Coronavirus Disease (COVID-19) and Traumatic Stress: Probable Risk Factors and Correlates of Posttraumatic Stress Disorder

Cancer and Covid-19: a preliminary study on the trauma aspects of Coronavirus in cancer patients

Objective

Because of Covid 19, it has become necessary to revise the treatment of cancer patients (“how” and “when”). That has had important psychological repercussions. The purpose of this study is the evaluation of the impact of Covid19 in terms of Post‐Traumatic Stress Disorder and Depression and the potential association with coping strategies.

Methods

We conducted an exploratory study with 106 patients undergoing treatment, using following questionnaires: Screening Questionnaire for Disaster Mental Health and Mini‐Mental Adjustment to Cancer.

Results

Only 25.5% of our sample showed symptoms of posttraumatic stress disorder (PTSD) and 6.6% revealed a probable presence of depression. In addition, it came up a significant correlation between SQD_P and the coping styles “Hopelessness” (r = 0.41 p < 0.001) and “Anxious Preoccupation” (r = 0.45, p < 0.001).

A strong correlation also emerged between non‐Covid 19 patients and PTSD (r = 0.29, p = 0.002).

Conclusions

Our preliminary data did not reveal a prevalence of PTSD, but the persistence of the health emergency requires to focus future research on protective and risk factors related to PTSD and psychological distress in cancer patients, in order to reduce the mental health burden of Covid19.

Impact of SARS-CoV-2 on Host Factors Involved in Mental Disorders

COVID-19, caused by SARS-CoV-2, is a systemic illness due to its multiorgan effects in patients. The disease has a detrimental impact on respiratory and cardiovascular systems. One early symptom of infection is anosmia or lack of smell; this implicates the involvement of the olfactory bulb in COVID-19 disease and provides a route into the central nervous system. However, little is known about how SARS-CoV-2 affects neurological or psychological symptoms. SARS-CoV-2 exploits host receptors that converge on pathways that impact psychological symptoms. This systemic review discusses the ways involved by coronavirus infection and their impact on mental health disorders. We begin by briefly introducing the history of coronaviruses, followed by an overview of the essential proteins to viral entry. Then, we discuss the downstream effects of viral entry on host proteins. Finally, we review the literature on host factors that are known to play critical roles in neuropsychiatric symptoms and mental diseases and discuss how COVID-19 could impact mental health globally. Our review details the host factors and pathways involved in the cellular mechanisms, such as systemic inflammation, that play a significant role in the development of neuropsychological symptoms stemming from COVID-19 infection.

Symptoms of Post-Traumatic Stress Disorder and the Sense of Gains and Losses during the COVID-19 Pandemic: An International Study

This study was primarily designed to investigate the perception of changes in selected areas of life experienced by adults of various nationalities in connection to the long-lasting COVID-19 pandemic. The second objective was to identify the factors increasing the risk of perception of negative changes in life during the pandemic. The tools applied in the study include a self-report questionnaire designed to measure sociodemographic data and health status of the subjects, COVID-19 Sense of Life Changes Questionnaire, as well as the Impact of Event Scale: Revised. The study involved over 600 adult subjects. With increased intensity of intrusions, the likelihood of negative perception of the changes emerging as a result of the pandemic was reduced by approximately 7%, whereas a higher intensity of hyperarousal increased that risk. Individuals reporting a sense of negative changes presented a greater degree of hyperarousal compared to those reporting positive changes. In the group of subjects perceiving the changes in a positive way, increasing the intensity of intrusion and/or hyperarousal corresponded to a growing conviction about a negative nature of life changes concerning the relationship with their partner and affecting their work as well as regarding a positive meaning of the changes in relations with their parents and in daily life. Generally, there was a prevailing sense of negative changes; however, there was also a group of subjects that perceived these as positive. Intrusions and hyperarousal in certain individuals may play a role in motivating them to take action in protecting against effects of the pandemic and, in others, may lead to frustration and anxiety.

Coping Matters: An Examination of Coping among Black Americans During COVID-19

Using a critical race theory framework and a convergent mixed-method design, this study examined the relationship between coping with stress and psychological distress among Black U.S. Americans ( N = 155) during the COVID-19 pandemic in the context of race-based stressors (e.g., anti-Black racism). Path analysis revealed mixed support for hypotheses; avoidant coping was positively related to all measured facets of psychological distress, whereas socially supported coping was associated with none. Self-sufficient coping was negatively associated with only depressive symptoms. Qualitative analysis revealed four salient themes: (a) Race and the COVID-19 Pandemic, (b) Complex Pandemic Related Changes to Life, (c) Emotional Responses to the Pandemic, and (d) Coping with the COVID Pandemic. These themes suggested the pandemic disrupted participants’ ability to engage in, or effectively use, typically adaptive coping strategies and distress was exacerbated by fears for the safety of other Black U.S. Americans. Implications for training, practice, research, and advocacy are discussed.

"Post-traumatic Stress Disorder and Difficulties in Emotion Regulation Among University Students under the COVID-19 Condition"

"The new global situation of COVID-19 affects the whole world in all aspects of life including mental health. The study’s goal is to detect the relationship between post-traumatic stress disorder (PTSD) and Emotion Regulation (ER) difficulties under the COVID-19 condition. Methods: University students were asked to complete: 1) Emotion Regulation Difficulties Questionnaire (DERS) 2) PTSD Checklist (PCL- 5). 3) Life Events Checklist for DSM-5 (LEC-5). Results: There were 441 students with suspected COVID-19 symptoms out of 1195 students. When compared to students who did not have suspected COVID-19 symptoms, those who did had a greater prevalence of PTSD symptoms (18.2% vs. 4.7%) and DERS (34.5% vs. 23.3%). Additionally, correlation studies demonstrated a significant positive link (Ps< .01) between the PCL, the overall DERS, and all six categories of emotion regulation difficulties. Conclusion: Students with suspected COVID-19 symptoms have more difficulty with emotion regulation and post-traumatic stress disorder than students without such symptoms. This research recommends that during the pandemic, health professionals should implement a suitable psychological intervention for students who exhibit COVID-19 symptoms."

The effects of perceived psychological, educational, and financial impact of COVID-19 pandemic on Greek university students' satisfaction with life through Mental Health

BACKGROUND

The purpose of this study was to provide an operating mechanism for understanding the effects of COVID-19's on satisfaction with life, subject to students' general mental health METHODS: A sample of 1653 Greek speaking university students (72.4% females, 65.3% undergraduate, M age=26.1) completed an online survey including measures for perceived psychological, academic, and financial impact of the COVID-19 pandemic, general mental health and satisfaction with life.

RESULTS

A mediation model was tested to illuminate these relationships by considering students' general mental health as a mediator. Findings demonstrated that there were significant direct effects of perceived COVID-19 impact on participants' financial status on satisfaction with life and indirect effects of perceived COVID-19 impact on participants' financial status and academic performance respectively on satisfaction with life through general mental health.

LIMITATIONS

The study's cross-sectional design, self-report data and snowball sampling.

CONCLUSIONS

The findings add to our understanding of the relationship between perceived COVID-19 impact and life satisfaction among university students, and they shed light on the critical role of general mental health in mediating the relationship. Targeting the factors that influence general mental health can help to mitigate potential problems while also finding ways to improve mental health and well-being.

Complications Post-COVID-19 and Risk Factors among Patients after Six Months of a SARS-CoV-2 Infection: A Population-Based Prospective Cohort Study

In October 2020, we conducted a population-based prospective cohort study to determine post-COVID-19 complications, recovery, return to usual health, and associated risk factors in 536 cases of COVID-19 outbreak in Borriana (Spain) by administering an epidemiological questionnaire via phone interviews. A total of 484 patients participated (90.3%), age mean 37.2 ± 17.1 years, and 301 females (62.2%). Mild illness was the most common COVID-19 manifestation. After six months, 160 patients (33.1%) suffered at least one complication post-COVID-19, and 47 (29.4%) of them sought medical assistance. The most frequent persistent symptoms were hair loss, fatigue, loss of smell or taste, and headache. Risk factors associated with a complication were female sex (adjusted relative risk, [aRR] = 1.93 95% confidence interval [CI] 1.41-2.65), age 35 years and above (aRR = 1.50 95% CI 1.14-1.99), B blood group (aRR = 1.51 95% CI 1.04-2.16), current smoker (RR = 1.61 95% CI 1.02-2.54), and at least a COVID-19 exposure (aRR = 2.13 95% CI 1.11-4.09). Male sex, age younger than 35 years, and low COVID-19 exposures were associated with better recovery and return to usual health. A third of patients presented persistent symptoms compatible with the long-COVID-19 syndrome. In conclusion, an active medical follow-up of post-COVID-19 patients must be implemented.

Factors associated with COVID-19 pandemic induced post-traumatic stress symptoms among adults living with and without HIV in Nigeria: a cross-sectional study

BACKGROUND

Nigeria is a country with high risk for traumatic incidences, now aggravated by the COVID-19 pandemic. This study aimed to identify differences in COVID-19 related post-traumatic stress symptoms (PTSS) among people living and not living with HIV; to assess whether PTSS were associated with COVID-19 pandemic-related anger, loneliness, social isolation, and social support; and to determine the association between PTSS and use of COVID-19 prevention strategies.

METHODS

The data of the 3761 respondents for this analysis was extracted from a cross-sectional online survey that collected information about mental health and wellness from a convenience sample of adults, 18 years and above, in Nigeria from July to December 2020. Information was collected on the study's dependent variable (PTSS), independent variables (self-reported COVID-19, HIV status, use of COVID-19 prevention strategies, perception of social isolation, access to emotional support, feelings of anger and loneliness), and potential confounder (age, sex at birth, employment status). A binary logistic regression model tested the associations between independent and dependent variables.

RESULTS

Nearly half (47.5%) of the respondents had PTSS. People who had symptoms but were not tested (AOR = 2.20), felt socially isolated (AOR = 1.16), angry (AOR = 2.64), or lonely (AOR = 2.19) had significantly greater odds of reporting PTSS (p < 0.001). People living with HIV (AOR = 0.39), those who wore masks (AOR = 0.62) and those who had emotional support (AOR = 0.63), had lower odds of reporting PTSS (p < .05).

CONCLUSION

The present study identified some multifaceted relationships between post-traumatic stress, HIV status, facemask use, anger, loneliness, social isolation, and access to emotional support during this protracted COVID-19 pandemic. These findings have implications for the future health of those affected, particularly for individuals living in Nigeria. Public health education should be incorporated in programs targeting prevention and prompt diagnosis and treatment for post-traumatic stress disorder at the community level.

Relationships Between Mental Health, Emotion Regulation, and Meaning in Life of Frontline Nurses During the COVID-19 Outbreak

BACKGROUND

The sporadic outbreak of COVID-19 and the constant mutation of the virus have put the public in panic. Frontline nurses' appropriate emotional regulation and mental health are the key to win the victory of fighting against the epidemic. The relationships between these variables directly influence the availability of human resources to combat COVID-19.

OBJECTIVE

To investigate the relationship between meaning in life, emotional regulation, and mental health of frontline nurses during the Delta virus epidemic.

METHODS

A cross-sectional survey was conducted in August 2021 among 105 nurses from the Second Xiangya Hospital, Central South University, Changsha, China, who were deployed at the COVID-19 units in Zhangjiajie People's Hospital. The Chinese Meaning in Life Questionnaire, Emotion Regulation Questionnaire, and Psychological Questionnaire for Emergent Events of Public Health were used to evaluate their meaning in life, emotion regulation, and mental health. Their correlation and the moderating effect of emotion regulation were conducted.

RESULTS

In total, 105 (100%) nurses responded. There were 14 men and 91 women and the mean age was (30.295 ± 4.653) years. The average score of meaning in life and mental health of frontline nurses was 49.971 ± 6.386 and 2.755 ± 2.580, respectively. The meaning in life of frontline nurses was positively correlated with cognitive reappraisal and negatively correlated with expressive suppression and mental health. Mental health was negatively correlated with cognitive reappraisal and positively correlated with expressive suppression. The emotional regulation of frontline nurses has a moderating effect between meaning in life and mental health.

CONCLUSION

Meaning in life and emotion regulation of frontline nurses were significantly correlated with mental health under the effects of the COVID-19 pandemic. Changing the emotion regulation of frontline nurses, strengthening cognitive reappraisal, and weakening expressive suppression could reduce the predictive effect of meaning in life on mental health.

Narratives of the worst experiences associated with peritraumatic distress during the COVID-19 pandemic: a mixed method study in the USA and Italy

Background: Although symptoms of posttraumatic stress disorder (PTSD) have been associated with the COVID-19 pandemic experiences, no study has explored yet the association of specific COVID-19 narratives with peritraumatic distress, the precursor of PTSD. Objective: To explore the worst experiences associated with peritraumatic distress during the first wave of the COVID-19 pandemic. Method: Adult residents (N = 1098), from the US (n = 741) and Italy (n = 357), completed an online survey including socio-demographic data, COVID-19-related experiences, the Peritraumatic Distress Inventory and an open question on their worst experiences during the first period of the COVID-19 pandemic (April-May 2020). A thematic content analysis (TCA) was conducted on the answers to the open question and a classification and regression tree (CART) analysis was used to identify the themes that best predicted the clinical levels of peritraumatic distress. Results: The main TCA themes related to participants' worst COVID-19 experiences were anxiety, threat, loss, anger, stress and constriction. Threat was the most prevalent theme and correlated with experiences such as being quarantined, being infected and a loved one receiving the diagnosis. US participants' descriptions of their worst experiences related more to life-threat and loss, while Italians reported more threat to the world, stress, social isolation, and feeling trapped. In the CART analysis, the main predictor (79.9%) was perceiving negative effects from the COVID-19 crisis. Among them, a COVID-related threat to self-experience was the most robust predictor. In its absence, being deprived of resources or experiencing high levels of anxiety were other robust predictors. Conclusions: The study provided evidence of the utility of a mixed-method approach in conceptualizing experiences associated with the COVID-19 pandemic and the risk of traumatic symptoms. Its findings may inform healthcare interventions and policies for tackling the new challenges posed by the COVID-19 pandemic. HIGHLIGHTS Clinically significant levels of peritraumatic distress symptoms were prevalent during the COVID-19 pandemic.Clinically significant levels of peritraumatic distress during the COVID-19 pandemic were related to experiences of life-threat, resource deprivation, and anxiety, cross-cutting the themes articulated by the thematic content analysis of anxiety, threat, loss, anger, stress and constriction.The US and Italian participants' descriptions of their worst experiences differed in subtle but important ways, with Americans reporting more life-threat and losses compared to Italians reporting more threat to the world, stress, social isolation, and feelings of being trapped.

An Integrative Systems-Oriented Interpersonal/Relational Group Approach to Understanding and Treating Mass Trauma, Dissociation and Enactments During the COVID-19 Pandemic

The coronavirus pandemic (COVID-19) is a new ongoing, long-term mass trauma event occurring simultaneously with overwhelming sociopolitical stressors. We propose an integrative, psychodynamic, systems-oriented, interpersonal/relational trauma group model to address the multiple losses, heightened anxieties, and complicated grief that have resulted from the pandemic, as well as various forms of interpersonal abuse associated with racist and oppressive systems. These manifest as dissociation and unconscious enactments in small and large psychotherapy groups. We examine the role and responsibilities of the group leader in working therapeutically with these phenomena. Case examples for large and small psychotherapy groups are provided.

Personal experience, posttraumatic symptomatology, and meaning in life during the first months of the COVID-19 pandemic

The traumatic subjective distress and personal meaning in life were examined in the context of the first months of the COVID-19 pandemic sanitary crisis and home lockdown.

METHOD

A total of 543 participants answered an online survey that included questions about the individual characteristics of the pandemic experience, the Impact of Event Scale-Revised, and the Personal Meaning Profile-Brief.

RESULTS

Nearly all of life impaired areas, having the suspicion of being ill with COVID-19, having lost a close person to this virus, and having been accompanied during the lockdown were experiences associated with higher PTSD symptoms. Posttraumatic symptomatology was inversely correlated with areas of meaning in life. Lastly, a higher number of affected areas and a negative subjective lockdown circumstance explained greater total PTSD symptoms.

CONCLUSION

Specific pandemic experiences and lockdown circumstances affected the presence of posttraumatic symptoms. The personal meaning of life seems to be involved in the process of less adverse traumatic consequences.

Long COVID, a comprehensive systematic scoping review

PURPOSE

To find out what is known from literature about Long COVID until January 30, 2021.

METHODS

We undertook a four-step search with no language restriction. A preliminary search was made to identify the keywords. A search strategy of all electronic databases resulted in 66 eligible studies. A forward and backward search of the references and citations resulted in additional 54 publications. Non-English language articles were translated using Google Translate. We conducted our scoping review based on the PRISMA-ScR Checklist.

RESULTS

Of 120 papers, we found only one randomized clinical trial. Of the 67 original studies, 22 were cohort, and 28 were cross-sectional studies. Of the total 120 publications, 49.1% focused on signs and symptoms, 23.3% on management, and 10.8% on pathophysiology. Ten publications focused on imaging studies. The results are also presented extensively in a narrative synthesis in separated sections (nomenclature, diagnosis, pathophysiology, risk factors, signs/symptoms, management).

CONCLUSIONS

The controversies in its definition have impaired proper recognition and management. The predominant symptoms were: fatigue, breathlessness, arthralgia, sleep difficulties, and chest pain. Recent reports also point to the risk of long-term sequela with cutaneous, respiratory, cardiovascular, musculoskeletal, mental health, neurologic, and renal involvement in those who survive the acute phase of the illness.

Stress research during the COVID-19 pandemic and beyond

The COVID-19 pandemic confronts stress researchers in psychology and neuroscience with unique challenges. Widely used experimental paradigms such as the Trier Social Stress Test feature physical social encounters to induce stress by means of social-evaluative threat. As lockdowns and contact restrictions currently prevent in-person meetings, established stress induction paradigms are often difficult to use. Despite these challenges, stress research is of pivotal importance as the pandemic will likely increase the prevalence of stress-related mental disorders. Therefore, we review recent research trends like virtual reality, pre-recordings and online adaptations regarding their usefulness for established stress induction paradigms. Such approaches are not only crucial for stress research during COVID-19 but will likely stimulate the field far beyond the pandemic. They may facilitate research in new contexts and in homebound or movement-restricted participant groups. Moreover, they allow for new experimental variations that may advance procedures as well as the conceptualization of stress itself. While posing challenges for stress researchers undeniably, the COVID-19 pandemic may evolve into a driving force for progress eventually.

Factor Structure and Psychometric Properties for the PTSD Checklist of Chinese Adolescents in the Closed Period after the COVID-19 Outbreak

After COVID-19 appeared in China in December 2019, the mental health of adolescents, as a vulnerable group in public health emergencies, was negatively affected by the epidemic and the unprecedented prevention and control measures. The purpose of this study was to investigate the factor structure and psychometric properties of the Posttraumatic Stress Disorder (PTSD) Checklist (PCL) among Chinese adolescents. A total of 915 participants completed the PTSD. Confirmatory factor analyses (CFAs) and multi-group CFAs were used to test the factor structure and psychometric properties of PTSD. The CFA results showed that five-factor PCL was the optimal fitting model with satisfactory reliability and validity; moreover, it was suggested that the properties of PCL were invariant across gender, PTSD and asymptomatic groups, early and late adolescents, as well as over time. In summary, PCL is applicable among Chinese adolescents and can be used for effective measurement of PTSD caused by epidemics and to conduct cross-group studies.

Analyzing the Stressors for Frontline Soldiers Fighting Against Coronavirus Disease 2019 Pandemic

This study aimed to analyze stressors to which medical staff is vulnerable due to the coronavirus disease 2019 (COVID-19) pandemic. It also imposes a hierarchy on complex relations among stressors for excavating underlying structure and builds a model of interrelationships contrasting reality. The design of this study comprises a literature survey, data collection from primary sources, and analysis. Stressors have been explored from within current published/unpublished literature and validated by experts through approval vote. Data were collected from the focus group (panel of experts), and interpretive structural modeling (ISM) was used as the research methodology. Findings of ISM are avowed through "cross-impact matrix multiplication applied to classification" (MICMAC) analysis. As a result of the literature survey, a list of stressors was generated, and a total of 19 stressors qualified as representative of the phenomenon. The results of ISM show that two stressors (i.e., "unavailability of proper personal protective equipment (PPE)" and "lack of proper communication") emerged as the most critical stressors since they occupy the bottom of the model, whereas, four stressors (i.e., "anxious about isolation/quarantine," "subject to violent crimes," "feeling frustrated and powerless," and "exhausting shifts/hours without clear end") are relatively less critical since they occupy the top of the model. The rest of the stressors occupy the middle of the model and therefore, have moderate-severe effects on frontline soldiers. The results of MICMAC show that the stressor "subject to violent crimes" is classified in the dependent cluster and the remaining fall in the linkage cluster but no stressor falls in independent and autonomous. Overall results indicate that all stressors are relevant to the phenomenon under this study, but they are currently not settled. This study is invaluable for policymakers, frontline soldiers, researchers, the international community, and society since it provides a lot of new information that is helpful in refining strategies and combating influential stressors.

Essential workers: Past month suicidal ideation and COVID-19 stress

OBJECTIVE

This study examined if essential workers (EW) reported higher past month suicidal ideation (SI) and coronavirus-19 (COVID-19) stress than non-EW, explored if the association between EW status and SI is indirect through COVID stress, and tested whether EW who identified as black, indigenous, and people of color (BIPOC) experienced more past month SI and COVID stress than white EW.

METHODS

Participants (N = 3500) were predominately white and female. COVID-19 was assessed with the COVID-19 subscale.

RESULTS

EWs reported higher past month ideation and COVID-19 stress than non-EWs. EWs who identified as BIPOC reported higher past month ideation and higher fears about economic consequences and compulsive checking and reassurance seeking subscales compared to White EWs.

CONCLUSION

EWs experience higher rates of SI and stress than non-EW; and BIPOC EWs experience higher SI and stress than White EWs. Accessibility of support should be a priority for this group at high risk for both the physical and emotional burden of COVID-19.

Prevalence of post-traumatic stress disorders and associated factors one month after the outbreak of the COVID-19 among the public in southwestern China: a cross-sectional study

BACKGROUND

The Coronavirus Disease 2019 (COVID-19) pandemic has rapidly spread across the whole world and brought strong psychological impact. This study aimed to evaluate the prevalence of post-traumatic stress disorders (PTSD) in the general people of southwestern China and associated factors 1 month after the outbreak of the COVID-19.

METHODS

This study was started on 4-10 Feb 2020 based on online survey. The present work was carried out in the provinces of southeastern China, including Sichuan Province, Guizhou Province, Yunnan Province, and Chongqing City.1593 respondents aged 18 years and above administered to this study. Data on whether they have experienced confirmed or suspected COVID-19 of themselves/family members/acquaintances were also collected, and based on 'yes' answers, the number of affected individuals (via COVID-19) were categorized into four exposure levels i.e., non-affected, less, moderately, or significantly affected. The civilian version of the PTSD checklist and the self-reported information about COVID-19 were used.

RESULTS

The prevalence of PTSD was approximately 25.2%(n = 401/1593). The chances of developing PTSD were 6.053(OR = 6.053, 95% CI 1.394 to 26.280) or 3.673(OR = 3.673, 95% CI 1.738 to 7.765) times higher among respondents who had been significantly and moderately affected than those who had not been affected, accordingly. Male (OR = 1.484, 95% CI 1.147 to 1.920),younger age individuals (40 ~ 49 age group/<30 age group, OR = 0.395, 95% CI 0.258 to 0.606) and health care workers (OR = 1.788, 95% CI 1.155 to 2.277) were at higher risk of developing PTSD.

CONCLUSION

Our findings highlight that a positive correlation between the pandemic and PTSD. It is urgent to establish a screening and prevention systems for the population who are significantly exposed to COVID-19,and provide different psychological intervention strategies for different groups.

Risk Perception, Perception of Collective Efficacy and Sleep Quality in Chinese Adults during COVID-19 Pandemic in Hong Kong: A Cross-Sectional Study

Background: Only a few studies have studied the link between risk perception and sleep in the context of the COVID-19 pandemic. The purpose of our study is to propose and test a theoretical model to understand the relationships between COVID-19 risk appraisals—risk perception and perception of collective coordinated defense (PCCD) in particular—and subjective sleep quality in Chinese adults in Hong Kong during the COVID-19 pandemic. COVID-19-related fear and rumination were examined as potential mediators of the relationships. Methods: Data were collected using a self-report online questionnaire from a convenience sample of 224 Chinese adults during the fourth wave of the COVID-19 pandemic in Hong Kong. Results: Risk perception and PCCD were found to predict poor sleep quality. Mediation analysis showed that both fear and rumination mediated the relationship between risk perception and sleep quality, whereas only fear mediated the relationship between PCCD and sleep quality. The model was an excellent fit to the data and accounted for 44% of the variance in sleep quality in Chinese adults. This study indicated that both perception of high risks of contracting COVID-19 and anticipations of collective disease preventive efforts had adverse effects on subjective sleep quality via increasing COVID-19-related fear. Conclusions: These findings underscore the need for addressing sleep problems induced by psychological consequences of the pandemic. While policy makers often deliver public messaging campaigns that frame disease prevention as a collective goal, developing evidence-based coping strategies to combat COVID-19 adverse impacts on psychological health is equally important.

Association of PTSD with COVID-19 testing and infection in the Veterans Health Administration

Posttraumatic stress disorder (PTSD) is associated with coronavirus disease 2019 (COVID-19) risk factors, such as hypertension and obesity. Associations between PTSD and COVID-19 outcomes may affect Veterans Health Administration (VA) services, as PTSD occurs at higher rates among veterans than the general population. While previous research has identified the potential for increased PTSD prevalence resulting from COVID-19 as a public health concern, no known research examines the effect of pre-existing PTSD on COVID-19 test-seeking behavior or infection. This study aimed to evaluate pre-existing PTSD as a predictor of COVID-19 testing and test positivity. The sample consisted of 6,721,407 veterans who sought VA care between March 1, 2018 and February 29, 2020. Veterans with a previous PTSD clinical diagnosis were more likely to receive COVID-19 testing than veterans without PTSD. However, among those with available COVID-19 test results (n = 168,032), veterans with a previous PTSD clinical diagnosis were less likely to test positive than veterans without PTSD. Elevated COVID-19 testing rates among veterans with PTSD may reflect increased COVID-19 health concerns and/or hypervigilance. Lower rates of COVID-19 test positivity among veterans with PTSD may reflect increased social isolation, or overrepresentation in the tested population due to higher overall use of VA services. As the COVID-19 pandemic continues, the identification of patient-level psychiatric predictors of testing and test positivity can facilitate the targeted provision of medical and mental health services to individuals in need.

How Do People Cope During the COVID-19 Pandemic and Stay Well? A Salutogenic Longitudinal Study in Israel

Employing the salutogenic approach, this longitudinal study explored the effects of coping with the COVID-19 pandemic in Israel, as it evolved from an acute to a chronic stress situation, during the first year. We examined the role of individual [sense of coherence (SOC)], social (perceived social support), and national [sense of national coherence (SONC)] coping resources, as well as situational and demographic factors, in predicting mental health and anxiety. Data was collected in five phases between March 2020 and February 2021 via a repeated panel sample and included 198 Jewish Israelis (52% males) age 18-64 (M = 43.5). The results confirmed the expected pattern of moving from acute to chronic stressful situation: levels of general anxiety were higher in the first phase of the pandemic outbreak as compared to the other phases. Levels of social and national coping resources significantly decreased over time. However, as expected, the salutogenic resource of the individual sense of coherence remained stable and was also found as the main predictor of both anxiety and mental health in the 5 phases of the study. Beyond the explanatory factor of SOC, mental health was better explained by the social and national coping resources, while anxiety was explained by situational factors (level of financial risk and gender). The discussion delineates the longitudinal effects of individual, social, and national coping resources on mental health and anxiety during the dynamic process of the long period of 1 year of the pandemic, evolving from acute to chronic phases of the complicated health, economic, social, and political crisis.

Pain-related disability, PTSD symptoms, and mood among a comorbid chronic pain and PTSD sample prior to and during the COVID-19 pandemic

There is a knowledge gap when treating comorbid chronic pain and posttraumatic stress disorder (PTSD) during the COVID-19 pandemic. Addressing this gap, 169 individuals (57.4% female), aged 39.8 years were recruited based on levels of pain-related disability and PTSD symptoms. Participants were assessed prior to, and during, the COVID-19 pandemic. Improvements in pain-related disability were marginally attenuated for the comorbid group, compared to the chronic pain group. Results show that some condition-specific symptoms may not have been affected by the COVID-19 pandemic. Cautious interpretation is warranted due to only two time points and the lack of a diverse sample.

The Prevalence and Determinant of PTSD Symptoms among Home-Quarantined Chinese University Students during the COVID-19 Pandemic

BACKGROUND

When COVID-19 emerged in China in late 2019, most Chinese university students were home-quarantined to prevent the spread of the virus, considering the great impact of the lockdown on young people habits and their psychological well-being. This study explored the prevalence of post-traumatic stress disorder (PTSD) and its associated factors among Chinese university students who are isolated at home during the COVID-19 pandemic.

METHOD

4520 participants from five universities in China were surveyed by online questionnaire and the PTSD Checklist-Civilian Version (PCL-C) was adopted as a screening instrument.

RESULTS

Exposure to virus was significantly related to PTSD outcomes. The most important predictors for PTSD outcomes were parents' relationship and the way parents educated, and university-provided psychological counseling was a protective factor against developing PTSD.

CONCLUSIONS

The COVID-19 pandemic had adverse psychological consequences on Chinese university students who were isolated at home due to the relatively high prevalence rate of PTSD which was reported. Adverse parental relationships and the extreme way parents educate their children could be the major risk factors for PTSD outcomes. Psychological interventions need to be made available to home-quarantined university students, and those in the worst-hit and exposed areas to virus should be given priority focus.

COVID-19: How the stress generated by the pandemic may affect work performance through the moderating role of emotional intelligence

This study aimed to assess the moderating effect of emotional intelligence (EI) in the direct impact of the stress generated by the pandemic on work performance and counterproductive work behaviors (CWB) in a multioccupational sample of 1048 professionals (60.7% women). The participants filled the Wong and Law Emotional Intelligence Scale, the Impact of Event Scale 6 and the Individual Work Performance Questionnaire. The results proved a relationship between Covid stress, performance and EI, which has a moderating effect between the stress and both indicators of performance, even when sociodemographic variables were controlled. In essence, professionals with high levels of EI and low Covid stress showed the highest performance and the lowest CWB when compared to those who presented less emotional capabilities and higher stress. These results confirm the importance of EI in improving the effectiveness of work performance and reinforce the role of EI as a protective variable that can safeguard occupational health.

Examining the associations between food worry and mental health during the early months of the COVID-19 pandemic in Canada

OBJECTIVE

Little is known about the association between mental health and diminished food worry during the COVID-19 pandemic. This paper examines worry about having enough food to meet household needs and its association with mental health during the early months of the pandemic in Canada.

METHODS

Data are drawn from the first round of a multi-round mental health monitoring survey. Online surveys were administered between May 14 and 29, 2020, to a nationally representative sample of Canadian adults (n = 3000). Logistic regression models were used to examine associations between food worry and mental health indicators (anxious/worried, depressed, worse mental health compared with pre-pandemic, and suicidal thoughts/feelings), after adjusting for socio-demographic characteristics and pre-existing mental health conditions. Fully adjusted models explored the impact of controlling for financial worry due to the pandemic in the previous 2 weeks.

RESULTS

Overall, 17.3% of the sample reported food worry due to the pandemic in the previous 2 weeks, with the highest prevalence found among those with a reported disability (29.3%), Indigenous identity (27.1%), or pre-existing mental health condition (25.3%). Compared with participants who did not report food worry, those who did had higher odds of reporting feeling anxious/worried (OR=1.36, 95% CI: 1.08-1.71) and suicidal thoughts/feelings (OR=1.87, 95% CI: 1.24-2.80) when controlling for socio-demographics, pre-existing mental health conditions, and financial worry.

CONCLUSION

This paper provides insights about the associations between food worry and mental health in Canada during the COVID-19 pandemic and indicates the need for improved policies and social supports to mitigate food worry and associated mental health outcomes.

Connecting the dots: A network approach to post‐traumatic stress symptoms in Chinese healthcare workers during the peak of the Coronavirus Disease 2019 outbreak

Healthcare workers are at elevated risk to develop symptoms of post-traumatic stress disorder (PTSD) in response to an outbreak of a highly infectious disease. The current study set-out to model the complex interrelations between PTSD symptoms during the peak of the Coronavirus Disease 2019 outbreak in 291 Chinese healthcare workers and 291 matched control cases that were selected from the general population. For this purpose, we estimated regularized partial correlation networks. Within the network of healthcare workers, we observed a central role for avoidance of reminders of the traumatic event, physiological cue reactivity, anger/irritability, re-experiencing, and startle. We identified three clusters of closely interconnected PTSD symptoms in healthcare workers, consisting of (a) symptoms of re-experiencing and anxious arousal, (b) symptoms of avoidance and amnesia and (c) symptoms of emotional numbing and dysphoric arousal. Respectively, startle, avoidance of reminders and feeling detached emerged as bridging nodes in these communities. Although yielding highly similar network models, the PTSD symptom structure of healthcare workers showed several unique features compared to the matched control sample. This is informative for interventions aimed at targeting PTSD symptoms in healthcare workers in the context of a public health emergency.

Maternal Stress, Depression, and Attachment in the Neonatal Intensive Care Unit Before and During the COVID Pandemic: An Exploratory Study

The main aim of the present study was to investigate the effects of the COVID-19 pandemic on the mothers' postnatal depression, stress, and attachment during their stay in the Neonatal Intensive Care Unit (NICU). Twenty mothers of very premature infants born before 32weeks of gestational age were recruited at the Geneva University Hospital between January 2018 and February 2020 before the COVID-19 pandemic started. Mothers were screened for postnatal depression after their preterm infant's birth (Edinburgh Postnatal Depression Scale, EPDS), then for stress (Parental Stressor Scale: Neonatal Intensive Care Unit, PSS:NICU), and attachment (Maternal Postnatal Attachment Scale, MPAS) at infant's term-equivalent age. Data were compared with 14 mothers recruited between November 2020 and June 2021 during the COVID-19 pandemic. No significant differences were found in the scores for depression, stress, and attachment between the two groups. However, a non-statistically significant trend showed a general increase of depression symptoms in mothers during the COVID-19 pandemic, which significantly correlated to the attachment and stress scores. Moreover, the PSS:NICU Sights and Sounds score was significantly positively correlated with EPDS scores and negatively with the MPAS score only in the During-COVID group. To conclude, we discussed a possible dampened effect of the several protective family-based actions that have been adopted in the Geneva University Hospital during the health crisis, and we discussed the most appropriate interventions to support parents in this traumatic period during the COVID-19 pandemic.

Trauma-informed career counselling to address work traumas resulting from the COVID-19 pandemic

Background

Sudden work traumas as a result of the coronavirus disease 2019 (COVID-19) pandemic have left thousands displaced from their current jobs and occupations. Traditional career counselling approaches that overlook the role of emotion are not adequate to address the numerous emotional difficulties that arise after a sudden unexpected job loss.

Objectives

The objective of this research is to examine to what extent career counselling theories and interventions incorporate a trauma-informed career counselling approach and are prepared to address the emotional, psychological, and career counselling concerns that arise from work traumas as a result of the COVID-19 pandemic.

Methods

A qualitative systematic literature review of all career-related journals that have trauma-informed career counselling in the title or body of the manuscript was conducted. Additionally, career related articles, books, and book chapters specifically mentioning work traumas and interventions to address these issues were also examined.

Results

Only one article on trauma-informed career counselling was found given the parameters of the literature review. Currently, no articles outline how to integrate career counselling and emotion-focused therapy for trauma in order to address work traumas related to COVID-19.

Conclusion

A trauma-informed career counselling approach that integrates career construction counselling and emotion-focused trauma therapy is needed to address the emotional, psychological, and career counselling concerns that arise from a work trauma as a result of the COVID-19 pandemic. An integrated approach to provide trauma-informed career counselling has been provided.

Mental health difficulties in students with suspected COVID-19 symptoms and students without suspected COVID-19 symptoms: A cross-sectional comparative study during the COVID-19 pandemic

INTRODUCTION

Mental health problems are taking a heavy toll on students during the COVID-19 pandemic. The purpose of this study was to compare the level of anxiety symptoms, depressive symptoms, post-traumatic stress symptoms (PTSS), and fear of COVID-19 between students with suspected COVID-19 symptoms and students without any suspected symptoms during the pandemic in Bangladesh.

METHODS

This cross-sectional comparative study was conducted online among Bangladeshi students from May to July 2020. Anxiety symptoms, depressive symptoms, PTSS, and fear of COVID-19 were assessed by using the Generalized Anxiety Disorder scale, Patient Health Questionnaire, the Impact of Event Scale, and Fear of COVID-19 Scale, respectively. College and University students were the participants of the study.

RESULTS

Among 3777 students, 1259 had suspected COVID-19 symptoms and 2518 had no suspected COVID-19 symptoms. Students who experienced suspected COVID-19 symptoms had higher prevalence (moderate to severe) of depressive symptoms (61.15% vs. 47.62%), anxiety symptoms (44.96% vs. 36.97%), and PTSS (48.3% vs. 39.75%) compared to those who had no such symptoms. The study identified having suspected COVID-19 symptoms as a significant associated factor for anxiety symptoms (β1' = 1.39; 95% CI: 1.03-1.74), depressive symptoms (β1' = 1.88; 95% CI: 1.43-2.32), PTSS (β1' = 3.66; 95% CI: 2.66-4.65), and fear of COVID-19 (β1' = 0.48; 95% CI: 0.02 to 0.94). Students with suspected COVID-19 symptoms thought more that they would be better off dead, or of hurting themselves (P < 0.01) and felt more afraid as if something awful might happen (P < 0.01) than their counterparts.

CONCLUSION

Mental health difficulties are more prevalent among students with suspected COVID-19 symptoms than the students without having such symptoms. This finding suggests that public health practitioners should deploy a rapid diagnostic system and consider psychological intervention in addition to clinical management for those who have COVID-19 like symptoms during the pandemic.

Impact of COVID-19 outbreak on posttraumatic stress in patients with psychiatric illness

The present study aimed to examine the prevalence of posttraumatic stress response in reaction to the COVID-19, including posttraumatic-stress-disorder-like symptoms (PTSD-like symptoms) and depressive symptoms, among patients with pre-existing psychiatric illness. The socio-demographic and psychological correlates of PTSD-like symptoms were also examined. A total of 193 participants were recruited. More than 45% of the respondents reported significant PTSD-like symptoms related to the COVID-19; this group of patients also had a high level of pandemic-related depressive symptoms. High level of PTSD-like symptoms were predicted by rumination on concerns about the outbreak of COVID-19 and feeling of social isolation. They were also associated with hypervigilance to cues related to the pandemic. Our results suggested that the pandemic had taken a psychological toll on people living with psychiatric illness. Further research is needed to understand the development and mechanism of traumatic stress reaction in response to a prolonged infectious disease outbreak among this vulnerable population. Clinical attention is also called to mitigate the psychiatric sequalae of the pandemic in this vulnerable group of people.

The Consequences of COVID-19 Toward Human Growth: The Role of Traumatic Event and Coping Strategies Among Indonesian Sample

COVID-19 has brought a massive psychological impact on individuals' life. The current study sets a significant purpose to test the model whether post-traumatic stress and coping strategies affect stress-related growth regarding the COVID-19 event. One hundred and ninety-nine participants have participated in an online survey in the period of lockdown. The proposed hypotheses model is further tested using PLS-SEM. The first model explains a significant moderate, 46% amount of variance for stress-related growth. With gender as moderator, the second model explains a significant 29% amount of variance for stress-related growth, which is also moderate. This study shows that active coping strategies and positive affirmation significantly influence individual stress-related growth. The trauma event (COVID-19) does not significantly affect growth. Women experience trauma compared to men, besides active coping with the COVID-19 situation is higher in men than women. Using the Bio-centric perspective, having a positive connection through acceptance and awareness of the situation, self-care, and affective interaction with others would develop growth regarding traumatic situations. Further, interventions about coping skills and positive affirmations are essential to give, especially to vulnerable groups such as women.

Financial and Mental Health Concerns of Impoverished Urban-Dwelling Bangladeshi People During COVID-19

Background: The COVID-19 pandemic has impacted the physical, mental and financial health of many individuals. Individuals living in impoverished crowded settings may be particularly vulnerable to COVID-19-related stressors. How substantially marginalized groups like impoverished urban-dwelling individuals have been impacted during this pandemic is poorly understood. The present study aimed to investigate the associated factors of financial concerns and symptoms of depression and posttraumatic stress disorder (PTSD) during the COVID-19 pandemic among impoverished urban-dwelling individuals residing in Dhaka, Bangladesh. Methods: A cross-sectional survey was conducted between August and September 2020 using face-to-face interviews in six disadvantaged neighborhoods ("slums") in Dhaka. Individuals were interviewed using a semi-structured questionnaire consisting of questions assessing socio-demographics, lifestyle, financial well-being relating to the COVID-19 pandemic, depression, and PTSD. Results: Four-hundred-and-thirty-five individuals (male = 54.7%; mean age = 45.0 ± 12.0 years; age range = 18-85 years) participated. Most (96.3%) reported that their household income decreased due to the COVID-19 pandemic. Factors associated with decreased household incomes included female gender, primary education, joblessness, food scarcity and depression. Depression symptoms were linked to female gender, joblessness, divorce, living in a joint family, excessive sleep and smoking. Low incomes, excessive sleep, joblessness and food scarcity were positively associated with PTSD symptoms. In contrast, less sleep appeared protective against PTSD. Conclusions: Public health initiatives, in particular mental health services that target stress and biocentric approaches that consider how humans interact with multiple facets of nature, should be introduced to mitigate against potential financial and psychological effects of the pandemic on impoverished urban-dwelling individuals in Bangladesh.

How Resiliency and Hope Can Predict Stress of Covid-19 by Mediating Role of Spiritual Well-being Based on Machine Learning

Nowadays, artificial intelligence (AI) and machine learning (ML) are playing a tremendous role in all aspects of human life and they have the remarkable potential to solve many problems that classic sciences are unable to solve appropriately. Neuroscience and especially psychiatry is one of the most important fields that can use the potential of AI and ML. This study aims to develop an ML-based model to detect the relationship between resiliency and hope with the stress of COVID-19 by mediating the role of spiritual well-being. An online survey is conducted to assess the psychological responses of Iranian people during the Covid-19 outbreak in the period between March 15 and May 20, 2020, in Iran. The Iranian public was encouraged to take part in an online survey promoted by Internet ads, e-mails, forums, social networks, and short message service (SMS) programs. As a whole, 755 people participated in this study. Sociodemographic characteristics of the participants, The Resilience Scale, The Adult Hope Scale, Paloutzian & Ellison's Spiritual Wellbeing Scale, and Stress of Covid-19 Scale were used to gather data. The findings showed that spiritual well-being itself cannot predict stress of Covid-19 alone, and in fact, someone who has high spiritual well-being does not necessarily have a small amount of stress, and this variable, along with hope and resiliency, can be a good predictor of stress. Our extensive research indicated that traditional analytical and statistical methods are unable to correctly predict related Covid-19 outbreak factors, especially stress when benchmarked with our proposed ML-based model which can accurately capture the nonlinear relationships between the collected data variables.

Impact of COVID-19 Related Stress on Sexual Desire and Behavior in a Canadian Sample

Objectives

We evaluated various facets of sexual health in Canadians across phases of the COVID-19 pandemic.

Methods

Online questionnaires every four weeks from April-August 2020.

Results

Higher COVID-19 stress predicted higher baseline dyadic sexual desire, lower relationship satisfaction, higher desire for solitary sexual behavior, and higher likelihood of experiencing sexual coercion among people with a live-in romantic partner. Dyadic sexual desire and pandemic-related stress both decreased with time, whereas solitary sexual behavior decreased and dyadic sexual behavior increased among participants without a live-in romantic partner.

Conclusions

Our findings reveal differential impacts of COVID-19 related stress on sexual outcomes.

Needs, gaps and opportunities for standard and e-mental health care among at-risk populations in the Asia Pacific in the context of COVID-19: a rapid scoping review

BACKGROUND

The COVID-19 pandemic is expected to have profound mental health impact, including in the Asia Pacific Economic Cooperation (APEC) region. Some populations might be at higher risk of experiencing negative mental health impacts and may encounter increased barriers to accessing mental health care. The pandemic and related restrictions have led to changes in care delivery, including a rapid shift to the use of e-mental health and digital technologies. It is therefore essential to consider needs and opportunities for equitable mental health care delivery to the most at-risk populations. This rapid scoping review: 1) identifies populations in the APEC region that are at higher risk of the negative mental health impacts of COVID-19, 2) identifies needs and gaps in access to standard and e-mental health care among these populations, and 3) explores the potential of e-mental health to address these needs.

METHODS

We conducted a rapid scoping review following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). We searched Medline, Embase and PsychInfo databases and Google Scholar using a search strategy developed in consultation with a biomedical librarian. We included records related to mental health or psychosocial risk factors and COVID-19 among at-risk groups; that referred to one or more APEC member economies or had a global, thus generalizable, scope; English language papers, and papers with full text available.

RESULTS

A total of 132 records published between December 2019 and August 2020 were included in the final analysis. Several priority at-risk populations, risk factors, challenges and recommendations for standard and e-mental health care were identified. Results demonstrate that e-mental health care can be a viable option for care delivery but that specific accessibility and acceptability considerations must be considered. Options for in-person, hybrid or "low-tech" care must also remain available.

CONCLUSIONS

The COVID-19 pandemic has highlighted the urgent need for equitable standard and e-mental health care. It has also highlighted the persistent social and structural inequities that contribute to poor mental health. The APEC region is vast and diverse; findings from the region can guide policy and practice in the delivery of equitable mental health care in the region and beyond.

Co-Housing Response to Social Isolation of COVID-19 Outbreak, with a Focus on Gender Implications

COVID-19 forced billions of people to restructure their daily lives and social habits. Several research projects have focused on social impacts, approaching the phenomenon on the basis of different issues and scales. This work studies the changes in social relations within the well-defined urban-territorial elements of co-housing communities. The peculiarity of this research lies in the essence of these communities, which base their existence on the spirit of sharing spaces and activities. As social distancing represented the only effective way to control the outbreak, the research studied how the rules of social distancing impacted these communities. For this reason, a questionnaire was sent to 60 communities asking them to highlight the changes that the emergency imposed on the members in their daily life and in the organization of common activities and spaces. A total of 147 responses were received and some relevant design considerations emerged: (1) the importance of feeling part of a “safe” community, with members who were known and deemed reliable, when facing a health emergency; and (2) the importance of open spaces to carry out shared activities. Overall, living in co-housing communities was evaluated as an “extremely positive circumstance” despite the fact that the emergency worsened socialization.

Prevalence and predictors of post-traumatic stress disorder in patients with cured coronavirus disease 2019 (COVID-19) one month post-discharge

Background: Coronavirus disease 2019 (COVID-19) can place an immense psychological strain on the infected patient. The psychological distress can linger after the initial recovery from the infection. Objective: This study aimed to evaluate the prevalence and predictors of provisional post-traumatic stress disorder (PTSD) in patients with cured COVID-2019. Methods: The baseline survey was conducted from 10 to 25 February 2020 in patients with COVID-19 in a designated hospital. Demographic and clinical characteristics were acquired, and depression and anxiety levels were assessed, using the 9-item Patient Health Questionnaire and 7-item Generalized Anxiety Disorder scale, respectively. A follow-up survey was conducted 1 month post-discharge. PTSD symptoms were measured by the Impact of Event Scale-6 (IES-6) and patients' perception of supportive care during hospitalization was investigated using a self-developed questionnaire. Results: In total, 114 patients completed both the baseline and follow-up surveys. Of these, 41 (36.0%) met the cut-off score for provisional PTSD diagnosis according to the IES-6. Female gender [odds ratio (OR) = 4.69, 95% confidence interval (CI) 1.54-14.37], educational level of high school or below (OR = 15.49, 95% CI 1.13-212.71), higher anxiety levels (OR = 1.34, 95% CI 1.12-1.61) and lower perceptions of emotional support during hospitalization (OR = 0.41, 95% CI 0.17-0.96) predicted a higher risk for provisional PTSD. Conclusions: PTSD is commonly seen in patients with COVID-19 1 month post-discharge. Female patients, and patients with lower educational levels, higher anxiety levels and lower perceptions of emotional support during hospitalization may be more likely to develop PTSD in the near future. Enhancing emotional support during hospitalization could help to prevent PTSD in patients with COVID-19.

COVID-19-Related Posttraumatic Stress Disorder Among Jordanian Nurses During the Pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) outbreak has been declared a pandemic and has affected both patients and health-care workers. This study was conducted to explore the extent of posttraumatic stress disorder (PTSD) experiences among nurses because of the COVID-19 pandemic in Jordan.

METHODS

This study used a cross-sectional study design with a convenience sampling approach. A sample of 259 participants completed the study questionnaires, including a socio-demographic questionnaire and the Posttraumatic Stress Disorder Checklist for DSM-5 between May and July 2020.

RESULTS

The prevalence of PTSD among the study participants was 37.1%. Most study participants who exhibited PTSD symptoms presented the lowest level of PTSD (17%). The results showed significant differences in overall COVID-19-related PTSD according to the participant's age (F = 14.750; P = 0.000), gender (F = 30.340; P = 0.000), level of education (F = 51.983; P = 0.000), years of experience (F = 52.33, P = 0.000), place of work (F = 19.593; P = 0.000), and working position (F = 11.597; P = 0.000), as determined by 1-way ANOVA.

CONCLUSIONS

Nurses must be qualified and accredited to cope with reported PTSD cases and their consequences in relation to COVID-19 outbreaks. A close collaboration with a multidisciplinary team is required to recognize, manage, and encourage safety literacy among health-care professionals and individuals diagnosed with or suspected of PTSD due to COVID-19 outbreaks or any other viral outbreaks.

Prevalence, Demographic, and Clinical Correlates of Likely PTSD in Subscribers of Text4Hope during the COVID-19 Pandemic

Background: During the COVID-19 pandemic, people may experience increased risk of adverse mental health, particularly post-traumatic stress disorder (PTSD). Methods: A survey measured stress, anxiety, depression, and PTSD symptoms in Text4Hope subscribers using the Perceived Stress Scale, Generalized Anxiety Disorder 7-Item Scale, Patient Health Questionnaire-9, and PTSD Checklist for DSM-5 Part 3, respectively. A Chi-square test and multivariate logistic regression were employed. Results: Most respondents were 41–60 years old (49.5%), Caucasian (83.3%), with post-secondary education (92.1%), employed (70.3%), married/cohabiting/partnered (64.9%), and homeowners (71.7%). Likely PTSD was reported in 46.8% of the respondents. Those who were afraid to contract the coronavirus had a history of depression before the pandemic, and those who received counselling during the pandemic exhibited a high prevalence of likely PTSD (OR (1.7 to 2.2)). Significant lower odds of likely PTSD were observed among subscribers who received absolute support from family/friends. Conclusions: This paper presents findings on the prevalence of likely PTSD and identified vulnerable groups during the COVID-19 pandemic. Our results support the proposal that public health advice should incorporate mental health wellness campaigns aiming to reduce the psychological impact of pandemics.

Dental health care providers' concerns, perceived impact, and preparedness during the COVID-19 pandemic in Saudi Arabia

BACKGROUND

Dental health care providers (DHCPs)are at high risk of cross-infection during clinical practice therefore, the aim of the study was to evaluate the DHCPs Covid-19 related concerns, its perceived impact, and their preparedness in Saudi Arabia.

METHODS

This cross-sectional study on DHCPs was carried out at five dental teaching hospitals/colleges in four provinces of Saudi Arabia from October to December 2020. A 35-item valid and reliable questionnaire was used to assess the concerns, perceived impact, and preparedness of DHCPs in the COVID-19 pandemic. Chi-square tests and logistic regression were used to compare parameters between the clinical and non-clinical staff.

RESULTS

A total of 320 DHCPs participated in this study with proportion of clinical staff (57.5%) surpassing the non-clinical staff (42.5%). The clinical DHCPs felt greater odds of falling ill with COVID-19 than non-clinical workers (OR, 2.61) and willing to look for another job (OR, 3.50). The higher proportion in both groups was worried that people close to them would be at higher exposure risk (96.3%) however, slightly more clinical DHCPs were concerned for their children than a non-clinical worker (OR, 3.57). The clinical DHCPs have greater odds of worrying that people would avoid them and their family members because of their job (OR, 2.75). A higher proportion in both groups (75.0%, 63.2%) felt that they would feel stress at work. More non-clinical DHCPs (94.1%) had received training for infection control than clinical (94.1% vs 63.0%: OR 0.10). Similarly, more DHCPs in the nonclinical group received adequate personal protective equipment training (88.2%; OR, 0.48). Most participants practiced self-preparation such as buying masks and disinfection (94.4%, 96.9%).

CONCLUSION

The majority of DHCPs felt concerned about their risk of exposure and falling ill from infection and infecting friends/family. These concerns could potentially affect the working of DHCPs during this pandemic. Measures to improve protection for DHCPs, minimize psychological implications, and potential social stigmatization should be identified at the planning phase before any pandemic.

Effect of the COVID-19 on Perceptions of Health, Anticipated Need for Health Services, and Cost of Health Care

OBJECTIVE

This article investigates how perceived vulnerability to the coronavirus disease 2019 (COVID-19) pandemic at its early stages is associated with people's perception of their health, the need for health-care services, and expenses related to addressing the COVID-19 impact on their health.

METHODS

The results are based on the analysis of surveys that were distributed among members of 26 random Facebook groups in April-May, 2020. Perceived COVID-19 pandemic related stress and health concerns were examined by using the analysis of variance (ANOVA) test.

RESULTS

Among 315 respondents, 64% have experienced COVID-19 related stress and identified anxiety, headache, insomnia, and weight gain as their primary health concerns. The ANOVA test revealed that females are more impacted by the COVID-19 stress than males. Around 40% of respondents believed that the COVID-19 would lead to an increase in the cost of health services, and 20% of respondents anticipated that the COVID-19 pandemic would increase their need for health services.

CONCLUSIONS

Learning about how people perceive the COVID-19 pandemic impact on their health, particularly in the pandemic's early stages can allow health professionals to develop targeted interventions that can influence pandemic preventative behaviors among different population groups. This study can help understand use patterns and mitigate financial barriers that could interfere with patients' care-seeking behavior.

Which personality traits can mitigate the impact of the pandemic? Assessment of the relationship between personality traits and traumatic events in the COVID-19 pandemic as mediated by defense mechanisms

The COVID-19 pandemic has had a significant influence on the lives of people around the world and could be a risk factor for mental health diseases. This study aimed to explore the psychological impact of the COVID-19 pandemic by identifying patterns related to post-traumatic symptoms by considering personality and defensive styles. Specifically, it was hypothesized that neuroticism was negatively associated with impact of event, as opposed to extraversion, agreeableness, conscientiousness, and openness traits. The mediation role of mature, neurotic, and immature defenses in these relationships was also investigated. This study involved 557 Italian individuals (71.3% women, 28.7% men; Mage = 34.65, SD = 12.05), who completed an online survey including the Impact of Event Scale-Revised, Forty Item Defense Style Questionnaire (DSQ-40) and Ten Item Personality Inventory. Results showed a nonsignificant effect for extraversion and openness on impact of event. The negative influence of neuroticism was instead confirmed in a partial parallel mediation involving significant effects from immature and neurotic defenses in the indirect path. Finally, agreeableness and conscientiousness delineated two protective pathways regarding impact of event, determining two total parallel mediation models in which both these personality traits were negatively associated with immature defensive styles, and conscientiousness was also positively related to mature defenses. These findings provide an exploration post-traumatic symptom patterns during the COVID-19 pandemic, involving the big five personality traits and defense mechanisms. These results may be useful for developing interventions, treatments, and prevention activities.

Early life stress and neural development: Implications for understanding the developmental effects of COVID-19

Chronic and/or extreme stress in childhood, often referred to as early life stress, is associated with a wide range of long-term effects on development. Given this, the COVID-19 pandemic has led to concern about how stress due to the pandemic will affect children's development and mental health. Although early life stress has been linked to altered functioning of a number of neural and biological systems, there is a wide range of variability in children's outcomes. The mechanisms that influence these individual differences are still not well understood. In the past, studies of stress in childhood focused on the type of events that children encountered in their lives. We conducted a review of the literature to formulate a new perspective on the effects of early life stress on development. This new, topological model, may increase understanding of the potential effects of the COVID-19 pandemic on children's development. This model is oriented on children's perceptions of their environment and their social relationships, rather than specific events. These factors influence central and peripheral nervous system development, changing how children interpret, adapt, and respond to potentially stressful events, with implications for children's mental and physical health outcomes.

Adult PTSD symptoms and substance use during Wave 1 of the COVID-19 pandemic

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About 13% of Alberta adults had significantly increased their substance use during the pandemic.

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These increases (alcohol and/or cannabis) did not differ by gender.

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Pandemic-related PTSD symptoms were associated with increased substance use.

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This association was moderate in strength and did not differ by gender.

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Almost 50% of adults indicated they needed supports to help them with these problems.

Introduction

This study examined associations between pandemic-related PTSD symptoms and substance use among adults, the role of gender and socioeconomic status in these outcomes, and the supports that adults needed to address these problems during Wave 1 of the COVID-19 pandemic in Alberta, Canada.

Methods and Measures

Data were collected from 933 community-based adults without a previous diagnosis of PTSD in June 2020. The Primary Care PTSD Screen was adapted to assess pandemic-related PTSD symptoms. Participants were asked if alcohol or cannabis use had increased in the past month. Adjusted logistic regression models examined associations between pandemic-related PTSD symptoms and substance use.

Results

More women (19%) than men (13%) met criteria for high pandemic-related PTSD symptomology, while a similar percentage (13.4% of women, 13.2% of men) reported significant increases in substance use during the pandemic. Adults 18–35 years; those who believed they would become infected with the virus; and those with low income, education, or pandemic-related job loss were more likely to report PTSD symptoms. High pandemic-related PTSD symptomology was associated with a significant substance use increase among both women (OR = 2.2) and men (OR = 2.3) in adjusted models. Many adults (50% of women, 40% of men) reported they needed help to address these problems.

Conclusions

Pandemic-related PTSD symptoms were common among adults during Wave 1 of COVID-19. These symptoms were associated with a significant increase in substance use among women and men. Many adults voiced a need for help with these problems. Findings suggest substance use interventions that consider and address pandemic-related PTSD symptoms may be needed.

Dealing With COVID-19 Patients: A Moderated Mediation Model of Exposure to Patients' Death and Mental Health of Italian Health Care Workers

Introduction: The COVID-19 pandemic is asking health care workers (HCWs) to meet extraordinary challenges. In turn, HCWs were experiencing tremendous psycho-social crisis as they have had to deal with unexpected emotional requirements (ERs) arising from caring for suffering and dying patients on a daily basis. In that context, recent studies have highlighted how HCWs working during the COVID-19 outbreak manifested extreme emotional and behavioral reactions that may have impacted their mental health, increasing the risk for developing post-traumatic stress symptoms.

Purpose: The aim of the study was to investigate post-traumatic stress symptoms, such as intrusion symptoms, as a potential mediator of the link between ERs and crying at work, and whether rumination moderates the relationship between ERs and intrusion-based PTS symptoms among HCWs who have had to deal with patients dying from COVID-19.

Methods: An online cross-sectional study design was performed. A total of 543 Italian HCWs (physicians and nurses) participated in the study. Participation was voluntary and anonymous. We used the SPSS version of bootstrap-based PROCESS macro for testing the moderated mediation model.

Results: ERs had an indirect effect on crying at work through the mediating role of intrusion symptoms. Results from the moderated mediation model showed that rumination moderated the indirect effect of ERs on crying at work via intrusion symptoms, and this effect was significant only for high rumination. Furthermore, when we tested for an alternative model where rumination moderates the direct effect of ERs on crying at work, this moderation was not significant.

Conclusions: As the second wave of the COVID-19 pandemic is ongoing, there is an urgent need for decision-makers to rapidly implement interventions aimed at offering timely psychological support to HCWs, especially in those contexts where the risk of emotional labor associated to patients dying from COVID-19 is higher.

Prevalence and predictors of post-traumatic stress symptoms and depressive symptoms among Bangladeshi students during COVID-19 mandatory home confinement: A nationwide cross-sectional survey

The COVID-19 pandemic has brought not only the risk of infection but also unbearable mental health difficulties with the concern of educational loss among students. This study explored the adverse impact of the COVID-19 outbreak on Bangladeshi students' mental health and detected potential influencing factors related to post-traumatic stress symptoms (PTSS) and depressive symptoms. Convenience sampling was applied to collect data via online survey from 3997 college and university students between 29th May and 22nd July 2020. PHQ-9 and IES scales were used to assess depressive symptoms and PTSS, respectively. Of all participants, 52.87% had depressive symptoms and 40.91% had PTSS. Severe educational disruption was a risk factor for depressive symptoms (AOR = 1.68; 95% CI: 1.37-2.06) and PTSS (AOR = 1.86; 95% CI: 1.51-2.29). COVID-19 like symptoms including fever, cough, breathing difficulty and fatigue showed a stronger association with higher IES and PHQ-9 scores than other symptoms (e.g., diarrhea, sore throat) (p ≤ 0.01). Fear of infection and death by COVID-19 were risk factors for PTSS and depressive symptoms (p ≤ 0.01). Recreational activity and regular physical exercise emerged as the most protective factors for depressive symptoms and PTSS. The mental health of students is significantly affected in this pandemic suggesting the need for adequate psychological support.

An internet-based self-help intervention for people with psychological distress due to COVID-19: study protocol for a randomized controlled trial

BACKGROUND

The coronavirus-19 (COVID-19) has reached pandemic status and is affecting countries all over the world. The COVID-19 pandemic is accompanied by various stressors that require adjustment in everyday life and possibly changes in personal future prospects. While some individuals cope well with these challenges, some develop psychological distress including depressive symptoms, anxiety, or stress. Internet-based self-help interventions have proven to be effective in the treatment of various mental disorders such as depression and anxiety. Based on that, we developed an internet-based self-help program for individuals with psychological distress due to the situation surrounding the COVID-19 pandemic. The 3-week self-help program consists of 6 modules comprising texts, videos, figures, and exercises. Participants can request guidance within the self-help program (guidance on demand). The primary aim of this study is to evaluate the efficacy and feasibility of the self-help program compared to a waiting control condition.

METHODS

The design is a parallel group randomized controlled trial. Participants are allocated to a 3-week self-help intervention plus care as usual or a 3-week waiting period with only care as usual. There are follow-ups after 6 weeks and 18 weeks. At least 80 participants with COVID-19 pandemic related psychological distress will be recruited. Primary outcome are depressive symptoms. Secondary outcomes include anxiety and chronic stress, suicidal experiences and behavior, health-related quality of life, generalized optimism and pessimism, embitterment, optimistic self-beliefs, emotion regulation skills, loneliness, resilience, and the satisfaction with and usability of the self-help program.

DISCUSSION

To the best of our knowledge, this is one of the first studies investigating the efficacy of an internet-based self-help program for psychological distress due to the situation surrounding the COVID-19 pandemic. Thus, the results of this study may give further insight into the use of internet-based self-help programs in pandemic-related psychological distress.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04380909 . Retrospectively registered on 8 May 2020.