Mental health and well-being during the COVID-19 pandemic: longitudinal analyses of adults in the UK COVID-19 Mental Health & Wellbeing study

Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A State-of-the-Art Review

The vast majority of patients (>99%) with severe acute respiratory syndrome coronavirus 2 survive immediate infection but remain at risk for persistent and/or delayed multisystem. This review of published reports through May 31, 2021, found that manifestations of postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC) affect between 33% and 98% of coronavirus disease 2019 survivors and comprise a wide range of symptoms and complications in the pulmonary, cardiovascular, neurologic, psychiatric, gastrointestinal, renal, endocrine, and musculoskeletal systems in both adult and pediatric populations. Additional complications are likely to emerge and be identified over time. Although data on PASC risk factors and vulnerable populations are scarce, evidence points to a disproportionate impact on racial/ethnic minorities, older patients, patients with preexisting conditions, and rural residents. Concerted efforts by researchers, health systems, public health agencies, payers, and governments are urgently needed to better understand and mitigate the long-term effects of PASC on individual and population health.

Factors Associated With Suicide Ideation in Lithuania and Poland Amid the COVID-19 Pandemic

Background: The COVID-19 pandemic had an impact on many risk and protective factors associated with suicide. Aims: The aim of this study was to identify pandemic-related factors associated with suicidal ideation in the two European countries, Lithuania and Poland, amid the COVID-19 pandemic. Method: The sample comprised 2,459 participants in both countries; 57.2% of the respondents were female. The M_age of the participants was 43.45 years (SD = 15.91). Pandemic-related stressors and adjustment problems were measured to assess associations with suicidal ideation. Results: High levels of adjustment problems, loneliness, and burden due to staying at home more during the COVID-19 pandemic were significantly associated with suicide ideation in both Lithuania and Poland. Limitations: This was a cross-sectional online study with different recruitment approaches in the two countries. Conclusion: Adjustment problems, loneliness, and stressors related to staying at home more could be important targets for suicide prevention amid the pandemic.

Perceived Decrease in Workplace Security Since the Beginning of the COVID-19 Pandemic: The Importance of Management Styles and Work-Related Attitudes

The coronavirus disease 2019 (COVID-19) pandemic has reduced the sense of security of people in everyday life. The efforts of managers in the workplace to minimize the health risks and economic damage, however, can provide the employees with a greater sense of security. The aim of this study was to identify the types of workplace responses to the pandemic outbreak with respect to the characteristics of employees and their employers accomplishing the differences in subjective sense of workplace security before the pandemic and during the outbreak. Three hundred and thirty-seven Polish employees completed an online survey during the first 2 weeks of the COVID-19 pandemic in March 2020. Using the cluster analysis, we identified four subgroups of employees differing in their sense of workplace security, work-related psychological factors, and perceived management styles of their supervisors. Employees led by developers and executive managers sustained a high sense of work security and positive attitude to work, while those led by compromisers and deserter managers suffered from the highest drop of subjective security. In this study, we proposed how employees can be protected from overreactions and unnecessary panic in a time of global crisis by virtue of the psychological competences of their supervisors and employers.

Changes in Depressive Symptoms, Stress and Social Support in Mexican Women during the COVID-19 Pandemic

The aim of this study was to examine changes in depression, stress and social support levels before and during the COVID-19 pandemic in women living in Mexico City. We studied 466 women enrolled in the Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS) study who completed the Edinburgh Depression Scale (EDS) questionnaire prior (2018–2019) and during the lockdown period of the pandemic (May–November 2020). Psychosocial stress and social support for both time periods were ascertained using the Crisis in Family Systems (CRISYS) questionnaire and the Social Support Network (SSN) Scale, respectively. Associations between stress, social support and change in EDS score/depression were analyzed using generalized linear models adjusting for covariates. Higher stress (>median) during the pandemic was associated with an increase in EDS score (β: 2.13; 95% CI (1.06, 3.19), p < 0.001), and higher odds of depression (OR: 3.75; 95% CI (2.17, 6.50), p < 0.001), while social support was associated with lower odds of depression (OR: 0.56, 95% CI (0.32, 0.97), p = 0.037). Higher levels of stress during the pandemic were associated with depression. Social support may act as a buffer for the effects of psychosocial stress. Future studies should examine the long-term effects of stress associated with the pandemic on mental and overall health.

COVID-19, social isolation and the mental health of autistic people and their families: A qualitative study

LAY ABSTRACT

In this study, we show that autistic people and their families have found it very difficult to deal with the lockdowns during the COVID-19 pandemic. Autistic and non-autistic researchers spoke to 144 people, including 44 autistic adults, 84 parents of autistic children and 16 autistic young people (12-18 years old). We asked them about their everyday lives and mental health during lockdown. People told us that they enjoyed having fewer obligations and demands compared to pre-COVID-19 life. They felt that life was quieter and calmer. But people also told us again and again how much they missed meeting people in real life, especially their friends, and their therapists and support workers. People told us that their mental health suffered because they did not have contact with their friends and services. Importantly, many people (including researchers) think that autistic people do not want friends or to be around people. But our results show that is not true. Many autistic people do want friends and to be around other people. Some people's mental health has been damaged by not being able to see people during COVID-19. Autistic people need support in many areas of life so they can keep socialising and seeing their friends even through difficult times, like pandemics.

Heterogeneous mental health development during the COVID-19 pandemic in the United Kingdom

The COVID-19 pandemic and the mitigation measures by governments have upended the economic and social lives of many, leading to widespread psychological distress. We explore heterogeneity in trajectories of psychological distress during the pandemic in the United Kingdom and relate this heterogeneity to socio-demographic and health factors. We analyze nine waves of longitudinal, nationally representative survey data from the UK Household Longitudinal Study ([Formula: see text]), covering the period from early 2020 to mid-2021. First, latent class mixture modelling is used to identify trajectories of psychological distress. Second, associations of the trajectories with covariates are tested with multinomial logistic regressions. We find four different trajectories of distress: continuously low, temporarily elevated, repeatedly elevated, and continuously elevated distress. Nearly two fifths of the population experienced severely elevated risks of distress during the pandemic. Long-term distress was highest among younger people, women, people living without a partner, those who had no work or lost income, and those with previous health conditions or COVID-19 symptoms. Given the threat of persistent stress on health, policy measures should be sensitized to the unintended yet far-reaching consequences of non-pharmaceutical interventions.

"My brain feels like a browser with 100 tabs open": A longitudinal study of teachers' mental health and well-being during the COVID-19 pandemic

BACKGROUND

Teaching and caring for pupils during the COVID-19 pandemic has been a challenge for many teachers, and its impact on teachers' mental health and well-being (MHWB) should be of great national and international concern.

AIM AND PARTICIPANTS

This study examines 24 primary and secondary school teachers' MHWB experiences across three time points (April, July, and November 2020) using longitudinal qualitative trajectory analysis.

METHOD

We used a mixture of inductive and deductive coding, based on the Job Demands-Resources Model, to identify the job demands (aspects of the job that can be physically or psychologically costly) and job resources (aspects of the job that can buffer the effects of job demands and promote achievement and growth) teachers reported experiencing across the three time points.

RESULTS

Generally, teachers' MHWB seemed to have declined throughout the pandemic, especially for primary school leaders. Six job demands contributed negatively to teachers' MHWB (i.e., uncertainty, workload, negative perception of the profession, concern for others' well-being, health struggles, and multiple roles) and three job resources contributed positively to their MHWB (i.e., social support, work autonomy, and coping strategies).

CONCLUSIONS

Policymakers and practitioners can support teachers' MHWB by engaging in more collaborative communication and ensuring greater accessibility to sources of social support. These discussions and provisions will be crucial in supporting teachers, and thereby the educational system, both during and after the pandemic.

Subjective Impact of the COVID-19 Pandemic on Schizotypy and General Mental Health in Germany and the United Kingdom, for Independent Samples in May and in October 2020

Studies reported a strong impact on mental health during the first wave of the COVID-19 pandemic in March-June, 2020. In this study, we assessed the impact of the pandemic on mental health in general and on schizotypal traits in two independent general population samples of the United Kingdom (May sample N: 239, October sample N: 126; participation at both timepoints: 21) and in two independent general population samples of Germany (May sample N: 543, October sample N: 401; participation at both timepoints: 100) using online surveys. Whereas general psychological symptoms (global symptom index, GSI) and percentage of responders above clinical cut-off for further psychological investigation were higher in the May sample compared to the October sample, schizotypy scores (Schizotypal Personality Questionnaire) were higher in the October sample. We investigated potential associations, using general linear regression models (GLM). For schizotypy scores, we found that loneliness, use of drugs, and financial burden were more strongly corrected with schizotypy in the October compared to the May sample. We identified similar associations for GSI, as for schizotypy scores, in the May and October samples. We furthermore found that living in the United Kingdom was related to higher schizotypal scores or GSI. However, individual estimates of the GLM are highly comparable between the two countries. In conclusion, this study shows that while the general psychological impact is lower in the October than the May sample, potentially showing a normative response to an exceptional situation; schizotypy scores are higher at the second timepoint, which may be due to a stronger impact of estimates of loneliness, drug use, and financial burden. The ongoing, exceptional circumstances within this pandemic might increase the risk for developing psychosis in some individuals. The development of general psychological symptoms and schizotypy scores over time requires further attention and investigation.

Mental health and its association with coping strategies and intolerance of uncertainty during the COVID-19 pandemic among the general population in Saudi Arabia: cross-sectional study

BACKGROUND

The COVID-19 pandemic has had a major impact on people's lives globally. The outbreak in Saudi Arabia worsened when the number of cases and deaths rose in March and April of 2020, leading to a national lockdown. This study aimed to assess the factors associated with mental health symptoms in a sample of people residing in Saudi Arabia during the COVID-19 pandemic.

METHODS

We conducted an observational cross-sectional study using an online survey distributed via social media, completed by 3032 respondents from all Saudi regions. We collected demographic data, illness history, and scores of validated self-report scales to assess mental health symptoms, intolerance of uncertainty, and coping strategies.

RESULTS

In total, respondents indicated moderate to very severe symptoms during the pandemic as follows: 20.9% for depression, 17.5% for anxiety, and 12.6% for stress. Younger age, female gender, and history of mental illness were associated with higher levels of depression, anxiety, stress, and insomnia. Intolerance of uncertainty and certain coping strategies (such as denial or self-blame) were associated with more severe symptoms.

CONCLUSIONS

Mental health is a key concern during the COVID-19 pandemic, especially for the identified vulnerable groups. Agencies concerned with mental health during crises may use the studied associated factors of mental health symptoms to generate targeted policies or interventions.

Does COVID-19 vaccination improve mental health? A difference-in-difference analysis of the Understanding Coronavirus in America study

BACKGROUND

Mental health problems increased during the COVID-19 pandemic. Knowledge that one is less at risk after being vaccinated may alleviate distress, but this hypothesis remains unexplored. Here we test whether psychological distress declined in those vaccinated against COVID-19 in the US and whether changes in perceived risk mediated any association.

METHODS

A nationally-representative cohort of U.S. adults (N=5,792) in the Understanding America Study were interviewed every two weeks from March 2020 to June 2021 (28 waves). Difference-in-difference regression tested whether getting vaccinated reduced distress (PHQ-4 scores), with mediation analysis used to identify potential mechanisms, including perceived risks of infection, hospitalization, and death.

RESULTS

Vaccination was associated with a 0.09 decline in distress scores (95% CI:-0.15 to -0.04) (0-12 scale), a 5.7% relative decrease compared to mean scores in the wave prior to vaccination. Vaccination was also associated with an 8.44 percentage point reduction in perceived risk of infection (95% CI:-9.15% to -7.73%), a 7.44-point reduction in perceived risk of hospitalization (95% CI:-8.07% to -6.82%), and a 5.03-point reduction in perceived risk of death (95% CI:-5.57% to -4.49%). Adjusting for risk perceptions decreased the vaccination-distress association by two-thirds. Event study models suggest vaccinated and never vaccinated respondents followed similar PHQ-4 trends pre-vaccination, diverging significantly post-vaccination. Analyses were robust to individual and wave fixed effects, time-varying controls, and several alternative modelling strategies. Results were similar across sociodemographic groups.

CONCLUSION

Receiving a COVID-19 vaccination was associated with declines in distress and perceived risks of infection, hospitalization, and death. Vaccination campaigns could promote these additional benefits of being vaccinated.

Mental Health and Psychological Wellbeing during the COVID-19 Lockdown: A Longitudinal Study in the Balearic Islands (Spain)

Confining the entire population to a lockdown after the outbreak of SARS-CoV-2 was an unprecedented measure designed to protect the health of those living in Spain. The objective of the present study is to assess the evolution of mental health and psychological wellbeing during lockdown. To do this, we carried out a longitudinal study, via an online survey over the eight weeks of lockdown (weekly assessments). Sociodemographic variables were recorded, along with data related to COVID-19, psychological wellbeing (anxiety, depression, psychotropic drugs, consultations made to improve mood or anxiety), life satisfaction, and self-perceived health. A total of 681 individuals participated in the study, 76.8% were women; the mean age was 43 years old (SD = 12.7). Initially, high scores were reported for anxiety, depression, and the number of consultations to improve mood, but these decreased significantly over the study period. The reverse seems to be true for life satisfaction, perceived good health, and intake of psychotropic drugs. We also identified groups whose psychological wellbeing was more susceptible to the effects of lockdown. Women, those worried about their jobs after the pandemic, and those afraid of being infected were the most affected individuals. More generally, after the initial negative effect on psychological wellbeing, various indicators improved over the lockdown period.

Suicide attempt risks among hotline callers with and without the coronavirus disease 2019 related psychological distress: a case-control study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic profoundly impacts on mental health, yet it is still unclear whether COVID-19 distress makes people more vulnerable to suicidal behavior. The present study aims to examine the association between COVID-19 related psychological distress and risk for suicide attempt, and moderators of this association, among hotline callers.

METHODS

This case-control study was conducted at the largest psychological support hotline in China. Hotline callers who sought help for psychological distress and reported whether or not they attempted suicide in the last 2 weeks (recent suicide attempt) were analyzed. The primary predictor of recent suicide attempt was the presence or absence of COVID-19 related psychological distress. Demographic variables and common risk and protective factors for suicidal behavior were also studied. Callers with COVID-19 related distress (COVID-19 callers) and those without such distress (non-COVID-19 callers) were compared on these variables. Recent suicide attempt was regressed on COVID-19 related distress and the other variables, and significant interaction terms of aforementioned predictors by COVID-19 related distress, to identify variables that moderate the association of COVID-19 related distress and recent suicide attempt.

RESULTS

Among 7337 included callers, there were 1252 COVID-19 callers (17.1%) and 6085 non-COVID-19 callers (82.9%). The COVID-19 callers were less likely to report recent suicide attempt (n = 73, 5.8%) than the non-COVID-19 callers (n = 498, 8.2%, P = 0.005). The COVID-19 callers were also less likely to have high scores on depressive symptoms (22.6% vs 26.3%, P < 0.001) and psychological distress (19.5% vs 27.3%, P < 0.001), and were more likely to have high hopefulness scores (46.5% vs 38.0%, P < 0.001). Tests of moderating effects showed that acute life events were associated with one-half lower risk (P = 0.021), and a trend that suicide attempt history was associated with two-thirds greater risk (P = 0.063) for recent suicide attempt, among COVID-19 callers than non-COVID-19 callers.

CONCLUSIONS

The COVID-19 calls are from individuals with lower suicide-related risk compared to more typical callers. Acute stressful life events provided a key context for suicide attempt in non-COVID-19 callers, i.e., more typical calls.

Suicidal ideation in university students in Lithuania amid the COVID-19 pandemic: A prospective study with pre-pandemic measures

We aimed to identify patterns of changes in suicidal ideation among university students six months after the COVID-19 outbreak, in comparison to the pre-pandemic suicidal ideation. Furthermore, we explored the links among these patterns and mental health indicators. 474 university students participated in the study in October-December 2019 and October-December 2020. The latent class change analysis revealed four groups: no-ideation (68.1%), stable low ideation (16.2%), increased ideation (8.9%), and decreased ideation (6.8%). Increased, in comparison to decreased ideation, was positively linked to changes in depression, stress, and anxiety. More loneliness during the pandemic was related to higher suicidal ideation.

Anxiety and depression symptoms after COVID-19 infection: results from the COVID Symptom Study app

BACKGROUND

Mental health issues have been reported after SARS-CoV-2 infection. However, comparison to prevalence in uninfected individuals and contribution from common risk factors (e.g., obesity, comorbidities) have not been examined. We identified how COVID-19 relates to mental health in the large community-based COVID Symptom Study.

METHODS

We assessed anxiety and depression symptoms using two validated questionnaires in 413,148 individuals between February and April 2021; 26,998 had tested positive for SARS-CoV-2. We adjusted for physical and mental pre-pandemic comorbidities, BMI, age, and sex.

FINDINGS

Overall, 26.4% of participants met screening criteria for general anxiety and depression. Anxiety and depression were slightly more prevalent in previously SARS-CoV-2 positive (30.4%) vs. negative (26.1%) individuals. This association was small compared to the effect of an unhealthy BMI and the presence of other comorbidities, and not evident in younger participants (≤40 years). Findings were robust to multiple sensitivity analyses. Association between SARS-CoV-2 infection and anxiety and depression was stronger in individuals with recent (<30 days) vs. more distant (>120 days) infection, suggesting a short-term effect.

INTERPRETATION

A small association was identified between SARS-CoV-2 infection and anxiety and depression symptoms. The proportion meeting criteria for self-reported anxiety and depression disorders is only slightly higher than pre-pandemic.

FUNDING

Zoe Limited, National Institute for Health Research, Chronic Disease Research Foundation, National Institutes of Health, Medical Research Council UK.

Swedish nationwide time series analysis of influenza and suicide deaths from 1910 to 1978

OBJECTIVES

There is concern that the COVID-19 pandemic will be associated with an increase in suicides, but evidence supporting a link between pandemics and suicide is limited. Using data from the three influenza pandemics of the 20th century, we aimed to investigate whether an association exists between influenza deaths and suicide deaths.

DESIGN

Time series analysis.

SETTING

Sweden.

PARTICIPANTS

Deaths from influenza and suicides extracted from the Statistical Yearbook of Sweden for 1910-1978, covering three pandemics (the Spanish influenza, the Asian influenza and the Hong Kong influenza).

MAIN OUTCOME MEASURES

Annual suicide rates in Sweden among the whole population, men and women. Non-linear autoregressive distributed lag models was implemented to explore if there is a short-term and/or long-term relationship of increases and decreases in influenza death rates with suicide rates during 1910-1978.

RESULTS

Between 1910 and 1978, there was no evidence of either short-term or long-term significant associations between influenza death rates and changes in suicides (β coefficients of 0.00002, p=0.931 and β=0.00103, p=0.764 for short-term relationship of increases and decreases in influenza death rates, respectively, with suicide rates, and β=-0.0002, p=0.998 and β=0.00211, p=0.962 for long-term relationship of increases and decreases in influenza death rates, respectively, with suicide rates). The same pattern emerged in separate analyses for men and women.

CONCLUSIONS

We found no evidence of short-term or long-term association between influenza death rates and suicide death rates across three 20th century pandemics.

Behavioural change in Prader-Willi syndrome during COVID-19 pandemic

BACKGROUND

Prader-Willi syndrome (PWS) is a rare genetic disorder that in many cases is associated with mental health disorders, in addition to characteristic symptoms such as hyperphagia. The current Sars-CoV-2 coronavirus pandemic has led to massive restrictions in health care and social life worldwide. People with PWS represent a particularly vulnerable population group to these restrictions, with unknown impact on their mental health.

METHODS

We conducted an online questionnaire to assess the impact of the restrictions associated with the COVID-19 pandemic on the mental health of people with PWS.

RESULTS

One hundred and eight caregivers completed the survey about individuals with PWS. Individuals with PWS > 6 years (n = 89) were included for evaluation with regard to psychopathological change. Respondents frequently reported an increase in psychopathological symptoms associated with PWS during the lockdown, with 51.7% reporting increased temper outbursts, 43.8% showing signs of sadness, 38.2% being anxious, 55.0% more irritable, and 39.3% showing more food seeking behaviour. Adjusted for the type of accommodation food seeking behaviour and irritability is increased to a significantly lesser extent in people with PWS accommodated in specialised care facilities compared with those living in their family home. No significant difference could be found between the sexes.

CONCLUSION

The COVID-19 pandemic has had a significant effect on the mental health of individuals with PWS, evidenced by an increase in behaviours associated with PWS, including temper outbursts, food-seeking, and irritability, which again underlines their need for specialised care. Individuals living with their families were particularly vulnerable, indicating that they and their families are in special need of support.

Mental health and well-being of indigenous people during the COVID-19 pandemic in Bangladesh

BACKGROUND

The ongoing pandemic caused by the novel coronavirus and the subsequent containment strategies has taken a heavy toll on the mental health of people irrespective of age, gender, race, ethnicity, and geographical location. Studies have documented the mental health status of non-indigenous Bangladeshi people, but little attention has been paid during the pandemic to the investigation of the mental health status of indigenous people living in remote hilly areas. To address this gap the present study aimed at investigating the prevalence and accompanying risk factors of depression, anxiety, stress, and compromised well-being among indigenous people during the pandemic.

METHODS

A cross-sectional survey was conducted on 422 indigenous people aged between 16 and 90 using the 21-item Bangla Depression Anxiety Stress Scale (BDASS-21) and the Bangla version of the WHO-5 Well-being Index from January 30 to April 10, 2021. Data were collected by trained research assistants from three remote hilly areas namely Bandarban, Rangamati, and Khagracchari in the Chattogram Hill Tracts (CHT). Chi-squares, logistic regression, and ANOVA were performed to examine the association of variables.

RESULTS

The prevalence of moderate to extremely severe depression, anxiety, stress, and low well-being among the indigenous population during the pandemic was found to be 49.3%, 47.2%, 36.7%, and 50.9%, respectively. Risk predictors for depression, anxiety, and stress included age, ethnicity, geographical locations, educational attainment, occupation, and marital status.

CONCLUSIONS

The results suggest that the ongoing pandemic has led to the rise of common mental health problems among indigenous people during the pandemic. The results can contribute to the formation of mental health policy for indigenous people and the development of suitable mental health intervention strategies especially during and after the COVID-19 pandemic.

Sufficient sleep attenuates COVID-19 pandemic-related executive dysfunction in late adolescents and young adults

Purpose

To investigate the interaction between (1) sleep and the COVID-19 pandemic; and (2) social cumulative risk and COVID-19 pandemic on executive function (EF).

Methods

Forty late adolescents/young adults (19.25 ± 1.12 y.o.) completed sleep questionnaires and the Behavior Rating Inventory of Executive Function- Adults (BRIEF-A) before and during the COVID-19 pandemic, yielding 80 observations for data analysis. Multilevel random-effects models with interaction terms were used to estimate the associations.

Results

Compared to pre-pandemic sleep, participants slept 24 min longer (t = −2.07, p = 0.03) and also had increased sleep latency (t = −1.83, p = 0.07) during COVID-19. Mid-sleep times shifted 40 min later (t = −3.22, p = 0.003), and BRIEF-A scores increased (indicating greater dysfunction), during the pandemic (p < 0.05). The worsening in EF during the pandemic was attenuated by increasing sleep duration (B = -4.38, p = 0.04) and magnified by social cumulative risk (B = 3.19, p = 0.04). Poor sleep quality was independently associated with increase in EF problems (p < 0.05).

Conclusion

Sufficient sleep may represent a resilience factor against EF decline during this unprecedented crisis.

State Anhedonia in Young Healthy Adults: Psychometric Properties of the German Dimensional Anhedonia Rating Scale (DARS) and Effects of the COVID-19 Pandemic

Healthy reward processing is a complex interplay of several components. Recent self-report measures of anhedonia, the decrease or loss of hedonic capacity, take this complexity into account. The Dimensional Anhedonia Rating Scale (DARS) measures interest, motivation, effort and consummatory pleasure across four domains: hobbies, food/drink, social activities and sensory experiences. In the present cross-sectional survey study, we validated the German version of the DARS in a sample of 557 young healthy adults. Factor structure as well as convergent and divergent validity were assessed. As a secondary aim, we examined the effects of the COVID-19 pandemic on state anhedonia and depression severity. Our results suggest good convergent and divergent validity and high internal consistency of the German DARS. The original differentiation of four factors mapping onto the four domains was confirmed and measurement invariance before and during the COVID-19 pandemic was established. We conclude that the DARS is a valid instrument to comprehensively assess state anhedonia in healthy German samples. Future studies should further assess the utility of the German DARS in clinical contexts. In line with many previous studies, participants during the pandemic reported significantly higher levels of depressive symptoms compared to participants in the months before. We found no indication that the COVID-19 pandemic affected state hedonic capacity.

Optimizing Decision-Making Processes in Times of COVID-19: Using Reflexivity to Counteract Information-Processing Failures

The effectiveness of policymakers' decision-making in times of crisis depends largely on their ability to integrate and make sense of information. The COVID-19 crisis confronts governments with the difficult task of making decisions in the interest of public health and safety. Essentially, policymakers have to react to a threat, of which the extent is unknown, and they are making decisions under time constraints in the midst of immense uncertainty. The stakes are high, the issues involved are complex and require the careful balancing of several interests, including (mental) health, the economy, and human rights. These circumstances render policymakers' decision-making processes vulnerable to errors and biases in the processing of information, thereby increasing the chances of faulty decision-making processes with poor outcomes. Prior research has identified three main information-processing failures that can distort group decision-making processes and can lead to negative outcomes: (1) failure to search for and share information, (2) failure to elaborate on and analyze information that is not in line with earlier information and (3) failure to revise and update conclusions and policies in the light of new information. To date, it has not yet been explored how errors and biases underlying these information-processing failures impact decision-making processes in times of crisis. In this narrative review, we outline how groupthink, a narrow focus on the problem of containing the virus, and escalation of commitment may pose real risks to decision-making processes in handling the COVID-19 crisis and may result in widespread societal damages. Hence, it is vital that policymakers take steps to maximize the quality of the decision-making process and increase the chances of positive outcomes as the crisis goes forward. We propose group reflexivity-a deliberate process of discussing team goals, processes, or outcomes-as an antidote to these biases and errors in decision-making. Specifically, we recommend several evidence-based reflexivity tools that could easily be implemented to counter these information-processing errors and improve decision-making processes in uncertain times.

COVID-19 and Open Notes: A New Method to Enhance Patient Safety and Trust

From April 5, 2021, as part of the 21st Century Cures Act, all providers in the United States must offer patients access to the medical information housed in their electronic records. Via secure health portals, patients can log in to access lab and test results, lists of prescribed medications, referral appointments, and the narrative reports written by clinicians (so-called open notes). As US providers implement this practice innovation, we describe six promising ways in which patients' access to their notes might help address problems that either emerged with or were exacerbated by the COVID-19 pandemic.

Short-Term Effect of the COVID-19 Pandemic on Suicidal Ideation

Background: Few studies have examined the effect of pandemics on suicide-related outcomes. Aims: We examined whether suicidal ideation levels among the general population changed owing to the COVID-19 pandemic by tracking individuals between January and April 2020. Method: We used a prospective observational longitudinal design (n = 6,683) and stratified sampling to conduct online surveys of the general adult population in Japan before (baseline) and during the pandemic (follow-up). Results: Suicidal ideation levels were significantly lower during than before the pandemic; however, the effect size was very small. Participants who were younger, with unstable employment, without children, with low income, and receiving psychiatric care were more likely to have higher suicidal ideation levels during the pandemic. Limitations: Because this was an Internet survey and subject to selection bias, the sample was not necessarily representative of the Japanese population. At the time of the survey, COVID-19 cases and deaths in Japan were relatively lower than in other developed countries. The dropout rate may have affected the results. Conclusion: Although the short-term impact of the COVID-19 pandemic on suicidal ideation is limited, relatively young and economically vulnerable individuals are more likely to show exacerbated suicidal ideation during the pandemic.

Development of the Adult Pandemic Attitude Scale (A-PAS)

This study aimed to develop an instrument for measuring the attitudes that reflect the characteristics of the pandemic (Adult Pandemic Attitude Scale (A-PAS)) and verifying its validity and reliability. This study used a methodological research design and was conducted with a development step and an evaluation step. The development step included development of preliminary items, content validity, face validity, and preliminary investigation. The evaluation step included item analysis, construct validity, convergent validity, discriminant validity, criterion validity, factor naming, reliability, and completion of the final instrument. The A-PAS developed in this study consisted of a total of 20 items in five dimensions. The internal consistency of 20 items of the A-PAS, Cronbach’s α was 0.92 for 20 items, Cronbach’s α for each factor, a subscale of instrument, was 0.61~0.87 and Raykov’s p coefficient of each factor, which is a subscale of the tool, was found to be 0.60 to 0.88. Analysis of construct validity showed the results as follows: χ² (p) = 134.05 (p < 0.001), RMSEA = 0.02, RMR = 0.02, GFI = 0.94, CFI = 0.99. The study findings suggest that the developed instrument can be utilized to measure the attitudes of adults toward pandemics, and reflect the reality of the pandemic situation. The outcomes can be used as valuable data for intervention, prevention activities, and policy preparation. The instrument will be applied in the event of a pandemic, such as COVID-19, and will be helpful in promoting the health of the people.

Changes in depression and suicidal ideation under severe lockdown restrictions during the first wave of the COVID-19 pandemic in Spain: a longitudinal study in the general population

AIMS

To assess whether there is a change in the prevalence of depression and suicidal ideation after the strict lockdown measures due to the first wave of the COVID-19 pandemic in Spain; and to assess which are the factors associated with the incidence of a depressive episode or suicidal ideation during the lockdown.

METHODS

Data from a longitudinal adult population-based cohort from the provinces of Madrid and Barcelona were analysed (n = 1103). Structured face-to-face home-based interviews (pre-pandemic) and telephone interviews were performed. Both depression and suicidal ideation were assessed through an adaptation of the Composite International Diagnostic Interview (CIDI 3.0). A variety of validated instruments and sociodemographic variables including age, sex, educational level, occupational status, home quietness, screen time, resilience, loneliness, social support, physical activity, disability, economic situation and COVID-19-related information were also considered. Population prevalence estimates and multivariable logistic regressions were computed.

RESULTS

Overall, prevalence rates of depression and suicidal ideation did not change significantly from before to after the COVID-19 outbreak. However, the rates of depression among individuals aged 50+ years showed a significant decrease compared to before the pandemic (from 8.48 to 6.41%; p = 0.01). Younger individuals (odds ratio (OR) = 0.97 per year older; 95% confidence interval (CI) = 0.95-0.99) and those feeling loneliness (OR = 1.96; 95% CI = 1.42-2.70) during the lockdown were at an increased risk of developing depression during the confinement. Resilience showed a protective effect against the risk of depression (OR = 0.46; 95% CI = 0.32-0.66) and suicidal ideation (OR = 0.33; 95% CI = 0.16-0.68), whereas individuals perceiving social support were at a lower risk of developing suicidal thoughts (OR = 0.35; 95% CI = 0.18-0.69).

CONCLUSIONS

Continuous reinforcement of mental health preventive and intervening measures during and in the aftermath of the crisis is of global importance, particularly among vulnerable groups who are experiencing the most distress. Future research should strive to evaluate the long-term effects of the COVID-19 crisis on mental health.

Effects of COVID-19-related stay-at-home order on neuropsychophysiological response to urban spaces: Beneficial role of exposure to nature?

Background

The COVID-19 pandemic has had severe negative effects on populations worldwide. The seriousness of the pandemic necessitated local and even national lockdowns. In Singapore a national lockdown with aStay-at-Home Order (SHO) lasted for over 7 weeks. The impact of the pandemic and of the long SHO period on neuropsychophysiological functioning remains unknown. Studies prior to the pandemic highlighted the beneficial role of nature exposure on mental health and well-being, although this has not yet been explored in the post-pandemic world. This is the first study to investigate the longitudinal changes in (1) brain frontal alpha asymmetry (FAA; neuroelectric marker of approach-related motivation), (2) depressive mood and (3) symptoms, and (4) emotional response to videos of various urban spaces from before COVID-19 to immediately after the SHO in Singapore was over. Finally, we examined whether higher vs lower exposure to nature during the SHO moderated changes over time.

Methods

The sample included 25 healthy adult Singaporeans (56% female, M_age = 40.4 y, SD = 17.8), who attended two electroencephalography (EEG) lab sessions, within a year before the COVID-19 pandemic (T1) and immediately following the SHO (T2). The participants viewed 9 fixed-frame videos, filmed before the pandemic, from 3 urban public spaces (Busy Downtown, Residential Green, Lush Garden) on the roll-up screen. They rated their emotional response (arousal, valence) after each video and completed Becks Depression Inventory-II (BDI-II) as a measure of depressive symptoms, Profile of Mood Scale (POMS), as a measure of momentary mood, and self-reported the frequency and duration of their nature visits during the SHO.

Results

Linear mixed models were fitted to examine changes over time, and effect moderation by amount of nature exposure during the SHO. The results showed decrease in FAA (p < 0.001), increase in depressive symptoms (p = 0.046), and a trend for marginal increase in momentary mood disturbance (p = 0.097) after the SHO. Importantly, people with high nature exposure during SHO had greater decrease in FAA over time (p = 0.005) than those with low nature exposure, FAA scores decreased the most for Residential Green. Valence and Arousal did not change over time, but Arousal towards Busy Downtown decreased among high nature exposure individuals (p = 0.002).

Conclusions

Post SHO, brain activity and responsiveness to landscapes changed, and showed a general reduction in positive emotions and increased depressive symptoms among participants. The higher nature exposure during the SHO did not help mitigate this depressive symptoms, as previous research would suggest. This can be due to the modified quality of nature exposure during lockdown, which highlights the importance of high quality nature experience in cities and the provision of diversified visual exposures. Potential neuropsychophysiological consequences of SHO should be considered by policy makers in the post-COVID-19 world.

Exploring Affect Balance: Psychological Well-being of Church of England Clergy and Laity During the COVID-19 Pandemic

Psychological well-being was assessed by affect balance (a function of negative and positive affect) during the first COVID-19 lockdown in 2020 among 4449 clergy and laity in the Church of England. Better well-being was promoted by preference for feeling over thinking in the psychological type judging process, being older, belonging to the Evangelical wing of the Church, and living in rural areas. Psychological well-being was lowered among people with a general tendency toward neuroticism, among those with an Epimethean (Sensing-Judging: SJ) psychological temperament, among Anglo-Catholics, among those living in inner cities, among clergy, and among those living with children under 13. The mitigating effects of relevant support were evident for both clergy and lay people. A key finding was that it was those sources of support that were least often rated highly that may have had the strongest positive effects on well-being, particularly on those groups where well-being was lowest.

Living in the "Bubble": Athletes' Psychological Profile During the Sambo World Championship

Background: The COVID-19 pandemic has changed the way we conduct daily life, as well as sports training and sports competitions. Given the stress produced by COVID-19, and the "bubble" safety measures for the World Sambo Championship, held in Novi Sad, from the 6th to the 8th of November, 2020, athletes might have experienced more stress than athletes normally would in non-pandemic conditions. Therefore, the current study aimed to create a psychological profile of sambo athletes participating in the Sambo World Championship and living in this condition. Methods: One-hundred-fifteen participants took part in the study, completing the Profile of Mood Scale (POMS), the Pittsburg Sleep Quality Index, the Perceived Stress Scale (PSS), and the Fear of COVID-19 Scale. A mediation model with Fear of COVID-19 predicting both stress level directly and stress level through mood disturbance was hypothesized. Gender differences were evaluated through t-test. Results: The results showed that the sample presented higher levels of stress but no problems in sleeping. In particular, data analysis confirmed an indirect effect of Fear of COVID on Perceived stress through mood disturbance (β = 0.14, Z = 2.80, and p = 0.005), but did not have a significant impact on the direct effect (β = -0.04, Z = -0.48, and p = 0.63). Gender differences emerged in the perceived stress level (t = -2.86, df = 114, and p = 0.005) and daytime dysfunction (t = -2.52, df = 114, and p = 0.01) where females scored higher than males for both aspects. Conclusion: The athletes participating to the World Sambo Championship experienced stress levels determined by the mood disturbance produced by the fear of the COVID-19 pandemic. Female athletes were more stressed and showed higher daytime dysfunction. The findings of the current study are useful to understand the psychological profile of the athletes competing in the "bubble" conditions during COVID-19 pandemic.

Psychological distress among people with probable COVID-19 infection: analysis of the UK Household Longitudinal Study

Studies exploring the longer-term effects of experiencing coronavirus disease-2019 (COVID-19) on mental health are lacking. We explored the relationship between reporting probable COVID-19 symptoms in April 2020 and psychological distress (measured using the General Health Questionnaire) 1, 2, 3, 5 and 7 months later. Data were taken from the UK Household Longitudinal Study, a nationally representative household panel survey of UK adults. Elevated levels of psychological distress were found up to 7 months after probable COVID-19, compared with participants with no likely infection. Associations were stronger among younger age groups and men. Further research into the psychological sequalae of COVID-19 is urgently needed.

Intolerance of uncertainty and reactions to the COVID-19 pandemic

The COVID-19 pandemic has presented a threat to mental health worldwide. The current study aims to investigate the role of intolerance of uncertainty in cognitive, emotional and behavioral reactions to this pandemic and propose a path model of these reactions. In the first two months of the COVID-19 pandemic in Slovakia, participants in a general sample (n = 1,011) as well as an older adult sample (n = 655) completed measures regarding intolerance of uncertainty, mental health (anxiety, well-being, perceived stress) and adherence to preventive measures. Two rounds of data collection were carried out in the first sample. Intolerance of uncertainty was found to be related to mental health indicators and the structural equation model showed a direct and indirect effect on them as well as on the adherence to preventive measures. However, the comparison of data from different time points has brought inconsistent results. The findings highlight the role of intolerance of uncertainty in reaction to threat and indicate the potential of uncertainty reduction e.g., getting clear messages from authorities, as a way of decreasing mental health problems.

International survey for assessing COVID-19's impact on fear and health: study protocol

INTRODUCTION

COVID-19, caused by the SARS-CoV-2, has been one of the most highly contagious and rapidly spreading virus outbreak. The pandemic not only has catastrophic impacts on physical health and economy around the world, but also the psychological well-being of individuals, communities and society. The psychological and social impacts of the COVID-19 pandemic internationally have not been well described. There is a lack of international study assessing health-related impacts of the COVID-19 pandemic, especially on the degree to which individuals are fearful of the pandemic. Therefore, this study aims to (1) assess the health-related impact of the COVID-19 pandemic in community-dwelling individuals around the world; (2) determine the extent various communities are fearful of COVID-19 and (3) identify perceived needs of the population to prepare for potential future pandemics.

METHODS AND ANALYSIS

This global study involves 30 countries. For each country, we target at least 500 subjects aged 18 years or above. The questionnaires will be available online and in local languages. The questionnaires include assessment of the health impacts of COVID-19, perceived importance of future preparation for the pandemic, fear, lifestyles, sociodemographics, COVID-19-related knowledge, e-health literacy, out-of-control scale and the Patient Health Questionnaire-4. Descriptive statistics will be used to describe participants' characteristics, perceptions on the health-related impacts of COVID-19, fear, anxiety and depression, lifestyles, COVID-19 knowledge, e-health literacy and other measures. Univariable and multivariable regression models will be used to assess the associations of covariates on the outcomes.

ETHICS AND DISSEMINATION

The study has been reviewed and approved by the local ethics committees in participating countries, where local ethics approval is needed. The results will be actively disseminated. This study aims to map an international perspective and comparison for future preparation in a pandemic.

More Positive Emotions During the COVID-19 Pandemic Are Associated With Better Resilience, Especially for Those Experiencing More Negative Emotions

The ongoing COVID-19 pandemic has taken a significant toll on mental health; people around the world are experiencing high levels of stress and deteriorated wellbeing. The past research shows that positive emotions can help people cultivate a resilient mindset; however, the reality created by the global crisis itself limits the opportunities for experiencing positive emotions. Thus, it is unclear to what extent their effect is strong enough to counter the psychological impact of the current pandemic. Here, the author reports the findings of a survey conducted across two large representative samples in the United Kingdom and the United States (N _total = 2000) during the first wave of the COVID-19 pandemic (in Spring 2020). A linear regression model revealed that the presence of positive emotions is strongly linked with resilience, in particular for individuals experiencing more negative emotions. These results show that positive emotions are particularly important to mental health in the context of high stress, reflected by increased levels of negative emotional experiences. These results are also consistent with the existential positive psychology perspective, which posits that even negative emotions can contribute to wellbeing once they are transformed. The author discusses the potential of positive emotions to transform suffering and thereby ameliorate the negative impact of the present collective crisis.

Anxiety reported by US adults in 2019 and during the 2020 COVID-19 pandemic: Population-based evidence from two nationally representative samples

BACKGROUND

The impact of the coronavirus disease 2019 (COVID-19) on the mental health of the US population is unclear. This study drew on two nationally representative samples to compare the prevalence rate of anxiety in the U.S. before and during the 2020 COVID-19 pandemic.

METHODS

The Generalized Anxiety Disorder-2 (GAD-2) screening tool was used to detect the proportion of US adults screening positive for high levels of anxiety symptoms. Anxiety symptoms was assessed in 2019 using the National Health Interview Survey (NHIS; N = 30,915) and during the pandemic using biweekly surveys collected as part of the Understanding America Study (UAS; N=8,022 Obs.=121,768) between March and December 2020.

RESULTS

The proportion of participants with high levels of anxiety symptoms increased significantly from 8.1% (95% CI[7.7, 8.5]) in 2019 to 21.4% (95% CI[19.9, 22.9]) at the beginning of April, 2020. The prevalence then declined to 11.4% (95% CI[10.3, 12.5]) in May and remained 3% above 2019 levels until December 2020. This pattern of increasing anxiety between 2019 and April 2020 followed by a rapid decrease in anxiety was identified across all demographic characteristics examined.

LIMITATIONS

The NHIS and UAS samples differ in their sampling and mode of administration which may bias comparisons between samples.

CONCLUSIONS

Anxiety symptoms increased markedly during the onset of the COVID-19 pandemic and reduced quickly as stay-at-home orders were lifted. These findings highlight the importance of providing mental health supports during future lockdowns and suggest that resilience in mental health may have been a key population-level response to the demands of the pandemic.

Suicide in England in the COVID-19 pandemic: Early observational data from real time surveillance

BACKGROUND

There have been concerns that the COVID-19 pandemic may lead to an increase in suicide. The coronial system in England is not suitable for timely monitoring of suicide because of the delay of several months before inquests are held.

METHODS

We used data from established systems of "real time surveillance" (RTS) of suspected suicides, in areas covering a total population of around 13 million, to test the hypothesis that the suicide rate rose after the first national lockdown began in England.

FINDINGS

The number of suicides in April-October 2020, after the first lockdown began, was 121•3 per month, compared to 125•7 per month in January-March 2020 (-4%; 95% CI-19% to 13%, p = 0•59). Incidence rate ratios did not show a significant rise in individual months after lockdown began and were not raised during the 2-month lockdown period April-May 2020 (IRR: 1•01 [0•81-1•25]) or the 5-month period after the easing of lockdown, June-October 2020 (0•94 [0•81-1•09]). Comparison of the suicide rates after lockdown began in 2020 for the same months in selected areas in 2019 showed no difference.

INTERPRETATION

We did not find a rise in suicide rates in England in the months after the first national lockdown began in 2020, despite evidence of greater distress. However, a number of caveats apply. These are early figures and may change. Any effect of the pandemic may vary by population group or geographical area. The use of RTS in this way is new and further development is needed before it can provide full national data.

FUNDING

This study was funded by the Healthcare Quality Improvement Partnership (HQIP).The HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing, and National Voices. Its aim is to promote quality improvement in patient outcomes, and in particular, to increase the impact that clinical audit, outcome review programs and registries have on healthcare quality in England and Wales. HQIP holds the contract to commission, manage, and develop the National Clinical Audit and Patient Outcomes Program (NCAPOP), comprising around 40 projects covering care provided to people with a wide range of medical, surgical and mental health conditions. The program is funded by NHS England, the Welsh Government and, with some individual projects, other devolved administrations, and crown dependencies.

Increased risk of mental health disorders in patients with RA during the COVID-19 pandemic: a possible surge and solutions

Depression is a common co-morbidity among rheumatoid arthritis (RA) patients, which may translate into difficulty performing activities of daily living. COVID-19 is an unprecedented disaster that has disrupted lives worldwide and led to a rise in the incidence of mental health disorders. Given the widespread economic devastation due to COVID-19, many RA patients, already susceptible to mental illness, maybe at an increased risk of inaccessibility to medical care, accentuated stress, and consequent worsening of existent mental health disorders, or the onset of new mental health disorders such as anxiety, post-traumatic stress disorder, or depression. The objective of this review is to assess if there is an increased risk of mental health disorders in patients with RA during the COVID-19 pandemic. Telemedicine has bridged the transition to remote chronic care in the pandemic period, though certain accessibility and technological challenges are to be addressed. Decreased access to care amid lockdowns and a proposed triggering of disease activity in patients with autoimmune disorders may potentially herald a massive spike in incidence or flares of patients diagnosed with RA in the coming months. Such a deluge of cases may be potentially devastating to an overburdened healthcare system. Rheumatologists may need to prepare for this eventuality and explore techniques to provide adequate care during these challenging times. The authors found that there is a significant association between the adverse impact on the mental health of RA patients and the COVID-19 pandemic. However, more research is needed to highlight individual risk factors.

Depression and Suicidal Ideation in a Sample of Malaysian Healthcare Workers: A Preliminary Study During the COVID-19 Pandemic

Objective: The burden of suicidal behavior is anticipated to increase as a sequela of the COVID-19 pandemic. However, there is limited evidence on suicidal behavior among healthcare workers, an at-risk population. Our study aimed to investigate suicidal ideation in terms of the rate and associated factors in a sample of Malaysian healthcare workers during the early-phase of the COVID-19 pandemic. Methods: A subpopulation analysis (N = 171) was conducted within a larger, nation-wide cross-sectional study of Malaysian healthcare worker psychological distress from March 18-21, 2020. Current suicidal ideation was measured with item 9 of the Patient Health Questionnaire-9 (PHQ-9). The following independent variables were assessed: socio-demographic profile, occupation and service-related factors, health-anxiety (Health Anxiety Inventory, HAI), lifetime anxiety disorder and severity of depression (PHQ-9). Results: The proportion of healthcare workers with current suicidal ideation (19/171) and clinical depression (17/171) were 11.1 and 9.9%, respectively. Multivariable analysis showed that clinical depression was the most significant factor associated with current suicidal ideation (p < 0.001, OR = 55.983, 95% CI = 9.015-347.671) followed by mild (subthreshold) depression (p = 0.001, OR = 115.984, 95% CI = 2.977-85.804). Service duration of more than 10 years was associated with significantly less suicidal ideation (p = 0.049, OR = 0.072, 95% CI = 0.005-0.993). Conclusions: Depression (subthreshold and especially within the clinical range) and early-career status (<10 years in service) may be target areas of early intervention for reduction of suicidal ideation amongst healthcare workers who have served during the COVID-19 pandemic. Further research is warranted to elucidate specific occupational stressors related to COVID-19 work conditions to tailor appropriate suicide preventive strategies in this population.

Mobile Sensing Apps and Self-management of Mental Health During the COVID-19 Pandemic: Web-Based Survey

BACKGROUND

During the COVID-19 pandemic, people had to adapt their daily life routines to the currently implemented public health measures, which is likely to have resulted in a lack of in-person social interactions, physical activity, or sleep. Such changes can have a significant impact on mental health. Mobile sensing apps can passively record the daily life routines of people, thus making them aware of maladaptive behavioral adjustments to the pandemic.

OBJECTIVE

This study aimed to explore the views of people on mobile sensing apps that passively record behaviors and their potential to increase awareness and helpfulness for self-managing mental health during the pandemic.

METHODS

We conducted an anonymous web-based survey including people with and those without mental disorders, asking them to rate the helpfulness of mobile sensing apps for the self-management of mental health during the COVID-19 pandemic. The survey was conducted in May 2020.

RESULTS

The majority of participants, particularly those with a mental disorder (n=106/148, 72%), perceived mobile sensing apps as very or extremely helpful for managing their mental health by becoming aware of maladaptive behaviors. The perceived helpfulness of mobile sensing apps was also higher among people who experienced a stronger health impact of the COVID-19 pandemic (β=.24; 95% CI 0.16-0.33; P<.001), had a better understanding of technology (β=.17; 95% CI 0.08-0.25; P<.001), and had a higher education (β=.1; 95% CI 0.02-0.19; P=.02).

CONCLUSIONS

Our findings highlight the potential of mobile sensing apps to assist in mental health care during the pandemic.

Investigating smoking and nicotine dependence among people with severe mental illness during the COVID-19 pandemic: analysis of linked data from a UK Closing the Gap cohort

Smoking rates are higher for people who use mental health services, which contributes substantially to health inequalities. Smoking can lead to worse COVID-19 outcomes, yet it remains unclear whether smoking has changed for people who use mental health services. We examined smoking patterns in a large clinical cohort of people with severe mental illness, before and during the pandemic. We found high levels of nicotine dependence and heavier patterns of smoking. Although some people had reported quitting, it is likely that smoking inequalities have become further entrenched. Mental health services should seek to mitigate this modifiable risk and source of poor health.

Tired, Worried and Burned Out, but Still Resilient: A Cross-Sectional Study of Mental Health Workers in the UK during the COVID-19 Pandemic

The burden of the COVID-19 pandemic on health systems and the physical and mental health of healthcare workers (HCWs) has been substantial. This cross-sectional study aims to assess the effects of COVID-19 on the psychological wellbeing of mental health workers who provide care to a vulnerable patient population that have been particularly affected during this crisis. A total of 387 HCWs from across a large urban mental health service completed a self-administered questionnaire consisting of socio-demographic, lifestyle and work-based information and validated psychometric scales. Depression and anxiety were measured using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7), respectively; sleep problems with the Athens Insomnia Scale (AIS); burnout with the Maslach Burnout Inventory (MBI); and resilience with the Resilience Scale-14 (RS-14). Multivariable logistic regression analysis was performed to determine potential mediating factors. Prevalence of burnout was notable, with 52% recording moderate/severe in Emotional Exhaustion, 19.5% moderate/severe in Depersonalisation, and 55.5% low/moderate Personal Accomplishment. Over half of all respondents (52%) experienced sleep problems; the presence of depressive symptoms was a significant predictor of insomnia. An increase in potentially harmful lifestyle changes, such as smoking, alcohol consumption and overeating was also observed. However, high Resilience was reported by 70% of the samples and the importance of this is highlighted. Female gender was associated with increased levels of depression and emotional exhaustion while those with a history of mental health conditions were most at risk of affective symptoms, insomnia, and burnout. Overall, our study revealed considerable levels of psychological distress and maladaptive coping strategies but also resilience and satisfaction with organizational support provided. Findings can inform tailored interventions in order to mitigate vulnerability and prevent long-term psychological sequelae.

Remote care for mental health: qualitative study with service users, carers and staff during the COVID-19 pandemic

OBJECTIVES

To explore the experiences of service users, carers and staff seeking or providing secondary mental health services during the COVID-19 pandemic.

DESIGN

Qualitative interview study, codesigned with mental health service users and carers.

METHODS

We conducted semistructured, telephone or online interviews with a purposively constructed sample; a lived experience researcher conducted and analysed interviews with service users. Analysis was based on the constant comparison method.

SETTING

National Health Service (NHS) secondary mental health services in England between June and August 2020.

PARTICIPANTS

Of 65 participants, 20 had either accessed or needed to access English secondary mental healthcare during the pandemic; 10 were carers of people with mental health difficulties; 35 were members of staff working in NHS secondary mental health services during the pandemic.

RESULTS

Experiences of remote care were mixed. Some service users valued the convenience of remote methods in the context of maintaining contact with familiar clinicians. Most participants commented that a lack of non-verbal cues and the loss of a therapeutic 'safe space' challenged therapeutic relationship building, assessments and identification of deteriorating mental well-being. Some carers felt excluded from remote meetings and concerned that assessments were incomplete without their input. Like service users, remote methods posed challenges for clinicians who reported uncertainty about technical options and a lack of training. All groups expressed concern about intersectionality exacerbating inequalities and the exclusion of some service user groups if alternatives to remote care are lost.

CONCLUSIONS

Though remote mental healthcare is likely to become increasingly widespread in secondary mental health services, our findings highlight the continued importance of a tailored, personal approach to decision making in this area. Further research should focus on which types of consultations best suit face-to-face interaction, and for whom and why, and which can be provided remotely and by which medium.

Relationships among the Degree of Participation in Physical Activity, Self-Concept Clarity, and COVID-19 Stress in Adolescents

The COVID-19 pandemic situation threatens the health of people globally, especially adolescents facing mental problems such as depression, anxiety, and obsessive-compulsive disorder due to constant COVID-19 stress. The present study aimed to provide basic data highlighting the need to alleviate COVID-19 stress among adolescents by promoting physical activity participation and strengthening self-concept clarity (SCC). To examine the relationships among participation in physical activity, SCC, and COVID-19 stress in pandemic-like conditions, the study was conducted on middle and high school students aged 14 to 19 and an online survey was conducted on 1046 Korean adolescents (521 male and 525 female students in the preliminary survey and main survey). Frequency, reliability, confirmatory factor, descriptive, and path analyses were performed using SPSS and AMOS 18.0. Participation in physical activity exerted a positive effect on SCC (p < 0.001) as well as a negative effect on COVID-19 stress (p = 0.031). Our findings also indicated that SCC exerted a negative effect on COVID-19 stress (p < 0.001). Regular participation in physical activity and strong SCC are also fundamental elements for alleviating COVID-19 stress. Given these results, state and local governments and educational institutions should encourage youth to participate in sports by suggesting policies, providing guidelines, and offering education. Such information may allow adolescents to endure and overcome COVID-19 stress during this critical period of life.

Sleep Quality and Physical Activity as Predictors of Mental Wellbeing Variance in Older Adults during COVID-19 Lockdown: ECLB COVID-19 International Online Survey

BACKGROUND

The COVID-19 lockdown could engender disruption to lifestyle behaviors, thus impairing mental wellbeing in the general population. This study investigated whether sociodemographic variables, changes in physical activity, and sleep quality from pre- to during lockdown were predictors of change in mental wellbeing in quarantined older adults.

METHODS

A 12-week international online survey was launched in 14 languages on 6 April 2020. Forty-one research institutions from Europe, Western-Asia, North-Africa, and the Americas, promoted the survey. The survey was presented in a differential format with questions related to responses "pre" and "during" the lockdown period. Participants responded to the Short Warwick-Edinburgh Mental Wellbeing Scale, the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and the short form of the International Physical Activity Questionnaire.

RESULTS

Replies from older adults (aged >55 years, n = 517), mainly from Europe (50.1%), Western-Asia (6.8%), America (30%), and North-Africa (9.3%) were analyzed. The COVID-19 lockdown led to significantly decreased mental wellbeing, sleep quality, and total physical activity energy expenditure levels (all p < 0.001). Regression analysis showed that the change in total PSQI score and total physical activity energy expenditure (F(2, 514) = 66.41 p < 0.001) were significant predictors of the decrease in mental wellbeing from pre- to during lockdown (p < 0.001, R2: 0.20).

CONCLUSION

COVID-19 lockdown deleteriously affected physical activity and sleep patterns. Furthermore, change in the total PSQI score and total physical activity energy expenditure were significant predictors for the decrease in mental wellbeing.

The Turkish adaptation and psychometric characteristics of the COVID-19 Traumatic Stress Scale

The study aimed to adapt and validate the COVID-19 Traumatic Stress Scale in Turkish. The scale consisted of three dimensions: "threat/fear of infection and death," "economic hardship," and "disturbed routines/isolation." The Turkish version (COVID-19 Traumatic Scale-TR) was tested on a convenience sample of 432 online participants. Confirmatory factor analysis confirmed the three dimensions of the COVID-19 Traumatic Stress Scale, but with item 9 removed, resulting in an 11-item scale. Cronbach's α score for the 11-item scale was 0.85. The scale may be important to test the impact of COVID-19 on different psychosocial domains, including economic impact and isolation, in Turkey.

Suicide and mental health during the COVID-19 pandemic in Japan

Background

The coronavirus disease (COVID-19) pandemic is an unprecedented public health crisis, but its effect on suicide deaths is little understood.

Methods

We analyzed data from monthly suicide statistics between January 2017 and October 2020 and from online surveys on mental health filled out by the general population in Japan.

Results

Compared to the 2017–19 period, the number of suicide deaths during the initial phase of the pandemic was lower than average but exceeded the past trend from July 2020. Female suicides, whose numbers increased by approximately 70% in October 2020 (incidence rate ratio: 1.695, 95% confidence interval: 1.558–1.843), were the main source of this increase. The largest increase was found among young women (less than 40 years of age). Our survey data indicated that the status of young women’s mental health has been deteriorating in recent months and that young female workers were more likely to have experienced a job or income loss than any other group, suggesting adverse economic conditions surrounding them.

Conclusions

Continuous monitoring of mental health, particularly that of the most vulnerable populations identified in this study, and appropriate suicide prevention efforts are necessary during the COVID-19 pandemic.

Suicide Thoughts and Attempts in the Norwegian General Population during the Early Stage of the COVID-19 Outbreak

The aim of the study was to examine the prevalence of suicide thoughts and attempts during the early stage of the COVID-19 outbreak and examine pandemic-related factors associated with suicide thoughts in the general Norwegian population. A sample of 4527 adults living in Norway were recruited via social media. Data related to suicide thoughts and attempts, alcohol use, pandemic-related concerns, and sociodemographic variables were collected. Associations with suicide thoughts were analyzed with logistic regression analysis. In the sample, 3.6% reported suicide thoughts during the last month, while 0.2% had attempted suicide during the same period. Previous suicide attempts (OR: 11.93, p < 0.001), lower age (OR: 0.69, p < 0.001), daily alcohol use (OR: 3.31, p < 0.001), being in the risk group for COVID-19 complications (OR: 2.15, p < 0.001), and having economic concerns related to the pandemic (OR: 2.28, p < 0.001) were associated with having current suicide thoughts. In addition to known risk factors, the study suggests that aspects specific to COVID-19 may be important for suicidal behaviors during the pandemic.

Predictors of Anxiety in the COVID-19 Pandemic from a Global Perspective: Data from 23 Countries

Prior and ongoing COVID-19 pandemic restrictions have resulted in substantial changes to everyday life. The pandemic and measures of its control affect mental health negatively. Self-reported data from 15,375 participants from 23 countries were collected from May to August 2020 during the early phases of the COVID-19 pandemic. Two questionnaires measuring anxiety level were used in this study—the Generalized Anxiety Disorder Scale (GAD-7), and the State Anxiety Inventory (SAI). The associations between a set of social indicators on anxiety during COVID-19 (e.g., sex, age, country, live alone) were tested as well. Self-reported anxiety during the first wave of the COVID-19 pandemic varied across countries, with the maximum levels reported for Brazil, Canada, Italy, Iraq and the USA. Sex differences of anxiety levels during COVID-19 were also examined, and results showed women reported higher levels of anxiety compared to men. Overall, our results demonstrated that the self-reported symptoms of anxiety were higher compared to those reported in general before pandemic. We conclude that such cultural dimensions as individualism/collectivism, power distance and looseness/tightness may function as protective adaptive mechanisms against the development of anxiety disorders in a pandemic situation.