset: a longitudinal sleep tracker and electronic diary-based study

Objective

Working from home (WFH) has become common place since the Covid-19 pandemic. Early studies observed population-level shifts in sleep patterns (later and longer sleep) and physical activity (reduced PA), during home confinement. Other studies found these changes to depend on the proportion of days that individuals WFH (vs. work from office; WFO). Here, we examined the effects of WFH on sleep and activity patterns in the transition to normality during the later stages of the Covid-19 pandemic (Aug 2021-Jan 2022).

Methods

Two-hundred and twenty-five working adults enrolled in a public health study were followed for 22  weeks. Sleep and activity data were collected with a consumer fitness tracker (Fitbit Versa 2). Over three 2-week periods (Phase 1/week 1-2: August 16-29, 2021; Phase 2/week 11-12: October 25-November 7, 2021; Phase 3/week 21-22: January 3-16, 2022), participants provided daily Fitbit sleep and activity records. Additionally, they completed daily phone-based ecological momentary assessment (EMA), providing ratings of sleep quality, wellbeing (mood, stress, motivation), and information on daily work arrangements (WFH, WFO, no work). Work arrangement data were used to examine the effects of WFH vs. WFO on sleep, activity, and wellbeing.

Results

The proportion of WFH vs. WFO days fluctuated over the three measurement periods, mirroring evolving Covid restrictions. Across all three measurement periods WFH days were robustly associated with later bedtimes (+14.7 min), later wake times (+42.3 min), and longer Total Sleep Time (+20.2 min), compared to WFO days. Sleep efficiency was not affected. WFH was further associated with lower daily step count than WFO (-2,471 steps/day). WFH was associated with higher wellbeing ratings compared to WFO for those participants who had no children. However, for participants with children, these differences were not present.

Conclusion

Pandemic-initiated changes in sleep and physical activity were sustained during the later stage of the pandemic. These changes could have longer term effects, and conscious effort is encouraged to harness the benefits (i.e., longer sleep), and mitigate the pitfalls (i.e., less physical activity). These findings are relevant for public health as hybrid WHF is likely to persist in a post-pandemic world.

Employees' support strategies for mental wellbeing during and beyond the COVID-19 pandemic: Recommendations for employers in the UK workforce

Throughout the COVID-19 pandemic, and beyond for many businesses, employees have had to adapt to new ways of working due to disruptions in traditional practices. It is therefore crucial to understand the new challenges that employees are facing when it comes to taking care of their mental wellbeing at work. To that end, we distributed a survey to full-time UK employees (N = 451) to explore how supported they felt throughout the pandemic, and to identify whether there are any additional types of support they would like to receive. We also compared employees' intentions to seek help before versus during the COVID-19 pandemic, and assessed their current attitudes toward mental health. Based on direct employee feedback, our results show remote workers felt more supported throughout the pandemic compared to hybrid workers. We also found that employees who had previously experienced an episode of anxiety or depression were significantly more likely to want extra support at work compared to those who had not. Furthermore, employees were significantly more likely to seek help for their mental health during the pandemic compared to before. Interestingly, the largest increase in intentions to seek help during the pandemic compared to before was with digital health solutions. Finally, we found that the strategies managers have adopted to better support their employees, an employee's mental health history, and their attitude to mental health all contributed to significantly increasing the likelihood that an employee would disclose a mental health concern to their line manager. We provide recommendations that encourage organisations to make changes to better support their employees, and we highlight the importance of mental health awareness training for both managers and employees. This work is of particular interest to organisations who are looking to tailor their current employee wellbeing offer to a post-pandemic world.

Psychological Research on Sleep Problems and Adjustment of Working Hours during Teleworking in the COVID-19 Pandemic: An Exploratory Study

Mandatory home isolation caused by COVID-19 in professional contexts led to a situation that required work activities to be converted into a remote modality. The literature on this topic is very recent, given the pandemic and the uncertainty of virtual and face-to-face work modalities. This study aimed to examine the effects of adults' prolonged exposure to screens on sleep quality, the type of devices used according to age and gender, periods of access to such devices and the impact on performance in the context of telework due to COVID-19. Specifically, the study analyzed the differences in the use of devices and in the time spent using them during and after teleworking between genders and age groups. A total of 127 Portuguese participants answered the Pittsburgh Sleep Quality Index and a questionnaire that we specifically developed to characterize teleworking habits. The results showed differences between men and women regarding the use of devices and its impact on sleep quality, as well as differences in terms of age. These results are discussed in terms of how the current work context may affect performance, sleep, gender differences and the adverse effects of exposure to screens during and after work hours.

Working from home, work-time control and mental health: Results from the Brazilian longitudinal study of adult health (ELSA-Brasil)

This cross-sectional study investigated the association between work-time control (WTC), independently and in combination with hours worked (HW), and four mental health outcomes among 2,318 participants of the Longitudinal Study of Adult Health (ELSA-Brasil) who worked from home during the COVID-19 pandemic. WTC was assessed by the WTC Scale, and mental health outcomes included depression, anxiety, stress (measured by the Depression, Anxiety and Stress Scale, DASS-21), and self-rated mental health. Logistic regression models were used to determine odds ratios (ORs) and 95% confidence intervals (CIs). Among women, long HW were associated with stress (OR = 1.56; 95% CI = 1.11–2.20) and poor self-rated mental health (OR = 1.64; 95% CI = 1.13–2.38), whereas they were protective against anxiety among men (OR = 0.59; 95% CI = 0.37–0.93). In both sexes, weak WTC was associated with all mental health outcomes. Among women, the long HW/weak WTC combination was associated with all mental health outcomes, and short HW/weak WTC was associated with anxiety and stress. Among men, long HW/strong WTC was protective against depression and stress, while short HW/strong WTC and short HW/weak WTC was associated with all mental health outcomes. In both sexes, weak WTC, independently and in combination with HW, was associated with all mental health outcomes. WTC can improve working conditions, protect against mental distress, and fosterwork-life balance for those who work from home.

Evolution of Mood Symptomatology Through the COVID-19 Pandemic: Findings From the CovidSense Longitudinal Study

Background The severe acute respiratory syndrome coronavirus 2 global pandemic, with its associated coronavirus disease 2019 (COVID-19) illness, has led to significant mental, physical, social, and economic hardships. Physical distancing, isolation, and fear of illness have significantly affected the mental health of people worldwide. Several studies have documented the cross-sectional elevated prevalence of mental anguish, but due to the sudden nature of the pandemic, very few longitudinal studies have been reported, especially covering the first phase of the pandemic. CovidSense, a longitudinal adaptive study, was initiated to answer some key questions: how did the pandemic and related social and economic conditions affect depression, which groups showed more vulnerability, and what protective factors emerged as the pandemic unfolded? Methodology CovidSense was deployed from April to December 2020. The adaptive design enabled adaption to fluctuating demographics/health status. Participants were regularly queried via SMS messages about their mental health, physical health, and life circumstances. The study included 1,190 participants who answered a total of 18,783 survey panels. This was a prospective longitudinal cohort study following adult participants in the general population through the COVID-19 pandemic. The participant cohort reported self-assessed measures ranging from subjective mood ratings and substance use to validated questionnaires, such as the Quick Inventory of Depressive Symptoms (QIDS) and Cognitive and Affective Mindfulness Scale-Revised (CAMS-R). Results Participants with pre-existing physical (especially pulmonary) or mental conditions had overall higher levels of depression, as measured by the QIDS and self-reported mood. Participants with pre-existing conditions also showed increased vulnerability to the stress caused by watching the news and the increase in COVID-19 cases. Younger participants (aged 18-25 years) were more affected than older groups. People with severe levels of depression had the most variation in QIDS scores, whereas individuals with none to low depressive scores had the most variability in self-reported mood fluctuations. Conclusions The effects of pandemic-related chronic stress were predominant in young adults and individuals with pre-existing mental and medical conditions regardless of whether they had acquired COVID-19 or not. These results point to the possibility of allocating preventive as well as treatment resources based on vulnerability.

A machine learning analysis of COVID-19 mental health data

In late December 2019, the novel coronavirus (Sars-Cov-2) and the resulting disease COVID-19 were first identified in Wuhan China. The disease slipped through containment measures, with the first known case in the United States being identified on January 20th, 2020. In this paper, we utilize survey data from the Inter-university Consortium for Political and Social Research and apply several statistical and machine learning models and techniques such as Decision Trees, Multinomial Logistic Regression, Naive Bayes, k-Nearest Neighbors, Support Vector Machines, Neural Networks, Random Forests, Gradient Tree Boosting, XGBoost, CatBoost, LightGBM, Synthetic Minority Oversampling, and Chi-Squared Test to analyze the impacts the COVID-19 pandemic has had on the mental health of frontline workers in the United States. Through the interpretation of the many models applied to the mental health survey data, we have concluded that the most important factor in predicting the mental health decline of a frontline worker is the healthcare role the individual is in (Nurse, Emergency Room Staff, Surgeon, etc.), followed by the amount of sleep the individual has had in the last week, the amount of COVID-19 related news an individual has consumed on average in a day, the age of the worker, and the usage of alcohol and cannabis.

Willingness to Work during Public Health Emergencies: A Systematic Literature Review

The identification of the factors underlying the willingness or lack thereof to respond to public health emergencies is paramount to informing more capable health services. The interest in this topic appears renewed with each surge of threat, either referring to natural disasters, man-made violence, or epidemic and pandemics. However, there is no systematic approach to the research patterns and related main findings concerning individual and contextual determinants. The present article contributes to this theme through a systematic literature review of a sample of 150 articles published in the last 30 years on the subject of willingness and preparedness of health professionals to deal with public health threats. Our findings show that the research is mainly phenomena and contextual driven, responding to whichever emergency threat is more salient in a given period. Geographically, research on this topic is led by USA and China, mostly solely, while European countries invest in collaborations that are more international. Universities, including health institutes and schools, and researchers at hospitals conduct most of the research on the topic. The main research areas are medicine, psychology, and psychiatry. Pandemics, including COVID-19, influenza, and natural disasters, are the phenomena gauging more attention as opposed to terrorism events and biological accidents. The specific role of health professionals within the institution, their belief in ethical duties, preparation training, and concerns regarding infection of self and family are the main variables influencing the willingness and ability to report to work in public health emergencies.

The fall of vulnerability to sleep disturbances in evening chronotypes when working from home and its implications for depression

Eveningness is distinctively associated with sleep disturbances and depression symptoms due to the misalignment between biological and social clocks. The widespread imposition of remote working due to the COVID-19 pandemic allowed a more flexible sleep schedule. This scenario could promote sleep and mental health in evening-type subjects. We investigated the effect of working from home on sleep quality/quantity and insomnia symptoms within the morningness-eveningness continuum, and its indirect repercussions on depressive symptomatology. A total of 610 Italian office workers (mean age ± standard deviation, 35.47 ± 10.17 years) and 265 remote workers (40.31 ± 10.69 years) participated in a web-based survey during the second contagion wave of COVID-19 (28 November–11 December 2020). We evaluated chronotype, sleep quality/duration, insomnia, and depression symptoms through validated questionnaires. Three moderated mediation models were performed on cross-sectional data, testing the mediation effect of sleep variables on the association between morningness-eveningness continuum and depression symptoms, with working modality (office vs. remote working) as moderator of the relationship between chronotype and sleep variables. Remote working was associated with delayed bedtime and get-up time. Working modality moderated the chronotype effect on sleep variables, as eveningness was related to worse sleep disturbances and shorter sleep duration among the office workers only. Working modality also moderated the mediation of sleep variables between chronotype and depression. The above mediation vanished among remote workers. The present study suggests that evening-type people did not show their characteristic vulnerability to sleep problems when working from home. This result could imply a reduction of the proposed sleep-driven predisposition to depression of late chronotypes. A working environment complying with individual circadian preferences might ensure an adequate sleep quantity/quality for the evening-type population, promoting their mental health.

Increased sleep duration and delayed sleep timing during the COVID-19 pandemic

Many studies have examined how the 2019 Coronavirus Disease (COVID-19) has impacted sleep health. Early evidence suggests that lockdown policies worldwide have led to changes in sleep timing, duration, and quality; however, few studies have attempted to look at the longer-term effects across multiple countries in a large data set. This study uses self-reported data from 64,858 users of the Sleep As Android smartphone application from around the world over a 24-month period in 2019 to 2020. We found a significant but modest increase in time in bed (TIB), as well as a significant delay in sleep timing that was especially prominent on weekdays. While this effect persisted throughout the year, differences in sleep timing were more widespread and pronounced in the earlier months of the pandemic. We observed a small overall increase in TIB when comparing 2020 to 2019, but these changes depended on location and time of year, suggesting that sleep duration may have more closely tracked the progression of the pandemic in each country. Our findings suggest that pandemic-induced changes in lifestyle, such as remote work and lockdown policies, may have facilitated later sleep timing but that these changes may diminish as restrictions are lifted.

Changes and correlates of screen time in adults and children during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

Screen time has increased as a result of the COVID-19 pandemic, and several correlates have been associated with these increases. These changes, however, have not been aggregated. It was the aim of this review to (a) aggregate changes in screen time in adults and children, and (b) report on variables in relation to screen time during the COVID-19 pandemic.

METHODS

A systematic review of major databases was undertaken for studies published from inception to 06/12/2021, using a pre-published protocol (PROSPERO ID: CRD42021261422). Studies reporting (a) screen time pre-versus-during the pandemic, (b) screen time percentage change, or (c) correlates of screen time during the pandemic were included. A random effects meta-analysis was undertaken with subgroup analysis by age group and type of screen time.

FINDINGS

After review, 89 studies (n = 204,734; median age=20·6; median female=53·3%) were included. The majority of studies were cross-sectional. With regards to total screen time, primary aged children (6-10 years) reported largest increases (1·4 hrs/day; 95%CI 1·1-1·7), followed by adults (>18 years; 1·0 hrs/day; 95%CI 0·7-1·2), adolescents (11-17 years; 0·9 hrs/day; 95%CI 0·3-1·5), and young children (0-5 years; 0·6 hrs/day 95%CI 0·3-0·9 hrs/day). For leisure screen time (non-work/non-academic), primary aged children reported largest increases (1·0 hrs/day 95%CI 0·8-1·3), followed by adults (0·7hr/day 95%CI 0·3-1·2), young children (0·6 hrs/day; 95%CI 0·4-0·8), with adolescents reporting the lowest increase (0·5 hrs/day 95%CI 0·3-0·7). Several correlates were associated with reported increases in screen time, including adverse dietary behaviours, sleep, mental health, parental health, and eye health.

INTERPRETATION

Pooled evidence suggest that primary aged children reported the highest increase in both total and leisure screen time during COVID-19. It is recommended that screen time should be reduced in favour of non-sedentary activities. This study has the potential to inform public health policy and future guidance regarding screen time, and to inform future research in this area.

FUNDING

No funding was received for this study.

Assessment of Healthcare Professionals’ Wellbeing During a Peak of the COVID-19 Pandemic in a Healthcare System in Ohio

Objective

The purpose of this cross-sectional study was to evaluate multiple indices of wellbeing in healthcare professionals during the COVID-19 pandemic.

Methods

Healthcare professionals were invited to participate across the University Hospitals healthcare system in Ohio, USA. Participants (N = 6397) completed online questionnaires on their wellbeing, including healthy behaviors, safety and security, mental and physical health concerns, and social support. Differences in wellbeing across demographics were also assessed.

Results

Overall, healthcare professionals’ mean subjective wellbeing was 7.98 (1.50) and their future health score was 3.98 (1.13). Room for improvement was noted for diet, sleep, and positive thinking. Males reported significantly higher levels of overall wellbeing and future health scores, including fruit and vegetable intake and physical activity, and alcohol use, whereas females reported higher levels of positive thinking and tobacco use. Of the three largest racial groups, White and Asian employees scored significantly higher on future health, M = 4.00 (1.17) and M = 4.10 (1.13), than Black or African American employees, M = 3.74 (1.10).

Conclusions

This cross-sectional study assessed the wellbeing of healthcare workers during the initial peak of the COVID-19 pandemic prior to vaccine delivery. Future work will implement strategies to improve healthcare workers’ wellbeing in an individualized way based on our findings, as well as evaluate changes in wellbeing and future health scores across time.

Work-Life Balance and Productivity Among Academic Faculty During the COVID-19 Pandemic: A Latent Class Analysis

Background: For faculty in academic health sciences, the balance between research, education, and patient care has been impeded by the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to identify personal and professional characteristics of faculty to understand the impact of the pandemic on faculty and consequent policy implications. Methods: A 93-question survey was sent to faculty at a large urban public university and medical center. Demographic, family, and academic characteristics, work distribution and productivity before and during the pandemic, stress, and self-care data information were collected. Latent class analysis (LCA) was performed to identify classes of faculty sharing similar characteristics. Comparisons between latent classes were performed using analysis of variance and chi-square analyses. Results: Of 497 respondents, 60% were women. Four latent classes of faculty emerged based on six significant indicator variables. Class 1 individuals were more likely women, assistant professors, nontenured with high work and home stress; Class 2 faculty were more likely associate professors, women, tenured, who reported high home and work stress; Class 3 faculty were more likely men, professors, tenured with moderate work, but low home stress; and Class 4 faculty were more likely adjunct professors, nontenured, and had low home and work stress. Class 2 reported significantly increased administrative and clinical duties, decreased scholarly productivity, and deferred self-care. Conclusions: The pandemic has not affected faculty equally. Early and mid-career individuals were impacted negatively from increased workloads, stress, and decreased self-care. Academic leaders need to acknowledge these differences and be inclusive of faculty with different experiences when adjusting workplace or promotion policies.

Stress, PTSD, and COVID-19: the Utility of Disaster Mental Health Interventions During the COVID-19 Pandemic

Purpose of review

In the context of an ongoing, highly uncertain pandemic, disaster mental health measures can increase community capacity for resilience and well-being, support formal mental health treatment, and help address the risk for mental health reactions in high-stress occupations. The purpose of this review is to summarize the literature on disaster mental health interventions that have been helpful both prior to and during the pandemic in a broad range of applications, including for use with high-stress occupations in an effort to mitigate risk for post-traumatic stress disorder (PTSD) and other mental health sequelae.

Recent findings

Evidence-based and evidence-informed disaster mental health interventions, frameworks, and treatments have been studied in pilot studies, non-randomized trials, and randomized clinical trials prior to and in the context of the current COVID-19 pandemic. The studies have demonstrated feasibility and acceptability of these modalities and improved perceived support, as well as significant reductions in distress, and mental health symptoms such as depression, anxiety, and PTSD.

Summary

A disaster mental health approach to the COVID-19 pandemic can generate opportunities for prevention and support at multiple levels with timely interventions tailored for different concerns, cultures, and available resources.

Harmful Alcohol Use Among Healthcare Workers at the Beginning of the COVID-19 Pandemic in Kenya

BACKGROUND

Healthcare workers play a key role in responding to pandemics like the on-going COVID-19 one. Harmful alcohol use among them could result in inefficiencies in health service delivery. This is particularly concerning in sub-Saharan Africa where the health workforce is already constrained. The aim of this study is to document the burden and correlates of harmful alcohol use among healthcare workers at the beginning of the COVID-19 pandemic in Kenya with the aim of informing policy and practice.

METHODS

This study was a cross-sectional analysis of data obtained from a parent online survey that investigated the burden and factors associated with mental disorders among healthcare workers during the COVID-19 pandemic in Kenya. We analyzed data obtained from a sub-population of 887 participants who completed the Alcohol Use Disorder Identification Test questionnaire. We used descriptive statistics to summarize the socio-demographic characteristics of the participants and multivariate analysis to determine the factors associated with harmful alcohol use.

RESULTS

Three hundred and eighty nine (43.9%) participants reported harmful alcohol use. The factors significantly associated with increased odds of endorsing harmful alcohol use were: being male (AOR = 1.56; 95% CI = 1.14, 2.14; p = 0.006), being unmarried (AOR = 2.06; 95% CI = 1.48, 2.89; p < 0.001), having 11-20 years of experience as compared to having 20+ years of experience (AOR = 1.91; 95% CI = 1.18, 3.12; p = 0.009), and being a specialist (AOR = 2.78; CI = 1.64, 4.78; p = < 0.001) or doctor (AOR = 2.82; 95% CI = 1.74, 4.63; p < 0.001) as compared to being a nurse.

CONCLUSIONS

A high proportion of healthcare workers reported harmful alcohol use at the beginning of the COVID-19 pandemic in Kenya. Males, the unmarried, those with 11-20 years of experience in the health field, doctors and specialists, were more likely to report harmful alcohol use. These findings highlight the need to institute interventions for harmful alcohol use targeting these groups of healthcare workers in Kenya during the COVID-19 pandemic in order to optimize functioning of the available workforce.

Association of Delayed Sleep/Wake Rhythm with Depression During the First COVID-19 Lockdown in France

PURPOSE

The containment of the population during the COVID-19 pandemic led to the emergence or recurrence of psychiatric conditions and sleep disorders. The influence of sleep/wake rhythm on mental health is well known. The objective of our study was to evaluate the link between the shift in sleep/wake rhythm and the presence of depressive symptoms during the March to May 2020 lockdown in the French population.

PARTICIPANTS AND METHODS

Participants (n = 2513) were recruited via newspapers and social networks in March 2020. We evaluated i) the chronotype before and during the lockdown, assessed by the change in mid-sleep time on work-free days corrected for sleep debt on workdays (delta MSFsc); ii) morningness-eveningness circadian preference (Horne & Ostberg questionnaire); iii) depressive symptoms (Patient Health Questionnaire-9, PHQ-9). The delta MSFsc and the PHQ-9 score were compared between circadian preference types. A multivariate model adjusted for age, sex, circadian preference, housing type, and marital status was used to assess the influence of delta MSFsc on the PHQ-9 score in the whole population.

RESULTS

The population consisted of 77% women, of median (IQR) age 39 (30-48) years. Compared with the pre-lockdown period, the median (IQR) MSFsc was shifted by 30 (0-66) min during the lockdown, with a significant difference between evening [60 (15-120) min], morning [15 (0-46) min] and neutral [30 (0-70) min] circadian type individuals, p < 0.001. One-third of all participants had moderate to severe depressive symptoms (PHQ-9 ≥ 10). A 1-hour shift in MSFsc was associated with a 0.50-point increase [95% CI (0.28; 0.72), p < 0.001] in the PHQ-9.

CONCLUSION

A phase delay in the chronotype was observed in the general population during lockdown. Such disruption was associated with depressive symptoms but the direction of the relationship remains hypothetical. The impact on mental health of preventive measures targeting the sleep/wake rhythm in this context needs further evaluation.

Stay-at-Home Orders during COVID-19: The Influence on Physical Activity and Recreational Screen Time Change among Diverse Emerging Adults and Future Implications for Health Promotion and the Prevention of Widening Health Disparities

BACKGROUND

The purpose of this study was to examine changes in physical activity (PA) and recreational screen time (RST) behaviors from pre-COVID-19 in 2018 to Spring 2020 during the mandatory stay-at-home order in an ethnically/racially, socioeconomically diverse sample of emerging adults.

METHODS

Longitudinal data were analyzed from 218 participants (Mage = 24.6 ± 2.0 years) who completed two surveys: EAT 2018 (Eating and Activity over Time) and C-EAT in 2020 (during COVID-19). Repeated ANCOVAs and multiple linear regression models were conducted.

RESULTS

Moderate-to-vigorous and total PA decreased (4.7 ± 0.3 to 3.5 ± 0.3 h/week [p < 0.001] and 7.9 ± 0.4 to 5.8 ± 0.4 h/week [p < 0.001], respectively), and RST increased from 26.5 ± 0.9 to 29.4 ± 0.8 h/week (p = 0.003). Perceived lack of neighborhood safety, ethnic/racial minoritized identities, and low socioeconomic status were significant predictors of lower PA and higher RST during COVID-19. For example, low SES was associated with 4.04 fewer hours of total PA compared to high SES (p < 0.001).

CONCLUSIONS

Stay-at-home policies may have significantly influenced PA and RST levels in emerging adults with pre-existing disparities exacerbated during this mandatory period of sheltering-in-place. This suggests that the pandemic may have played a role in introducing or magnifying these disparities. Post-pandemic interventions will be needed to reverse trends in PA and RST, with a focus on improving neighborhood safety and meeting the needs of low socioeconomic and ethnic/racial minoritized groups.

Distinct Circadian Assessments From Wearable Data Reveal Social Distancing Promoted Internal Desynchrony Between Circadian Markers

Mobile measures of human circadian rhythms (CR) are needed in the age of chronotherapy. Two wearable measures of CR have recently been validated: one that uses heart rate to extract circadian rhythms that originate in the sinoatrial node of the heart, and another that uses activity to predict the laboratory gold standard and central circadian pacemaker marker, dim light melatonin onset (DLMO). We first find that the heart rate markers of normal real-world individuals align with laboratory DLMO measurements when we account for heart rate phase error. Next, we expand upon previous work that has examined sleep patterns or chronotypes during the COVID-19 lockdown by studying the effects of social distancing on circadian rhythms. In particular, using data collected from the Social Rhythms app, a mobile application where individuals upload their wearable data and receive reports on their circadian rhythms, we compared the two circadian phase estimates before and after social distancing. Interestingly, we found that the lockdown had different effects on the two ambulatory measurements. Before the lockdown, the two measures aligned, as predicted by laboratory data. After the lockdown, when circadian timekeeping signals were blunted, these measures diverged in 70% of subjects (with circadian rhythms in heart rate, or CRHR, becoming delayed). Thus, while either approach can measure circadian rhythms, both are needed to understand internal desynchrony. We also argue that interventions may be needed in future lockdowns to better align separate circadian rhythms in the body.

A Counseling Application as an Alternative Tool in Increasing Coping Self-Efficacy Among University Students With Academic Distress During Coronavirus Disease 2019 Pandemic in Indonesia: A Study Protocol for a Randomized Controlled Non-Inferiority Trial

The coronavirus disease 2019 (COVID-19) pandemic increased education-related distress among University students globally, including in Indonesia. Psychological factors, such as academic demands, limited opportunity to meet their peers, problematic use of technology, and domestic problems, influenced the well-being of the students, leading to poor academic performance. A mobile-based counseling application was developed to address the distress among University students. The application was meant to reach students living remotely to enable them to access psychological assistance. Therefore, the purpose of this study was to describe a protocol aimed to evaluate the equivalence of the application when compared to the Treatment-As-Usual (TAU) in increasing the coping self-efficacy (CSE) and resilience of students as well as in decreasing their level of depression. A two-armed parallel randomized control non-inferiority trial will be conducted among approximately 430 students with selected academic problems. The participants will be randomly allocated into the TAU and the intervention groups. The primary and secondary outcomes will be measured by the Indonesian versions of the Coping Self-Efficacy (CSE) Scale, the Resilience Scale (RS-14), and the Patient Health Questionnaire (PHQ-9). The data will be collected at baseline, at the end of each session, and after 3 months. The outcomes will be analyzed using repeated-measures ANOVAs, intention-to-treat, and per-protocol analysis. If proven, the application will be used as an alternative media in helping the students.

Clinical Trial Registration: Thailand Clinical Trials Registry (TCTR20200530001); Date of registration: May 28, 2020.

Impact of Working from Home on Cardiovascular Health: An Emerging Issue with the COVID-19 Pandemic

Mandatory working from home is one of the consequences of the COVID-19 pandemic for a large number of workers. Transition to working from home may significantly impact lifestyle, psychosocial status, and the overall health of workers. This review summarizes available data about the effects of lockdown measures, particularly working from home, on cardiovascular risk factors including sedentary lifestyle, unhealthy diet pattern, psychological distress, smoking, alcohol misuse, and cardiometabolic parameters. Finally, we suggest countermeasures that can attenuate the negative health impact of working from home. Indeed, timely and tailored interventions implemented by companies in cooperation with the health care system could allow workers to benefit more from some of the advantages associated with working from home.

Impact of work routines on parents' and children's sleep during the COVID-19 pandemic lockdown

Objective

To evaluate the effects of parental sleep and work arrangements on children's sleep duration during the national lockdown period, referred to as ‘Circuit Breaker’ (CB), due to COVID-19.

Methods

Cross-sectional, anonymous, online questionnaire to parents with school-going children aged between 3 and 16 years. Child and parental sleep duration in relation to change in parental work arrangements, housing type and number of individuals in the household as reported by parents were evaluated. Descriptive statistics and tests of comparison were used to evaluate data.

Results

School-going children (n = 593) had a mean age of 8.68 (SD = 3.65; median 7) years. Both, fathers and mothers had gains in sleep during CB (based on self-reported sleep data), compared to pre-CB. Change in both maternal and paternal sleep duration positively correlated with change in child sleep duration (based on parent-reported sleep data) among all children (r² = 0.27, p < 0.001 and r² = 0.17, p < 0.001 respectively); pre-schoolers mirrored their mothers’ sleep more closely. Parents who changed to working from home during the CB (compared to working from outside home previously) had the greatest gains in sleep during this period. Housing type was not significantly associated with change in child sleep duration from pre-CB to CB.

Conclusions

Greater gains in sleep in parents was associated with working from home during CB. Child sleep duration mirrored gains in parental sleep, especially in pre-school and primary-school-going children. Optimising parental sleep may therefore be one of the means to improve child sleep.

Chronic circadian phase advance in male mice induces depressive-like responses and suppresses neuroimmune activation

Altered working and sleeping schedules during the COVID-19 pandemic likely impact our circadian systems. At the molecular level, clock genes form feedback inhibition loops that control 24-hr oscillations throughout the body. Importantly, core clock genes also regulate microglia, the brain resident immune cell, suggesting circadian regulation of neuroimmune function. To assess whether circadian disruption induces neuroimmune and associated behavioral changes, we mimicked chronic jetlag with a chronic phase advance (CPA) model. 32 adult male C57BL/6J mice underwent 6-hr light phase advance shifts every 3 light/dark cycles (CPA) 14 times or were maintained in standard light/dark cycles (control). CPA mice showed higher behavioral despair but not anhedonia in forced swim and sucrose preferences tests, respectively. Changes in behavior were accompanied by altered hippocampal circadian genes in CPA mice. Further, CPA suppressed expression of brain-derived neurotrophic factor (BDNF) and pro-inflammatory cytokine interleukin-1 beta in the hippocampus. Plasma corticosterone concentrations were elevated by CPA, suggesting that CPA may suppress neuroimmune pathways via glucocorticoids. These results demonstrate that chronic circadian disruption alters mood and neuroimmune function, which may have implications for shift working populations such as frontline health workers.

COVID-19 and digitalization: The great acceleration

Inspired by burgeoning scholarly interest in the role of digitalization in the COVID-19 pandemic, this paper examines how the COVID-19 pandemic is driving or constraining the digitalization of businesses around the globe. We contend that COVID-19 is "the great accelerator" in fast-tracking the existing global trend towards embracing modern emerging technologies ushering in transformations in lifestyle, work patterns, and business strategies. Thus, COVID-19 has evolved to be a kind of "catalyst" for the adoption and increasing use of digitalization in work organization and the office, alongside presenting foreseen and unforeseen opportunities, challenges, and costs-leading to negative and positive feedback loops. In this article, we develop and advance a conceptual model by linking the different forces for and against digitalization in response to the pandemic. Our analysis indicates that adoption of emerging technologies may be hindered by vested external interests, nostalgia, and employer opportunism, as well as negative effects on employee well-being that undermine productivity, work-life balance, and future of work. Whilst digitalization may bring new opportunities, the process imparts risks that may be hard to mitigate or prepare for. Finally, we draw out the wider theoretical and practical implications of our analysis.

Sleep quality and related factors in a sample of Turkish healthcare workers during the COVID-19 pandemic: A cross-sectional study

BACKGROUND

Increasing workloads and psychological pressure have led to fatigue among healthcare workers during the COVID-19 pandemic. Increasing stress and social isolation can also lead to sleep problems. The purpose of this study was to evaluate sleep quality and related factors among healthcare workers during the COVID-19 pandemic in Turkey.

METHODS

The data in this cross-sectional study were collected using an online questionnaire. This included sociodemographic data, the Multidimensional Scale of Perceived Social Support, the National Stressful Events Survey PTSD Short Scale and the Pittsburgh Sleep Quality Index.

RESULTS

Two hundred seventy-eight physicians, 104 nurses and 52 dentists were enrolled. The total prevalence of poor sleep quality was 56.7%. The prevalence of poor sleep quality was 67.3% in nurses, 55.4% in physicians and 42.3% in dentists. Poor sleep quality was more prevalent among women, nurses, hospital workers, frontline workers, individuals with <5 years of work experience, those with low social support and individuals with increased traumatic stress levels. High levels of social support and family social support were identified as protective factors against poor sleep quality. Multivariate regression analyses showed that poor sleep quality was significantly associated with working in hospitals and high traumatic stress levels during the COVID-19 pandemic.

CONCLUSIONS

Poor sleep quality was common among healthcare workers during the COVID-19 pandemic. Working in hospitals and high traumatic stress levels were identified as factors associated with poor sleep quality.

No Sex Differences in Psychological Burden and Health Behaviors of Healthcare Workers During the COVID-19 Stay-at-Home Orders

Background: Females with novel coronavirus disease 2019 (COVID-19) state-ordered home isolation were associated with higher anxiety and reduced sleep quality than males. Sex differences in psychobehavioral changes during the COVID-19 stay-at home orders among healthcare workers remained unclear. The purpose of this study was to explore the sex differences in psychological burden and health behaviors among these persons.

Methods: This was a cross-sectional study using online data available in the open Interuniversity Consortium for Political and Social Research (OPENICPSR). Healthcare workers including females and males who transitioned to working from home during the COVID-19 stay-at-home orders were included. Sex differences were compared using the chi-square test and Student's t-test. We performed logistic and linear regression analyses to determine the association of females with psychological burden and health behaviors.

Results: A total of 537 respondents (425 females and 112 males) were enrolled in our study. Sex differences in age (42.1 ± 12.3 years vs. 46.6 ± 15.7 years, t = −2.821, p = 0.005), occupation (χ² = 41.037, p < 0.001), mood change (n = 297, 69.9% vs. n = 61, 54.5%, χ² = 9.482, p = 0.002), bedtime schedule (χ² = 6.254, p = 0.044) and news consumption (n = 344, 80.9% vs. n = 76, 67.9%, χ² = 8.905, p = 0.003) were statistically significant. Logistic regression showed that females was negatively associated with better mood status (OR = 0.586, 95% CI 0.153–2.247, p = 0.436). In addition, linear regression showed that females were not correlated with total sleep time after adjusting for sio-demographics, mental health outcomes and health behaviors (B = 0.038, 95% CI −0.313–0.388, p = 0.833).

Conclusion: No sex differences in psychological burden and health behaviors of healthcare workers were found during the COVID-19 stay-at-home orders. The COVID-19 state-ordered home isolation may be a potential way to reduce disproportionate effects of COVID-19 pandemic on females and help to minimize sex differences in psychological burden and health behaviors among healthcare workers.

Social-distancing fatigue: Evidence from real-time crowd-sourced traffic data

INTRODUCTION

To mitigate the COVID-19 pandemic and prevent overwhelming the healthcare system, social-distancing policies such as school closure, stay-at-home orders, and indoor dining closure have been utilized worldwide. These policies function by reducing the rate of close contact within populations and result in decreased human mobility. Adherence to social distancing can substantially reduce disease spread. Thus, quantifying human mobility and social-distancing compliance, especially at high temporal resolution, can provide great insight into the impact of social distancing policies.

METHODS

We used the movement of individuals around New York City (NYC), measured via traffic levels, as a proxy for human mobility and the impact of social-distancing policies (i.e., work from home policies, school closure, indoor dining closure etc.). By data mining Google traffic in real-time, and applying image processing, we derived high resolution time series of traffic in NYC. We used time series decomposition and generalized additive models to quantify changes in rush hour/non-rush hour, and weekday/weekend traffic, pre-pandemic and following the roll-out of multiple social distancing interventions.

RESULTS

Mobility decreased sharply on March 14, 2020 following declaration of the pandemic. However, levels began rebounding by approximately April 13, almost 2 months before stay-at-home orders were lifted, indicating premature increase in mobility, which we term social-distancing fatigue. We also observed large impacts on diurnal traffic congestion, such that the pre-pandemic bi-modal weekday congestion representing morning and evening rush hour was dramatically altered. By September, traffic congestion rebounded to approximately 75% of pre-pandemic levels.

CONCLUSION

Using crowd-sourced traffic congestion data, we described changes in mobility in Manhattan, NYC, during the COVID-19 pandemic. These data can be used to inform human mobility changes during the current pandemic, in planning for responses to future pandemics, and in understanding the potential impact of large-scale traffic interventions such as congestion pricing policies.

Sleep patterns of US healthcare workers during the first wave of the COVID-19 pandemic

Purpose

During the first few months of the COVID-19 outbreak, healthcare workers (HCW) faced levels of personal risk, emotional distress, and professional strain not seen in their lifetimes. This study described how these stressors influenced various aspects of their sleep patterns.

Methods

From May 19 to June 20, 2020, an electronic, cross-sectional survey was administered to a convenience sample of in- and outpatient HCW in a large, nonprofit healthcare system. Respondents described the pandemic’s initial impact on personal and professional life and various sleep dimensions: regularity, efficiency, duration, timing, quality, and daytime sleepiness.

Results

Two hundred seven providers responded, representing 17 different healthcare roles. Most (82%) were women with a median age of 39 years (IQR1–3, 31–53). A majority of respondents (81%) worked in an inpatient setting, with half (46%) primarily on the “frontline.” Approximately one-third of respondents (37%) were physicians and one-quarter (28%) were nurses. Overall, 68% of HCW reported at least one aspect of sleep worsened during the beginning of the pandemic; the most impacted were daytime sleepiness (increased in 43%) and sleep efficiency (worse in 37%). After adjusting for COVID exposure and burnout, frontline providers had twofold higher odds of poor pandemic sleep, aOR 2.53, 95%CI 1.07–5.99. Among frontline providers, physicians were fivefold more likely to develop poor pandemic sleep compared to nurses (OR 5.73, 95%CI 1.15–28.57).

Conclusions

During the initial wave of COVID-19, a majority of HCW reported a decline in sleep with an increase in daytime sleepiness and insomnia. Frontline workers, specifically physicians, were at higher risk.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11325-021-02515-9.

Reopening after lockdown: The influence of working-from-home and digital device use on sleep, physical activity, and wellbeing following COVID-19 lockdown and reopening

Study Objectives

COVID-19 lockdowns drastically affected sleep, physical activity, and wellbeing. We studied how these behaviors evolved during reopening the possible contributions of continued working from home and smartphone usage.

Methods

Participants (N = 198) were studied through the lockdown and subsequent reopening period, using a wearable sleep/activity tracker, smartphone-delivered ecological momentary assessment (EMA), and passive smartphone usage tracking. Work/study location was obtained through daily EMA ascertainment.

Results

Upon reopening, earlier, shorter sleep and increased physical activity were observed, alongside increased self-rated stress and poorer evening mood ratings. These reopening changes were affected by post-lockdown work arrangements and patterns of smartphone usage. Individuals who returned to work or school in-person tended toward larger shifts to earlier sleep and wake timings. Returning to in-person work/school also correlated with more physical activity. Contrary to expectation, there was no decrease in objectively measured smartphone usage after reopening. A cluster analysis showed that persons with relatively heavier smartphone use prior to bedtime had later sleep timings and lower physical activity.

Conclusions

These observations indicate that the reopening after lockdown was accompanied by earlier sleep timing, increased physical activity, and altered mental wellbeing. Moreover, these changes were affected by work/study arrangements and smartphone usage patterns.

Detrimental changes to the health and well-being of healthcare workers in an Australian COVID-19 hospital

Background

Most studies examining the psychological impact of COVID-19 on healthcare workers (HCWs) have assessed well-being during the initial stages or the peak of the first wave of the pandemic. We aimed to measure the impact of COVID-19 and potential changes over time in its impact, on the health and well-being of HCWs in an Australian COVID-19 hospital.

Methods

An online questionnaire assessed current and retrospective physical and mental health; psychological distress (Kessler Psychological Distress Scale); lifestyle behaviours; and demographics, providing measures of health and wellbeing at three phases of the pandemic. Targeted staff were invited to participate via email and in-person. Additional promotional activities were directed to all staff. Changes in general health, mental health and psychological distress were examined using McNemar’s Chi-square. Associations between other categorical variables were tested using Chi-Square or non-parametric equivalents as appropriate. Logistic regression explored risk factors for current distress.

Results

Four hundred thirty-three eligible HCWs answered all (74 %) or part of the questionnaire. Current self-rated health and mental health were significantly better than during the height of the pandemic, but had not returned to pre-pandemic levels. Psychological distress was significantly more common during the height of the pandemic (34.2 %) than currently (22.4 %), and during the height of the pandemic distress was significantly more common among younger than older HCWs. Females were significantly more likely to be distressed that males currently, but not during the height of the pandemic. High distress during the height of the pandemic was more likely to be maintained by HCWs who were less physically active than usual during the height of the pandemic (OR = 5.5); had low self-rated mental health before the pandemic (OR = 4.8); and who had 10 or more years of professional experience (OR = 3.9).

Conclusions

The adverse effects of the pandemic on HCWs have lessened with the easing of pandemic demands, but health and well-being have not reverted to pre-pandemic levels. This indicates continued exposure to elevated levels of stress and/or a sustained effect of earlier exposure. Initiatives that provide ongoing support beyond the pandemic are needed to ensure that HCWs remain physically and mentally healthy and are able to continue their invaluable work.

Leaning Into Whole Health: Sustaining System Transformation While Supporting Patients and Employees During COVID-19

BACKGROUND

The US Veterans Health Administration (VA) is transforming its healthcare system to create a Whole Health System (WHS) of care. Akin to such reorganization efforts as creating patient-centered medical homes and primary care behavioral health integration, the WHS goes beyond by transforming the entire system to one that takes a proactive approach to support patient and employee health and wellness. The SARS-CoV-2 pandemic disrupted the VA's healthcare system and added stress for staff and patients, creating an exogenous shock for this transformation towards a WHS.

OBJECTIVE

We examined the relationship between VA's WHS transformation and the pandemic to understand if transformation was sustained during crisis and contributed to VA's response.

METHODS

Qualitative interviews were conducted as part of a multi-year study of WHS transformation. A single multi-person interview was conducted with 61 WHS leaders at 18 VA Medical Centers, examining WH transformation and use during the pandemic. Data were analyzed using rapid directed content analysis.

RESULTS

While the pandemic initially slowed transformation efforts, sites intentionally embraced a WH approach to support patients and employees during this crisis. Efforts included conducting patient wellness calls, and, for patients and employees, promoting complementary and integrative health therapies, self-care, and WH concepts to combat stress and support wellbeing. A surge in virtual technology use facilitated innovative delivery of complementary and integrative therapies and promoted continued use of WH activities.

CONCLUSION

The pandemic called attention to the need for healthcare systems to address the wellbeing of both patients and providers to sustain high quality care delivery. At a time of crisis, VA sites sustained WH transformation efforts, recognizing WH as one strategy to support patients and employees. This response indicates cultural transformation is taking hold, with WH serving as a promising approach for promoting wellbeing among patients and employees alike.

Impact of Sleep Deprivation on Emotional Regulation and the Immune System of Healthcare Workers as a Risk Factor for COVID 19: Practical Recommendations From a Task Force of the Latin American Association of Sleep Psychology

Healthcare workers who are on the front line of coronavirus disease 2019 (COVID-19) and are also undergoing shift schedules face long work hours with few pauses, experience desynchronization of their circadian rhythm, and an imbalance between work hours effort and reward in saving lives, resulting in an impact on work capacity, aggravated by the lack of personal protective equipment (PPE), few resources and precarious infrastructure, and fear of contracting the virus and contaminating family members. Some consequences are sleep deprivation, chronic insomnia, stress-related sleep disorders, and post-traumatic stress disorder. These sleep alterations critically affect mental health, precipitating or perpetuating anxiety, stress, and depression, resulting in the inability to regulate positive and negative emotions. Pre-existing sleep disorders are an important risk factor for the development and maintenance of PSTD when individuals are exposed to an important stressor such as a COVID-19 pandemic. At the same time, how an individual regulates the emotion associated with worries during daytime functioning impacts nighttime sleep, precipitating and perpetuating difficulties in sleeping. All of these changes in sleep and emotional regulation also alter the immune system. Sleep deprivation is commonly associated with chronic inflammatory diseases, due to the desynchronizations in circadian rhythms, causing possible psychophysiological disorders and impaired neuroimmune-endocrine homeostasis. From this perspective, we clarify in this article how sleep disorders affect the immune system and emotional regulation, explaining their phenomenological and neurobiological mechanisms, and discussing elements of cognitive and behavioral coping for health professionals to adopt and manage a healthier sleep pattern in the COVID-19 outbreak.

Sleep Disturbances in Frontline Health Care Workers During the COVID-19 Pandemic: Social Media Survey Study

BACKGROUND

During the COVID-19 pandemic, health care workers are sharing their challenges, including sleep disturbances, on social media; however, no study has evaluated sleep in predominantly US frontline health care workers during the COVID-19 pandemic.

OBJECTIVE

The aim of this study was to assess sleep among a sample of predominantly US frontline health care workers during the COVID-19 pandemic using validated measures through a survey distributed on social media.

METHODS

A self-selection survey was distributed on Facebook, Twitter, and Instagram for 16 days (August 31 to September 15, 2020), targeting health care workers who were clinically active during the COVID-19 pandemic. Study participants completed the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI), and they reported their demographic and career information. Poor sleep quality was defined as a PSQI score ≥5. Moderate-to-severe insomnia was defined as an ISI score >14. The Mini-Z Burnout Survey was used to measure burnout. Multivariate logistic regression tested associations between demographics, career characteristics, and sleep outcomes.

RESULTS

A total of 963 surveys were completed. Participants were predominantly White (894/963, 92.8%), female (707/963, 73.4%), aged 30-49 years (692/963, 71.9%), and physicians (620/963, 64.4%). Mean sleep duration was 6.1 hours (SD 1.2). Nearly 96% (920/963, 95.5%) of participants reported poor sleep (PSQI). One-third (288/963, 30%) reported moderate or severe insomnia. Many participants (554/910, 60.9%) experienced sleep disruptions due to device use or had nightmares at least once per week (420/929, 45.2%). Over 50% (525/932, 56.3%) reported burnout. In multivariable logistic regressions, nonphysician (odds ratio [OR] 2.4, 95% CI 1.7-3.4), caring for patients with COVID-19 (OR 1.8, 95% CI 1.2-2.8), Hispanic ethnicity (OR 2.2, 95% CI 1.4-3.5), female sex (OR 1.6, 95% CI 1.1-2.4), and having a sleep disorder (OR 4.3, 95% CI 2.7-6.9) were associated with increased odds of insomnia. In open-ended comments (n=310), poor sleep was mapped to four categories: children and family, work demands, personal health, and pandemic-related sleep disturbances.

CONCLUSIONS

During the COVID-19 pandemic, nearly all the frontline health care workers surveyed on social media reported poor sleep, over one-third reported insomnia, and over half reported burnout. Many also reported sleep disruptions due to device use and nightmares. Sleep interventions for frontline health care workers are urgently needed.