Resilience, COVID-19-related stress, anxiety and depression during the pandemic in a large population enriched for healthcare providers

A qualitative examination of the mental health impact of Covid-19 in marginalized communities in Guatemala: The Covid Care Calls survey

BACKGROUND

The mental health impact of Covid-19 from the perspective of individuals experiencing psychological distress during lockdown period in marginalized, high-risk communities remains underinvestigated.

AIMS

This study aims to identify key factors related to psychological distress resulting from the Covid-19 pandemic across highly vulnerable districts in Guatemala.

METHODS

The Covid Care Calls (CCC) survey was administered to households in 11 districts in Guatemala to gather information about medical, mental health, and psychosocial status during the lockdown period; provide referral for care; and disseminate information on evidence-based protective measures to stem the spread of the virus. The 330 individuals participated the survey. Conventional content analysis was used to analyze survey data.

RESULTS

Most commonly reported mental health issues since the start of the pandemic were anxiety (46%), stress (36%), and exacerbation of pre-Covid-19 mental health conditions (19%). Depression and burnout were equally reported by 12% of participants. Only 2% reported issues with safety in the home. Concerns about catching the virus and economic worries were the most commonly reported sources of psychological distress.

CONCLUSION

Results of this study indicate a high prevalence of anxiety, stress, and increased prior mental health symptoms resulting from the onset of the Covid-19 pandemic in low-income, high-risk communities across Guatemala. Efforts focused on enhancing coping strategies as well as psychoeducation to address stigma and increase help-seeking for depression are particularly important.

Augmentation of a Hospital Incident Command System to Support Continued Waves of the COVID-19 Pandemic

Stamford Hospital (SH) is a 305 bed Level II Trauma center located in Fairfield County, the epicenter of the coronavirus disease 2019 (COVID-19) pandemic in Connecticut. The COVID-19 pandemic was a fast paced, rapidly evolving crisis, presenting our leadership team with unique challenges related to resource availability, patient care, and staff safety. The existing Hospital Incident Command System (HICS) was activated in March 2020 to coordinate our operational emergency management planning, response, and recovery capability for this unplanned event. Although HICS lays the groundwork for hospital preparations and protocol implementation, it is not designed to withstand prolonged crisis circumstances. Given the conditions that the COVID-19 pandemic presented, the possibility for future waves became an impending reality, prompting the need for a long-term solution. To establish guidelines that promoted balance between necessary preparations in the case of additional surges of the pandemic and concurrent resumption then maintenance of routine hospital operations, the SH COVID-19 Playbook was created. The Playbook, presented here, is arranged in accordance with the evidence-based 4 S’s (Space, Staff, Systems, and Stuff) strategic critical care planning framework, to address surge capacity management within our hospital’s four main patient care areas and additional supportive services. Through feedback from frontline caregivers and leaders within SH, the Playbook captures our experience, best practices, and insight acquired during the first wave of the pandemic. Established with the intentions of equipping leadership and staff globally, guidelines are presented to aid in the navigation of future pandemic surges and successfully care for COVID-19 patients, ensure staff safety, allow for normal services to operate, and provide optimal communication and support for the community, patients, and staff.

Risk and resilience in couple's adjustment to the COVID-19 pandemic

The COVID-19 pandemic's global scope and resulting social distancing measures have caused unprecedented economic, lifestyle, and social impacts to personal and relationship well-being. While lockdowns have prompted individuals to increase reliance on intimate partners for support, stressful external contexts can also interfere with partners' capacity to request and provide support, resulting in relationship dissatisfaction and even dissolution. Guided by a risk and resilience framework, this study examined the impact of perceived stress, social contextual factors, and dyadic coping on self-reported relationship satisfaction changes during the initial United States COVID-19 lockdown period. Participants were adults in romantic relationships who completed an online survey between April 13 and June 8, 2020. Overall, survey respondents (N = 1106) reported higher perceived stress levels than established population norms, and small but significant decrements in relationship satisfaction. Multivariable models revealed that higher perceived stress levels were associated with lower relationship satisfaction levels. Additionally, dyadic coping was found to moderate the impact of perceived stress on relationship satisfaction (B = .05, 95% CI = .02- .07), suggesting that engaging in dyadic coping buffered individuals from adverse effects of perceived stress on their relationships. Findings emphasize heightened stress experienced by individuals during the pandemic, potential detrimental effects of stress on couple relationships, and suggest dyadic coping may help buffer couples from adverse effects of the pandemic on their relationships. As such, dyadic coping may be an important target for future interventions designed to assist couples during the ongoing pandemic and future pandemics/natural disasters.

ENACT study: What has helped health and social care workers maintain their mental well-being during the COVID-19 pandemic?

A growing body of research has highlighted the adverse impact of COVID-19 stressors on health and social care workers' (HSCWs) mental health. Complementing this work, we report on the psychosocial factors that have had both a positive and negative impact on the mental well-being of HSCWs during the third lockdown period in Scotland. Using a cross-sectional design, participants (n = 1364) completed an online survey providing quantitative data and free open-text responses. A multi-method approach to analysis was used. The majority of HSCWs were found to have low well-being scores, high levels of COVID-19 stress, worry, burnout and risk perception scores and almost half of HSCWs met the clinical cut-off for acute stress (indicative of PTSD). HSCWs with higher scores on adaptive coping strategies and team resilience reported higher scores on mental well-being. HSCWs were significantly more likely to seek informal support for dealing with personal or emotional problems compared to formal supports. Barriers to formal help-seeking were identified including stigma and fear of the consequences of disclosure. HSCWs mostly valued peer support, workplace supports, visible leadership and teamwork in maintaining their mental well-being. Our findings illuminate the complexity of the effects of the COVID-19 pandemic on HSCWs' well-being and will inform future intervention development seeking to increase positive adaptation and improve staff well-being. Addressing barriers to mental health help-seeking among HSCWs is essential. The implications emphasise the importance of lessons learned across health and social care contexts, planning and preparedness for future pandemics.

Profiles of emerging adults' resilience facing the negative impact of COVID-19 across six countries

Although emerging adults (i.e., individuals aged 18-29 years old) may be at a lesser risk of COVID-19 severe illness and mortality, studies have found that the negative impact of COVID-19 on mental health and well-being is higher among emerging adults when compared to other age groups. The current study aimed to identify profile(s) based on resilience resources, which could help emerging adults in managing the disruptions to their lives following the pandemic. A cross-national sample of 1,768 emerging adults from China, Italy, Lithuania, Portugal, Slovenia, and the US was utilized to identify profiles based on different resilience dimensions (ego-resiliency, positivity, religiosity, socioeconomic status, family support, peer support). Results of the Latent Profile Analysis suggest the presence of four different profiles: no resources, only peer, only family, and well-equipped. The association of these profiles with demographic variables, adulthood markers, self-perceived COVID-19 impact, present well-being, and future life perception was investigated. Implications for resilience theory as well as for future interventions are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03658-y.

Challenges faced by university students during the COVID-19: An international study in five countries during the early phase of the pandemic

This study focused on the specific challenges of university students in the face of the COVID-19 pandemic and examined similarities and differences in COVID-related concerns and difficulties in functioning in samples of undergraduate students in five countries. A sample of 4306 undergraduate university students (43.8% males, 56.2% females) from Israel, Kosovo, Ukraine, Cyprus and Germany participated in an anonymous online survey during the first wave of the pandemic, between March and June 2020. Study variables included the assessment of the exposure to COVID-19, perceived health status, specific COVID-related concerns and functional difficulties, social support, and the perceived level of coping. Similar concerns about the uncertainty regarding the termination of the health crisis and worry for the health of family members were identified as the most common concerns in the five countries. Challenges in online learning and financial difficulties were rated as the most central difficulties. Both COVID-related concerns and COVID-related difficulties predicted lower levels of perceived coping. Greater social support was associated with better perceived coping. Policymakers should be informed by the accumulating research showing the substantive relationships between academic difficulties and perceived COVID-related distress and coping.

Prenatal stress from the COVID-19 pandemic predicts maternal postpartum anxiety as moderated by psychological factors: The Australian BITTOC Study

BACKGROUND

While there have been reports of increased perinatal anxiety during the COVID-19 pandemic (Stepowicz et al., 2020), there has been a lack of research on the relative importance of objective hardship and subjective distress. In this study, we explored the extent to which resilience, tolerance of uncertainty, and cognitive appraisal of the pandemic's consequences moderate the effect of prenatal objective hardship and subjective distress due to the pandemic on 2-month postpartum anxiety.

METHODS

Data were collected as part of the Birth in the Time of COVID (BITTOC) study. We measured objective hardship and subjective distress, mental health, and potential psychological moderators in 419 pregnant women residing in Australia, and at two months postpartum. Hierarchical multiple regressions were used.

RESULTS

Objective hardship and subjective distress independently predicted postpartum anxiety. All three psychological factors moderated the effect of objective hardship on anxiety. For women with low/neutral resilience, or low/moderate tolerance of uncertainty, or a negative cognitive appraisal, greater objective hardship predicted higher postpartum anxiety. Conversely, for women with high resilience, or high tolerance of uncertainty, or neutral/positive cognitive appraisal, there was no association. Only a neutral/positive cognitive appraisal significantly buffered the effect of subjective distress on anxiety.

LIMITATIONS

Participants self-selected themselves into the study. The generalizability of our results could be restricted to women of higher socio-economic status.

CONCLUSIONS

These findings help us better understand options for intervention and assessment of vulnerable women during times of stress, along with the mechanisms by which COVID-related stress during pregnancy contributes to postpartum anxiety.

Worry about COVID-19 as a predictor of future insomnia

The coronavirus disease 2019 (COVID-19) pandemic resulted in significant increases in insomnia, with up to 60% of people reporting increased insomnia. However, it is unclear whether exposure to risk factors for the virus or worries about COVID-19 are more strongly associated with insomnia. Using a three-part survey over the course of the first 6 months of the pandemic, we evaluated associations between COVID-19 exposures, COVID-19 worries, and insomnia. We hypothesised that COVID-19-related worries and exposure to risk of COVID-19 would predict increases in insomnia. Participants (N = 3,560) completed a survey at three time-points indicating their exposures to COVID-19 risk factors, COVID-19-related worries, and insomnia. COVID-19 worry variables were consistently associated with greater insomnia severity, whereas COVID-19 exposure variables were not. COVID-19 worries decreased significantly over time, and there were significant interactions between change in COVID-19 worries and change in insomnia severity over time. Individuals who experienced increases in COVID-19 worries also experienced increases in insomnia severity. Changes in worry during the COVID-19 pandemic were associated with changes in insomnia; worries about COVID-19 were a more consistent predictor of insomnia than COVID-19 exposures. Evidence-based treatments targeting virus-related worries may improve insomnia during this and future calamities.

Experiencing Pregnancy during the COVID-19 Lockdown in Poland: A Cross-Sectional Study of the Mediating Effect of Resiliency on Prenatal Depression Symptoms

The COVID-19 pandemic in Poland brought uncertainty, not only to the general population but also to women preparing for childbirth, which increased the risk of mental health illnesses during this special period of life. Resilience, which refers to positive adaptation or the ability to maintain good mental health, can be a protective factor against the development of psychiatric problems such as depressive symptoms. This study aimed to assess the protective role of resilience in the relationship of such risk factors as traumatic childbirth perception and pandemic-related pregnancy stress with prenatal depressive symptoms. The study was performed at the end of the first wave of the COVID-19 pandemic. A total of 80 pregnant women took part. A mediation analysis, an independent t-test, and a Pearson correlation analysis were conducted. The lower resilience group declared the inclusion of slightly more participants (n = 41; 51.2%); 39 women (48.8%) demonstrated a higher risk of prenatal depression. The analysis revealed a significant direct effect between pandemic-related stress and prenatal depression (βc = 0.285, SE = 0.05, t = 2.63, p < 0.05) as well as between pandemic-related stress and resilience (βa = −0.283, SE = 0.07, t = −2.61, p < 0.05) and between resilience and prenatal depression (βb = −0.585, SE = 0.07, t = −6.34, p < 0.001). After the introduction of resilience as a mediator, the strength of the relationship not only decreased, but also ceased to be statistically significant (βc′ = 0.120, SE = 0.04, t = 1.29, p = 0.19), which indicates that it was in a full mediation state (R2 = 0.39, F = 25.31, p < 0.001; Z = 2.43, p < 0.05). The results indicate that in pregnant women, a high level of resilience protects them from the effects of pandemic-related stress on perinatal depression symptoms.

Effects of the COVID-19 pandemic on quality of life among relatives of individuals with intellectual disabilities: A longitudinal study

Background

The COVID‐19 pandemic poses risks to the quality of life (QoL) of relatives of individuals with intellectual disabilities. This paper investigates relatives' QoL and associated risk and buffering factors before and during the pandemic.

Method

Surveys were administered to three samples of relatives in the Netherlands in 2019 (N = 105) and during the first waves of COVID‐19 in June (N = 207) and October 2020 (N = 332). Associations between QoL and care burden, care competence, social support, and resilience, and changes over time were analysed using (logistic) regressions.

Results

No significant changes in overall QoL nor its domains were found. Care burden was negatively associated with QoL and increased during the pandemic. Care competence was lower than in 2019. Competence, social support, and resilience were positively associated with QoL.

Conclusions

Although relatives' QoL remained stable, the pandemic poses non‐negligible risks to their wellbeing. It is, therefore, crucial to provide relatives with adequate support.

Lifestyle Changes, Emotional Eating, Gender, and Stress during COVID-19 Lockdown

Emotional eating poses health risks. It is associated with adverse weight gain and a higher body mass index and is frequently triggered by stressful situations such as pandemics. The COVID-19 pandemic was found to cause stress as well as lifestyle changes of different magnitudes. This study examined the relationship between lifestyle changes and emotional eating by focusing on the moderating effect of gender and COVID-19-related stressors. A total of 1969 respondents completed online questionnaires during the first COVID-19 lockdown in Israel. The questionnaires assessed COVID-19-related lifestyle changes concerning eating habits, alcohol consumption, sleep quality, physical activity, and cigarette smoking, COVID-19-related stressors, and emotional eating (Dutch Eating Behavior Questionnaire). People with positive and negative COVID-19-related lifestyle changes demonstrated higher emotional eating compared to people with no lifestyle changes. The relationship between lifestyle changes and emotional eating was moderated by gender and COVID-19-related stressors. In conclusion, health officials should consider recommendations about lifestyle changes given to the public in times of unpredictable changes, with special attention to populations at risk of emotional eating. As emotional eating is related to poor emotional regulation skills, public nutrition recommendations should focus on improving these skills rather than adopting better diets.

Psychological resilience and mood disorders: a systematic review and meta-analysis

OBJECTIVE

This systematic review aims to describe the relationship between psychological resilience and mood disorders.

METHODS

This is a systematic review and meta-analysis. The following databases were searched on November 6, 2020: PubMed, PsycINFO, and Embase.

RESULTS

Twenty-three articles were included and the majority of the studies included (95.7%) showed that psychological resilience has a positive impact in mood disorders. Our meta-analysis showed that individuals with bipolar disorder presented significantly lower levels of psychological resilience compared to controls (standardized mean difference [SDM]: -0.99 [95% confidence interval {95%CI}: -1.13 to -0.85], p < 0.001). In addition, individuals with depression had significantly lower levels of psychological resilience compared to controls (SDM: -0.71 [95%CI -0.81 to -0.61], p < 0.001).

CONCLUSION

Our results showed that individuals with mood disorders are less resilient than individuals without mood disorders. Our findings reinforce the importance of investigating interventions that may help to improve psychological resilience considering its positive impact in the context of mood disorders.

A Longitudinal Investigation of Resilience as a Protective Factor During the COVID-19 Pandemic

COVID-19 is a global stressor that has been shown to impact mental health outcomes. Given that COVID-19 is a unique stressor that has been shown to have mental health consequences, identifying protective factors is imperative. The protective influences of resilience are demonstrated through the extant literature, though less is known about resilience and COVID-19 impact. The current study seeks to expand the existing literature on resilience, and on mental health outcomes influenced by COVID-19, by longitudinally investigating relative resilience as a buffer against posttraumatic stress disorder (PTSD) symptoms and alcohol consumption, in the wake of a global pandemic. Participants included 549 undergraduates with a history of lifetime trauma exposure. Using a longitudinal path model, we tested the interaction between relative resilience (i.e., an individual's deviation from distress levels predicted by prior trauma exposure relative to other individuals in the same cohort) and COVID-19 impact domains (i.e., social media use, worry, exposure, change in substance use, and housing/food insecurity) on PTSD symptoms and alcohol consumption. Findings demonstrate a significant interaction between the COVID-19 worry impact domain and baseline resilience on later PTSD symptoms, whereby COVID-19 worry impacts PTSD symptoms at low levels of resilience (β = .26, p < .001), marginally impacts PTSD symptoms at mean levels of resilience (β = .09, p = .05), and does not impact PTSD symptoms at high levels of resilience (β = -.08, p = .16). There were no significant main effects nor interaction effects of resilience on alcohol consumption. This article adds to the literature on resilience and COVID-19 through examining both internalizing (i.e., PTSD) and substance use outcomes, using longitudinal data, and using a quantitative measure of resilience.

Teachers' Response to Stress, Anxiety and Depression During COVID-19 Lockdown: What Have We Learned From the Pandemic?

BACKGROUND

As a result of national lockdown due to the COVID-19 outbreak, teachers were forced to suspend their classes and replace them with online teaching and home schooling. Additional stressors such as competing family responsibility have increased their worries and mental health problems. The aim of this study was to determine the impact of COVID-19-related worries on teachers' emotional symptoms, considering the mediating role of several protective factors.

METHODS

A total of 614 Chilean teachers (94.60% women) participated in this study using a cross-sectional design and incidental sampling method. Self-report data was collected assessing emotional symptoms, COVID-19-related worries, life satisfaction, affect balance, and resilience. Descriptive analyses, Pearson's correlations, hierarchical regressions, and mediation models were conducted.

RESULTS

The results indicated that emotional symptoms were associated with prepandemic physical and mental health problems, higher levels of worries and negative affect, as well as lower levels of life satisfaction and resilience. Results from the mediation models showed that the negative impact of COVID-19-related worries on emotional symptoms was alleviated by affect balance and resilience.

CONCLUSIONS

These findings highlight the importance of addressing the risk and protective factors for teachers' mental health during exceptional situations such as the ongoing pandemic.

Evolution of Posttraumatic Symptoms and Related Factors in Healthcare Workers During the COVID-19 Pandemic: A Longitudinal Study

OBJECTIVE

This study aimed to (1) evaluate the evolution of mental health (posttraumatic stress symptoms [PTSSs], depression, and burnout) of healthcare workers during the second wave of the pandemic (November to December 2020) and compare it with the first wave (March to May 2020), and (2) ascertain the predictors of PTSSs.

METHODS

In March to May 2020 (T1), 269 healthcare professionals working in Spain completed PTSSs, sadness, resilience, and coping questionnaires. In November to December 2020 (T2, N = 58), we assessed PTSSs, sadness, burnout, and depression.

RESULTS

Among the healthcare professionals, 63.8% displayed severe PTSSs, 51.7% depressive symptoms, and 79.3% emotional exhaustion (T2). Some risk factors were caring for patients who were severely ill or dying and using rumination, thinking avoidance, self-isolation, emotional expression, and self-blaming as coping strategies.

CONCLUSIONS

The pandemic has had a deep and long-lasting impact on the healthcare workers' mental health.

Effects of the COVID-19 Crisis on Resident Well-Being in a Community Teaching Hospital

OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic has been an unexpected crisis that continues to challenge the medical community at large. Healthcare environments have been forced to change dramatically, including for medical residents, who are vital members of the innovative emergency response teams. Articles have previously been published on the effects of crises on the well-being of healthcare practitioners; however, there is a paucity of literature targeting medical residents' experiences and general wellness during devastating events. The objective of our study aimed at understanding the emotional impact of the COVID-19 pandemic on residents' stress, academics, and support systems.

METHODS

An anonymous, voluntary Likert scale questionnaire was sent via SurveyMonkey to Internal Medicine and Family Medicine residents in July 2020. Questions focused on residents' mood; stress levels; sense of support; and academics before, during, and immediately after the first surge of COVID-19 at our hospital between March 13 and June 15, 2020.

RESULTS

Residents felt sad, stressed, and overworked during the first wave, as opposed to feelings of neutrality and happiness before and immediately after. Levels of concern for personal and loved ones' safety were significantly increased during and after our first wave. The impact on educational training was rated as neutral. Residents noted that institutional support could be improved by the provision of wellness activities and sponsored social events.

CONCLUSIONS

This study provides insight on resident well-being during the initial months of the pandemic and identifies areas that could be improved. Our results demonstrated that the pandemic affected many aspects of residents' well-being and education, and the lessons learned can help guide healthcare institutions when implementing wellness activities for trainees during subsequent crises.

Durable functional limitation in patients with coronavirus disease-2019 admitted to intensive care and the effect of intermediate-dose vs standard-dose anticoagulation on functional outcomes

INTRODUCTION

Patients affected with severe forms of coronavirus disease 2019 (COVID-19) suffer from a wide range of sequelae, from limited airway diseases to multiple organ failure. These sequelae may create exercise limitation, impair the daily activity and thus impact the mental health and the social life. However, the extent of functional limitations and depressive symptoms are understudied especially in patients with COVID-19 after intensive care unit (ICU) hospitalization.

METHODS

The Intermediate versus Standard-dose Prophylactic anticoagulation In cRitically-ill pATIents with COVID-19: An opeN label randomized controlled trial (INSPIRATION) was a clinical trial that randomized ICU patients with COVID-19 to intermediate-dose vs standard-dose anticoagulation. In the current study, we assessed the interval change in 30-day and 90-day functional limitations based on the post-COVID-19 functional status scale (PCFS) and depressive symptoms based on the Patient Health Questionnaire-2 (PHQ-2) in the trial participants. We also assessed the effect of intermediate-dose vs standard-dose prophylactic anticoagulation on the functional outcomes and depressive symptoms.

RESULTS

Of 600 randomized patients in INSPIRATION, 375 (age: 62 years; 42% women) participated in the functional status study. 195 patients died during the 90-day follow up (191 by day 30). Among survivors, between day 30 and day 90, the proportion of patients with moderate-to-severe functional limitation (PCSF grade 3-or-4) decreased from 20.0% to 4.8% (P <0.001) and PHQ-2 ≥ 3 decreased from 25.5% to 16.6% (P = 0.05). The proportion of patients with no functional limitations (PCFS grade 0) increased (4.2% to 15.4%, P<0.001). Intermediate-dose compared with standard-dose prophylactic anticoagulation did not impact the 90-day proportion of patients with PCFS grade 3-or-4 (5.3% vs 4.2%; odds ratio (OR), 1.20, [95% CI, 0.46-3.11]; P = 0.80) or PHQ-2 ≥ 3 (17.9% vs 15.3%; OR, 1.14, [95% CI, 0.79-1.65]; P = 0.14), with similar results when accounting for study center.

CONCLUSION

In patients with COVID-19 admitted to the ICU, functional limitations and depressive symptoms were common at 30-day follow-up and had some improvement by 90-day follow-up among survivors. Intermediate-dose compared to standard-dose prophylactic anticoagulation did not improve functional outcomes.

Social Support and Resilience as Predictors of Prosocial Behaviors before and during COVID-19

The objective of this research was to analyze the relationship between social support and resilience with prosocial behavior before and during the confinement caused by COVID-19. Materials and Methods: The participants were divided into a confined group (228 women and 84 men) and an unconfined group (153 women and 105 men), all of whom were university students. Instruments were applied to measure the variables proposed. Results: Social support predicted 24.4% of the variance in prosocial behavior among women and 12% among men in the confined group; no evidence of this relationship was found in the unconfined groups. Resilience predicted 7% of the variance in prosocial behavior among confined women, 8.4% among confined men, 8.8% among unconfined women, and 5.1% in unconfined men. Discussion and Conclusion: The results show the importance of social support and resilience in prosocial behaviors, which are key elements for the proper functioning of society, especially in the face of a crisis such as COVID-19.

Conservation of Resources, Psychological Distress, and Resilience During the COVID-19 Pandemic

Objectives: The Conservation of Resources (COR) theory suggests that stress results from threatened or actual loss of resources following significant life events. This study used COR theory as the framework to explore the reflection of loss of resources during the COVID-19 pandemic on psychological distress and resilience, in an adult Jewish Israeli population.

Methods: We examined the association between background variables, stress, loneliness, concern, COVID-19-related post traumatic symptoms (PTS), resilience factors and COR via an online survey among 2,000 adults during April 2020.

Results: Positive relationships were identified between resource loss and PTS (r = 0.66, p < 0.01), and between resource gain and resilience (r = 0.30, p < 0.01). Psychological variables were significantly associated with PTS and explained 62.7% of the variance, F (20, 1,413) = 118.58, p < 0.001.

Conclusion: Loss of resources, stress, loneliness and concern were found to be risk factors for distress and PTS, whereas resilience factors played a protective role. We thus recommend using the COR theory to explore COVID-19 effects elsewhere.

Psychological impact on dental students and professionals in a Lima population during COVID-19s wave: a study with predictive models

Peru was the country with the highest COVID-19 case fatality rate worldwide during second wave of infection, with dentists and pre-professional students being susceptible to infection due to clinical procedures they perform. This situation could have generated some kind of psychological disorder within this group. Therefore, the present study aimed to assess how COVID-19 pandemic affected this population group during second wave, in relation to depression, anxiety and stress. This observational and cross-sectional study in 368 Peruvian dentists (186 students and 182 professionals), was carried out during August to November 2021. The DASS-21 Scale was used to diagnose depression, anxiety and stress. For the statistical analysis, Pearson's chi-square test was used, in addition to a logit model using odds ratio (OR) to evaluate depression, anxiety and stress with the following factors: gender, age group, marital status, monthly family income, children, academic level, history of COVID-19, COVID-19 symptomatology, close relative with COVID-19, living with vulnerable people and work dedication. In addition, predictive models were constructed considering all possible significant causes. A significance level of p < 0.05 was considered. Dental students and professionals presented significant differences in levels of depression, anxiety and stress (p < 0.001, p = 0.022, p = 0.001; respectively). Male students were 56% less likely to develop stress (OR 0.44; CI 0.22–0.85) compared to females; while those unmarried were 81% less likely to develop stress (OR 0.19; CI 0.04–0.85). Likewise, those with children were 83% less likely to develop stress (OR 0.17; CI 0.06–0.52) and 65% less likely to develop depression (OR 0.35; CI 0.15–0.80). In addition, COVID-19 asymptomatics were 60% less likely to develop depression (OR 0.40; CI 0.17–0.92). However, having relatives with COVID-19 caused almost three times the probability of developing depression (OR 2.96; CI 1.29–6.79) and twice the probability of developing stress (OR 2.49; CI 1.07–5.78). As for dental professionals, it was noticed that those unmarried had almost three times the probability of developing stress (OR 2.93; CI 1.38–6.23); while those who only worked had twice the probability of developing stress (OR 2.37; CI 1.17–4.78). Dental students had a higher prevalence of depression, anxiety and stress. In addition, having children and being asymptomatic were protective predictors for depression, while being male, unmarried and having children were protective predictors for stress. However, having a relative with COVID-19 was a risk predictor for depression and stress. In professionals, only working and being unmarried were risk predictors for stress.

Examining the mental health adversity among healthcare providers during the two waves of the COVID-19 pandemic: results from a cross-sectional, survey-based study

OBJECTIVES

The current global health crisis of the COVID-19 pandemic has drastically affected the whole population, but healthcare workers are particularly exposed to high levels of physical and mental stress. This enormous burden requires both the continuous monitoring of their health conditions and research into various protective factors.

DESIGN

Cross-sectional surveys.

SETTING AND PARTICIPANTS

Self-administered questionnaires were constructed assessing COVID-19-related worries of health workers in Hungary. The surveys were conducted during two consecutive waves of the COVID-19 pandemic (N-first wave=376, N-second wave=406), between 17 July 2020 and 31 December 2020.

PRIMARY AND SECONDARY OUTCOME MEASURES

COVID-19-related worry, well-being and distress levels of healthcare workers. We also tested whether psychological resilience mediates the association of worry with well-being and distress. Multiple linear regression analyses were performed.

RESULTS

The results indicated that healthcare workers had high levels of worry and distress in both pandemic waves. When comparing the two waves, enhanced levels of worry (Wald's χ²=4.36, p=0.04) and distress (Wald's χ²=25.18, p<0.001), as well as compromised well-being (Wald's χ²=58.64, p<0.001), were found in the second wave. However, not all types of worries worsened to the same extent across the waves drawing attention to some specific COVID-19-sensitive concerns. Finally, the protective role of psychological resilience was shown by a mediator analysis suggesting the importance of increasing resilience as a key factor in maintaining the mental health of healthcare workers in the burden of the COVID-19 pandemic.

CONCLUSIONS

Our results render the need for regular psychological surveillance in healthcare workers.

REGISTRATION

Hungarian Scientific and Research Ethics Committee of the Medical Research Council (IV/5079-2/2020/EKU).

Nutrition as Personalized Medicine against SARS-CoV-2 Infections: Clinical and Oncological Options with a Specific Female Groups Overview

Coronavirus disease 2019 (COVID-19) is a respiratory disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). It is acknowledged that vulnerable people can suffer from mortal complications of COVID-19. Therefore, strengthening the immune system particularly in the most fragile people could help to protect them from infection. First, general nutritional status and food consumption patterns of everyone affect the effectiveness of each immune system. The effects of nutrition could impact the level of intestinal and genital microbiota, the adaptive immune system, and the innate immune system. Indeed, immune system cells and mediators, which are crucial to inflammatory reaction, are in the structures of fats, carbohydrates, and proteins and are activated through vitamins (vit) and minerals. Therefore, the association of malnutrition and infection could damage the immune response, reducing the immune cells and amplifying inflammatory mediators. Both amount and type of dietary fat impact on cytokine biology, that consequently assumes a crucial role in inflammatory disease. This review explores the power of nutrition in the immune response against COVID-19 infection, since a specific diet could modify the cytokine storm during the infection phase. This can be of vital importance in the most vulnerable subjects such as pregnant women or cancer patients to whom we have deemed it necessary to dedicate personalized indications.

Youth Psychiatric Hospitalization in Israel during COVID-19: A Multi-Center Study

During the COVID-19 pandemic there have been numerous reports of increases in psychiatric morbidity and a deterioration of status among existing patients. There is little information about how this increase has affected youth and rates of adolescent psychiatric hospitalization. Our study was aimed at examining trends in youth psychiatric hospitalization during the first year of the COVID-19 pandemic. Method: We used medical records to compare trends in hospitalization rates from 2019 to 2020, among psychiatric youth wards from five different centers in Israel. Results: The number of patients that were hospitalized in youth psychiatric wards decreased significantly from 2019 (Mean ± SD=52.2 ± 28.6 per month) to 2020 (M ± SD = 40.8 ± 22.0; unstandardized B = −11.4, 95% CI = −14.4 to −8.3, p < 0.0001). There was a significant decrease in the number of patients that were hospitalized due to internalizing disorders from 2019 (M ± SD = 22.3 ± 9.3 per month) to 2020 (M ± SD = 16.8 ± 7.7; B = −5.5, 95% CI = −8.0 to −3.0, p = 0.0002) and a marginally significant increase in the number of restraints per month (2019: M ± SD = 2.8 ± 6.8, 2020: M ± SD = 9.0 ± 14.5; Z = −1.96, Rosenthal’s r = 0.36, p = 0.07). Conclusions: There was a significant decline in psychiatric hospitalizations during the pandemic, specifically among patients suffering from internalizing disorders. The reasons for this decline, and the future impact these changes had on hospitalizations during the pandemic demand further research. Study limitations: This is a retrospective multicenter study from five medical centers in Israel, therefore generalizability of our findings is limited.

Associations between Resilience and Food Intake Are Mediated by Emotional Eating in the NutriNet-Santé Study

BACKGROUND

Resilience, the ability to bounce back or recover from stress, has been associated with several health-related behaviors. However, data on food intake and emotional eating are lacking.

OBJECTIVES

The objective of this cross-sectional study was to analyze the associations between resilience and diet quality and ultraprocessed food (UPF) and food group consumption, and to assess whether emotional eating was a mediator of these associations.

METHODS

In 2017, 17,840 participants (73.5% female, mean age = 55.4 ± 14.0 y) of the NutriNet-Santé study completed the Brief Resilience Scale, the revised 21-item Three-Factor Eating Questionnaire, and ≥3 self-administered 24-h dietary records. Diet quality was assessed with the modified French National Nutrition and Health Program Guideline Score. Foods and beverages consumed were categorized according to their degree of processing by the NOVA classification. We assessed the association between resilience and emotional eating using linear regression models. We also assessed the mediating role of emotional eating in the associations between resilience and diet quality, energy intake, and UPF and food group consumption, controlling for sociodemographic characteristics.

RESULTS

In our study, resilience was negatively associated with emotional eating (P < 0.0001). More resilient participants had greater overall diet quality, greater intakes of seafood, whole-grain foods, fats, unsalted oleaginous fruits, and alcoholic beverages, and lower intakes of UPFs, starchy foods, dairy desserts, sugary fatty products, and sugar and confectionery (all P < 0.05). Emotional eating was a mediator of the inverse associations between resilience and intake of energy, UPFs, dairy desserts, sugary fatty products, and of the positive associations between resilience and alcoholic beverages (all P < 0.05), with a 20-70% mediation.

CONCLUSIONS

Our findings showed that resilience was associated with an overall better diet quality in the NutriNet-Santé population-based study. These associations were partially explained by emotional eating. These findings suggest that resilience should be considered in the promotion of healthy dietary habits.The study is registered at clinicaltrials.gov as #NCT03335644.

Student Subjective Wellbeing amidst the Covid-19 Pandemic in Iran: Role of Loneliness, Resilience and Parental Involvement

The COVID-19 pandemic and lockdowns potentially severely impact adolescents' mental well-being. This research aims to study students' subjective well-being during the covid-19 pandemic in Iran and investigate the role of loneliness, resilience, and parental involvement. For this study, 629 students (female = 345) were recruited by purposive sampling. Students were assessed on the Student's Subjective Well-Being, Loneliness Scale, Resilience Scale, and Parental Involvement. The results confirm our hypothesis that the relationship between parental involvement and students' subjective well-being is mediated by loneliness. Furthermore, the results indicated a partial mediation of resilience in the relationship between parental involvement and students' subjective well-being. This study theoretically contributes to a better understanding of the factors determining the impact of traumatic events such as a pandemic on adolescents' mental health. The implications of this study indicate interventions that can be carried out to minimize the negative psychological consequences of the pandemic.

The effect of subjective age on loneliness in the old adults: The chain mediating role of resilience and self-esteem

Objectives

This study aimed to explore the effect of subjective age on loneliness in old adults, and the mediating role of resilience and self-esteem in subjective age and loneliness.

Methods

Approximately 450 old adults from Jiangxi, Hunan, Henan provinces completed the third edition of the Loneliness Scale (UCLA-LS III), Age Decade Scale (ADS), Connor-Davidson Resilience Scale (CD-RISC), and Self-Esteem Scale (SES).

Results

(1) Subjective age was significantly positively correlated with loneliness. (2) Resilience, self-esteem, and loneliness were significantly negatively correlated. (3) Subjective age affected loneliness through the mediating effects of resilience and self-esteem, respectively. (4) Resilience and self-esteem played a chain mediating role between subjective age and loneliness.

Conclusion

Resilience and self-esteem can directly affect the loneliness of the old adults alone and can also affect the loneliness of the old adults through the chain mediating effect of resilience and self-esteem.

The spatiotemporal evolution of COVID-19 in China and its impact on urban economic resilience

The spread of the novel coronavirus (COVID-19) has had a major political, economic, social, and cultural impact on various countries worldwide. Based on economic operation, public opinion, public health, government policies and population inflow in the affected areas, this study measures daily economic resilience during the COVID-19 outbreak in 286 prefecture-level cities in China (from 1st January to 8th February, 2020). Specifically, this study further investigates the economic resilience and the number of COVID-19 cases by analysing the evolutionary trend of their spatial distribution pattern using the standard deviation ellipse (SDE). The impact of COVID-19 on economic resilience is examined using a panel vector autoregressive model. The following are the findings. (1) The economic resilience value decreased throughout the study period, but the cities with high economic resilience showed a trend of spatial diffusion in the late study period. Wuhan's lockdown strategy was benefit to control the spread of COVID-19, and promptly stopped the decline of China's economic resilience. (2) Economic resilience and the number of COVID-19 cases influenced their future trends positively, but this effect gradually decreased over time. During the COVID-19, although the number of confirmed cases significantly influenced China's economic resilience, and the disease's spread was evident, China maintained a high level of economic development resilience. (3) The rise in economic resilience during the pandemic's early stages promoted the number of confirmed cases, but the strength of this relationship gradually declined as the pandemic progressed. Returning to work and other activities may increase the risk of infection. Numerous policies implemented at the outbreak' inception aided in laying the groundwork for economic resilience. Although the outbreak had a detrimental effect on economic resilience in the later stages of the pandemic, a convergent trend was observed at the end of the research period. (4) Using variance decomposition, we discovered that future economic resilience was significantly influenced by itself and by relatively few changes. However, the impact of confirmed cases on economic resilience becomes apparent after the fourth period. This indicates that the number of confirmed cases must be limited during the initial stages. The early support of various sectors in China facilitated the spatial expansion of economically resilient cities. The pandemic has a non-negligible negative impact on economic resilience, but this has been mitigated by Wuhan's timely closure.

Health care workers' mental health in the face of COVID-19: a systematic review and meta-analysis

BACKGROUND

Healthcare workers are leading the way in treating patients with coronavirus disease 2019 (COVID-19). Due to the high levels of psychological stress, this group is more likely to experience psychological issues. These psychological problems in healthcare providers include depression, anxiety, insomnia, stress and post-traumatic stress disorder (PTSD). The goal of this systematic review and meta-analysis was to find out how common these problems were in the face of COVID-19.

METHODS

On 20 February 2022, systematic searches were conducted in the PubMed, Cochrane Library, Scopus, EMBASE, Science Direct, Web of Science and ProQuest databases. Two authors selected articles based on search keywords. As a last step, articles about the prevalence of psychological problems among healthcare workers in the face of COVID-19 were looked at and analysed for five different outcomes.

RESULTS

The initial search yielded 18,609 articles. After reviewing the titles, abstracts and full texts of the articles, 44 were chosen for the final analysis and 29 were subjected to a meta-analysis. Insomnia, anxiety, depression, PTSD and stress are among the psychological issues faced by healthcare workers. Furthermore, the highest pooled prevalence of depression, anxiety, insomnia, PTSD and stress was 36% (95% confidence interval (CI) 24-50%), 47% (95% CI 22-74%), 49% (95% CI 28-70%), 37% (95% CI 19-59%) and 27% (95% CI 6-69%).

CONCLUSIONS

In this meta-analysis, insomnia was found to be the most common mental health problem, followed by anxiety, PTSD, depression and stress in healthcare workers in the face of the COVID-19 pandemic. Generally, the pooled prevalence of these mental health problems was higher among physicians, nurses and older staff in the subgroup analysis. As a result, health policymakers and managers of the health care system should think about effective interventions to promote mental health, paying particular attention to these two groups.Key pointsStudies conducted in China reported more mental problems than in other countries.Health policymakers and health system managers should hold training programs to promote healthcare workers' mental health with a particular focus on more vulnerable groups.The prevalence of PTSD, stress, anxiety, depression and insomnia were higher among physicians, nurses and older staff.Health systems at both national and local levels have to take older physicians, nurses and healthcare providers into consideration while designing interventions.

Predicting Parental Mental Health During COVID-19: Economic Pressure, COVID-19 Stress, and Coping Strategies

As the COVID-19 pandemic continues, understanding connections between economic pressures and mental health experiences is critical in comprehending how stressful global events can affect families. Although economic pressures and stress can negatively impact mental health, approach coping strategies may provide reductions in negative mental health experiences for parents compared to avoidant coping strategies. Despite recent work showing that stress resulting from the pandemic can have negative implications for the mental health of parents with young children, there is little known about the mental health of parents with adolescents. This study utilized a longitudinal sample of 198 parents (194 biological parents; 103 Fathers, and 91 Mothers) of adolescents and examined the mediating impact of COVID-19 stress on the relationship between economic pressure and subsequent depressive and anxious symptoms. Additionally, approach and avoidant coping strategies were examined as potential moderators between COVID-19 stress and later mental health. Results indicated that parents who experienced economic pressure reported worsening mental health across the school semester, with COVID-19 stress mediating this pathway. Further, approach coping strategies moderated the association between COVID-19 stress and later anxiety symptoms such that higher levels of coping associated with greater rates of later anxiety symptoms, while lower levels of coping associated with less anxiety symptoms later. Avoidant coping strategies also moderated these associations, such that greater use associated with greater depressive and anxious symptomology later. These findings emphasize that parents are experiencing worsening mental health following the onset of the pandemic and that there is an urgent need for increased mental health services to assist families during this time.

Overexposure to COVID-19 information amplifies emotional distress: a latent moderated mediation model

An infodemic has accompanied the COVID-19 pandemic. This study explores whether overexposure to COVID-19-related information amplifies emotional distress. A cross-sectional online survey was conducted in China during the outbreak and after the peak of the pandemic (N = 1313). A latent moderated mediation model was built to analyze this relationship. COVID-19 information exposure was found to relate positively with emotional distress, and risk perception mediated the association between them. Additionally, psychological resilience moderated the mediating effects of risk perception. However, five factors of resilience differed in their moderating effects. This study offers theoretical and practical implications apropos clinical intervention and public health management.

COVID-19 related stressors and mental health outcomes of expatriates in international construction

The construction industry is labor-intensive, and employees' mental health has a significant impact on occupational health and job performance. In particular, expatriates in international projects under the normalization of the epidemic are under greater pressure than domestic project employees. This paper aims to explore the association of stressors and mental health in international constructions during COVID-19. Furthermore, test the mediation effect of psychological resilience and moderating effort of international experience in this relationship. A survey of 3,091 expatriates in international construction projects was conducted. A moderating mediation model was employed to test the effect of psychological resilience and international experience. Then, statistical analysis with a bootstrap sample was used to test the mediation effect of the model, and a simple slope was used to test the moderating effect. Moderated by experience, the slope of the effect of stressors on psychological resilience changed from -1.851 to -1.323. And the slope of the effect of psychological resilience on mental health outcomes reduced by about 0.1. This suggests that experience is one of the buffering factors for individual psychological resilience of expatriates to regulate stress. Theoretically, this study verifies the mediation effect of psychological resilience between COVID-19 related stressors and mental health outcomes and importance of an expatriate's experience in an international assignment. Practically, this study provides guidelines for international construction enterprises and managers to make an assistant plan for expatriates during this pandemic time and pay more attention to their psychological status. The research also suggests that the best choice for challenging assignments is choosing a more experienced employee.

Alleviating Work Exhaustion, Improving Professional Fulfillment, and Influencing Positivity Among Healthcare Professionals During COVID-19: A Study on Sudarshan Kriya Yoga

Demanding work-life and excessive workload, the conflict between professional and personal lives, problems with patients and those related to the occurrence of death and high risk for their own life are a few factors causing burnout, disengagement, and dissatisfaction in the professional lives of healthcare professionals (HCPs). The situation worsened during the COVID-19 pandemic. It is of utmost importance to find effective solutions to mitigate the stress and anxiety adversely affecting the mental well-being and professional lives of HCPs. This study was designed to examine the efficacy of Sudarshan Kriya Yoga (SKY) for alleviating work exhaustion, improving Professional Fulfillment, and influencing positivity among HCPs during COVID-19. In a comparative observation before the intervention (Pre), after the intervention (Post), and 30 days after the intervention (Day 30) in the Experimental Group (29 physicians) and Control Group (27 physicians), it was found that immediately after SKY, HCPs experienced a significant improvement in Professional Fulfillment (p = 0.009), work exhaustion (0.008), positive affect (p = 0.02), and negative affect (p < 0.001) compared to the Control Group. The effect of SKY continued until Day 30 for Professional Fulfillment and had positive and negative effects. Findings suggest that SKY elevated Professional Fulfillment among HCPs during the COVID-19 pandemic and reduced their work exhaustion and the negative effect on their mental health. SKY can aid HCPs in maintaining their well-being when faced with unprecedented challenges.

Psychological Wellbeing and Employability of Retrenched Workforce During COVID-19: A Qualitative Study Exploring the Mitigations for Post Pandemic Recovery Phase

The ongoing COVID-19 pandemic has triggered several employment-related issues, followed by different response strategies. With retrenchment measures being a common response strategy during economic downturns, many individuals have been faced with unemployment. This study aimed to explore the effect of the COVID-19 pandemic related retrenchment on the psychological wellbeing of the Malaysian workforce, using a qualitative research approach and based on the Latent-deprivation Model. A purposive sample of 30 retrenched participants was interviewed via telephone during Malaysia's Movement Control Order (MCO). Thematic analysis was subsequently conducted to identify key themes in the data set. Six themes emerged from the thematic analysis: (1) Retrenchment leading to the deterioration of psychological wellbeing; (2) Unemployment, financial strain and economic uncertainty; (3) Emotions related to the COVID-19 virus; (4) Coping with lifestyle change; (5) Recommendations to improve the psychological wellbeing and mental health of the retrenched workforce, and (6) Career and financial support at the recovery phase. The present study provides valuable insight into the wellbeing of retrenched workforce who are forced to cope with both unemployment and a global pandemic, and workforce perspectives regarding types of support needed during the recovery phase.

Difference between Minorities and Majorities in the Association between COVID-19-Related Stress and Psychological Distress: A Socio-Ecological Perspective and the Moderating Role of Parenthood

This study introduces a socio-ecological perspective of differences in psychological distress between the Palestinian minority and Jewish majority citizens of Israel during lockdown due to COVID-19. The study examines the association between COVID-19-related stress and psychological distress, and the moderating effect of parenthood. Online questionnaires, completed by 1934 participants (1391 Jews, 552 Palestinians; 1306 parents, 637 without children; 54.86% female, 45.13% male; M age = 40.38, SD = 13.77) assessed COVID-19-related stressors and depression, anxiety, and stress. The Palestinian minority showed a higher level of COVID-19-related stress and psychological distress than the Jewish majority. Parenthood showed a moderating effect on the association between COVID-19-related stress and distress for the Jewish majority but not the Palestinian minority. The results emphasize the significance of considering social status when seeking to understand the differences between minorities and majorities in terms of distress and resilience during pandemic events, and the need for cultural sensitivity and awareness when issuing instructions in such circumstances. Additionally, the results highlight the potential role of parenthood as a resilience factor, depending upon social status.

Disentangling the associations between past childhood adversity and psychopathology during the COVID-19 pandemic: The mediating roles of specific pandemic stressors and coping strategies

BACKGROUND

Individuals with a history of adverse childhood experiences (ACEs) display heightened symptoms of psychopathology during the COVID-19 pandemic. Yet, no study has investigated what aspects of the pandemic are of particular concern for this population and ways in which strategies to coping with pandemic stressors may exacerbate their clinical symptomatology.

OBJECTIVE

This study explores what pandemic stressors and coping strategies are associated with ACEs, depression, and posttraumatic stress disorder (PTSD) during the COVID-19 pandemic, before investigating whether the identified chief stressors and coping styles mediate the effects of ACEs on depression and PTSD.

PARTICIPANTS AND SETTING

1107 Greek adults were sampled from the general population.

METHODS

Participants completed the Adverse Childhood Experiences Questionnaire, Patient Health Questionnaire, Primary Care PTSD Screen for DSM-5, Pandemic Stressor Scale, and Brief Cope Scale.

RESULTS

ACEs and depression were both predominantly associated with difficult housing conditions as a stressor (b = 0.079, p < .001 and b = 0.046, p < .001, respectively), whereas PTSD was mainly related to fear of contracting the COVID-19 virus (b = 0.065, p < .001). Self-blame was the main coping strategy associated with both ACEs (b = 0.046, p = .010), depression (b = 0.071, p < .0005), and PTSD (b = 0.088, p < .0005). Difficult housing conditions and self-blame further demonstrated a significant serial mediation effect in the relationship between ACEs with both depression (b = 0.105, 95% CI [0.0607, 0.158]) and PTSD (b = 0.019, 95% CI [0.011, 0.031]).

CONCLUSIONS

The findings indicate that policy makers should identify ways of ameliorating challenging housing conditions, and that service providers should target self-blame in the psychological treatment of adults with ACEs during the COVID-19 pandemic.

A systematic concept analysis of healthcare team resilience in times of pandemic disasters

BACKGROUND

The concept of resilience has been used as a descriptor for individuals and organizations with the dominant themes of bouncing back and moving forward.

AIMS

To examine the concept of resilience in providers and healthcare teams during pandemic disasters.

RESEARCH DESIGN

Walker and Avant's eight-step concept analysis method.

DATA SOURCE

CINAHL, EBSCO Host, PubMed, and SCOPUS were searched using the combined terms "resilience" or "resiliency" or "resilient" and "healthcare professionals," or "healthcare worker" or "healthcare team" or "physician" or "nurse" or "doctor" and "pandemic" or "disaster."

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Checklist was used to review the literature and apply findings using the eight-step Walker and Avant method for concept analysis.

RESULTS

Three clusters emerged as attributes of individual resilience that may be applied to healthcare teams in times of pandemic disasters: (1) resilience is a dynamic contextual process, (2) resilience stabilizes the team to maintain a routine level of function, and (3) resilience is a catalyst for the actualization of innate or acquired skills and ability within the healthcare team.

CONCLUSION

This analysis suggests that resilience enhances the healthcare team's ability to maintain function during acute changes created by pandemic disasters. Resilience in healthcare teams during pandemics requires future research to explore the phenomenon.

Coping strategies at the frontline of care: Comparisons between Covid-19 and non-Covid-19 units' nurses and the role of moderator variables

INTRODUCTION

Relatively few studies focused on the coping strategies adopted by the healthcare workers during the second phase of the pandemic. The present study compared the coping strategies between Italian nurses working in Covid-19 and in other units and it explored whether socio-demographic and work-related variables moderate the relation between the type of unit and coping strategies.

METHODS

A web-based questionnaire that included sociodemographic and work-related questions and the Coping Orientation to Problem Experienced-New Italian Version-25 item was administered. Moderation effects between variables and coping strategies were analyzed using generalized linear models.

RESULTS

253 nurses participated. Nurses who worked in a Covid-19 unit had significantly lower scores on Avoidance Strategies subscale and higher scores on Positive Attitude and Social Support subscales than nurses working in other units.

DISCUSSION

Gender differences emerged only on the social support coping dimension, with women being more likely to adopt social support than men. No association between the type of unit and the other coping strategies was found.

CONCLUSION

Nurses working in Covid-19 units showed better coping strategies than their colleagues: this suggests that support interventions aimed to promote coping strategies should be offered also to Covid-19-free units' nurses.

Patient Perceptions of Cancer and Reconstructive Care During the COVID-19 Pandemic

Background: The Coronavirus-2019 (COVID-19) pandemic profoundly impacted care for breast cancer patients. Oncologic and reconstructive surgeries were delayed as hospitals attempted to preserve personal protective equipment and bed capacity. Little is known about how this unprecedented time has affected breast cancer patients’ mental health and perceptions regarding their care. Methods: A survey was sent to surgical oncology and plastic surgery patients who received breast cancer care between March and May 2020, during which our institution suspended elective surgery. The survey questions included patient demographics, as well as questions focused on worries related to COVID-19, individualized cancer and reconstructive care, and patient satisfaction with telemedicine. Descriptive statistics were used to assess patient responses. Results: 56 breast cancer patients completed the survey, which reflected a 25% response rate. A majority of patients expressed moderate concern about contracting COVID-19, accessing high-quality cancer care (78%), and receiving timely surgical care (68%). Only 43% of patients reported delays in their surgical cancer and reconstructive care, when in actuality 57% of patients experienced surgical delays. Overall, patients were satisfied with telemedicine and did not feel it negatively impacted their care (69%). Conclusions: The COVID-19 pandemic has led to disruptions of routine oncologic and reconstructive care for breast cancer patients. Patients were concerned about receiving high-quality cancer and reconstructive care, and the results of this study uncovered gaps in patient–physician communication. The implementation of telemedicine was received positively. These data can be used to improve future health system practices as the medical community faces new potential shutdowns of surgical services.

Resilience and Risk Factors Predict Family Stress Among Married Palestinians in Israel During the COVID-19 Pandemic

The present study examined effects of sociodemographic, risk, and resilience factors on marital, parental, and financial stress early in the COVID-19 pandemic. A cross-sectional online survey was conducted among 480 married Palestinians living in Israel, using self-report questionnaires. Descriptive statistics and bivariate correlations were computed. Then, hierarchical multiple regression analyses were conducted to predict each of the three stress measures. Finally, dominance analyses were conducted to compare the contributions of sociodemographic, risk, and resilience factors. The results showed considerable differences between predictors of marital and parental stress and predictors of financial stress. For marital and parental stress, resilience factors mainly family resilience were the strongest predictors, followed by risk factors and then sociodemographic characteristics. For financial stress, risk factors (mainly financial damage and prior stressful life events) were the strongest predictors, followed by sociodemographic characteristics and resilience factors (mainly individual resilience). These results suggest that family and individual resilience reduce marital and parental stress under difficult conditions, including the COVID-19 pandemic. Though resilience has been found to ameliorate financial stress to some extent, it appears that other measures are required to manage stress related to financial difficulties.

Systematic Review on Pathophysiological Complications in Severe COVID-19 among the Non-Vaccinated and Vaccinated Population

COVID-19, caused by SARS-CoV-2, is one of the longest viral pandemics in the history of mankind, which have caused millions of deaths globally and induced severe deformities in the survivals. For instance, fibrosis and cavities in the infected lungs of COVID-19 are some of the complications observed in infected patients post COVID-19 recovery. These health abnormalities, including is multiple organ failure-the most striking pathological features of COVID-19-have been linked with diverse distribution of ACE2 receptor. Additionally, several health complications reports were reported after administration of COVID-19 vaccines in healthy individuals, but clinical or molecular pathways causing such complications are not yet studied in detail. Thus, the present systematic review established the comparison of health complication noted in vaccinated and non-vaccinated individuals (COVID-19 infected patients) to identify the association between vaccination and the multiorgan failure based on the data obtained from case studies, research articles, clinical trials/Cohort based studies and review articles published between 2020-2022. This review also includes the biological rationale behind the COVID-19 infection and its subsequent symptoms and effects including multiorgan failure. In addition, multisystem inflammatory syndrome (MIS) has been informed in individuals post vaccination that resulted in multiorgan failure but, no direct correlation of vaccination with MIS has been established. Similarly, hemophagocytic lymphohistiocytosis (HLH) also noted to cause multiorgan failure in some individuals following full vaccination. Furthermore, severe complications were recorded in elderly patients (+40 years of age), indicates that older age individuals are higher risk by COVID-19 and post vaccination, but available literature is not sufficient to comply with any conclusive statements on relationship between vaccination and multiorgan failure.

Smartphone-based home workout program for shift-work nurses working during the COVID-19 pandemic

This study aimed to develop a smartphone-based home workout program for shift-work nurses to increase their levels of exercise and examine its effects on health (sleep disturbance, fatigue, musculoskeletal problems, and resilience) and nursing performance. For this quasi-experimental study with a nonequivalent control group, 54 shift-work nurses were recruited from two general wards at a hospital in Korea and assigned to the intervention and control groups. Nurses in the intervention group were encouraged to exercise regularly using the home workout application for 18 weeks. For the first 12 weeks, text-message counseling and environmental improvement were carried out; only environmental improvement was implemented in the remaining 12-18 weeks. The control group did not receive any intervention. After excluding dropouts, the data of the final 25 participants in the intervention group and 24 participants in the control group were analyzed. Compared with the control group, the intervention group showed statistically significant improvements in physical and psychological health. Hospital organizations could adopt a smartphone-based home workout program to overcome obstacles to exercise, which could lead to positive health outcomes for shift-work nurses. This article is protected by copyright. All rights reserved.

Socioeconomic Inequalities in Times of COVID-19 Lockdown: Prevalence and Related-Differences in Measures of Anxiety and Stress in Palestine

Background

Implementation of quarantine and lockdown to COVID-19 pandemic has created dramatic negative psychological impact mainly the general population’s health worldwide. We aimed to assess the prevalence and predictors of anxiety and stress severity among the Palestinian population.

Methods

A cross-sectional web-based survey was conducted. An anonymous online questionnaire and snowball recruiting technique were used to target the general public in Palestine between 6 and 16 April, 2020 during COVID-19 pandemic lockdowns. Multivariate logistic regression models were developed for the outcome variables.

Results

Of the 2819 individuals who completed the questionnaire, more than two thirds of them (72.6%) were females. Nearly (83.5%), were residing at the West Bank. The mean age of participants was 29.47 (SD = 10.97) years. The anxiety prevalence was (25.15%) with (20.08%) had mild/moderate severity. The stress prevalence was (38.77%) with (22.21%) had mild/moderate severity. The prevalence of both anxiety and stress was (20.3%). In multivariate analysis, exposure to confirmed case of COVID-19, inadequacy of food supply and jobs that acquire leaving home during lockdown were significantly related to higher anxiety degree. As for stress, low monthly income, cohabitation with a person of a high-risk group and inadequacy of food supply were significantly related to higher stress degree.

Conclusion

Young adults with low socioeconomic status and inadequate food supply were more likely to have a higher degree of stress and/or anxiety. Providing alternative economical sources for those in need, and spreading more awareness regarding the pandemic, supporting the population’s psychological wellbeing, community connection and the availability of specialist mental health services are crucial to overcome the mental impacts of COVID-19 in Palestine.

Perceived Satisfaction with Online Study during COVID-19 Lockdown Correlates Positively with Resilience and Negatively with Anxiety, Depression, and Stress among Slovenian Postsecondary Students

BACKGROUND

The purpose of this study is to fill the research gap regarding the influence of satisfaction with distance learning on the correlates of mental health during the COVID-19 pandemic.

METHODS

An online cross-sectional study was conducted in February and March 2021, involving 4661 postsecondary students. Five validated instruments-PHQ-9 (depression), GAD-7 (anxiety), PSS-4 (stress), CD-RISC-10 (resilience) and SAT-5 (satisfaction with online study)-were used in the present study.

FINDINGS

The correlations between anxiety, depression, and stress were so high that they were almost inextricably linked. Both satisfaction with online learning and psychological resilience were negatively correlated with anxiety, depression, and stress. Satisfaction with online learning was also negatively correlated with psychological resilience. Females showed higher levels of vulnerability to anxiety, depression, and stress, and exhibited lower levels of psychological resilience than males.

CONCLUSION

Home-based distance-learning during the COVID-19-induced lockdown had a significant impact on students' mental health. Low satisfaction with distance learning can lead to the development of anxiety and depression symptoms, increase stress, and decrease the psychological resilience of postsecondary students; therefore, it is critical that educational institutions focus on implementing interventions that promote students' satisfaction with distance learning, and their psychological resilience, to protect their mental health.

The Impact of COVID-19 on Distress Tolerance in Pakistani Men and Women

The novel coronavirus (COVID-19) is an infectious disease that spread across the world, bringing with it serious mental health problems for men and women. Women in Pakistan are infected with COVID-19 at a much lower rate than men, yet report worse mental health. To explain this paradox, we surveyed 190 participants (46% male) shortly following the country lockdown, focusing on perceptions of the COVID-19 impact and positive adjustment. Measures used in this study included the Warwick-Edinburgh Mental Well-being Scale and Distress Tolerance Scale. Factor analysis revealed five distinct areas related to COVID-19, which did not differ by sex. However, men reported higher levels of both distress tolerance and well-being than women. High endorsement of actions to protect against COVID-19 was related to lower distress tolerance scores, but in different ways for men and women. Men, but not women, who endorsed more protective measures to stop the pandemic reported higher DTS absorption scores, and therefore being more consumed by distress; women who endorsed more protective measures to stop the pandemic reported less acceptance of distress than men, as reflected in DTS appraisal scores. An in-depth analysis of women’s beliefs and behaviors related to COVID-19 is warranted to understand why Pakistani women who are infected with COVID-19 at lower rates than men show more mental health symptoms.

Prior psychosocial profile and perceived impact of the COVID-19 pandemic: insights from the Baltimore Longitudinal Study of Aging

Stress, social isolation, and changes in health behaviors during the COVID-19 pandemic period may have a lasting influence on health. Here, the correlation between current or prior demographic, social and health related characteristics, including psychosocial factors with perceived impact of the COVID-19 pandemic assessed by questionnaire during the early pandemic period is evaluated among 770 participants of the Baltimore Longitudinal Study of Aging. In multinomial logistic regression models participants with higher pre-pandemic personal mastery, a construct related to self-efficacy, were more likely to report "both positive and negative" impact of the pandemic than a solely "negative" impact (OR: 2.17, 95% CI: 1.29-3.65). Higher perceived stress and frequent contact with family prior to the pandemic were also associated with pandemic impact. These observations highlight the relevance of psychosocial factors in the COVID-19 pandemic experience and identify characteristics that may inform interventions in future public health crises.

Mental health during the first wave of COVID-19 in Canada, the USA, Brazil and Italy

BACKGROUND

The mental health (MH) burden on healthcare practitioners (HCPs) is emerging as a significant cost of the pandemic, although few studies have compared the MH of HCPs in different countries.

METHODS

A link to an online survey was posted in the Spring of 2020 which included questions regarding perceived impact of the pandemic; current MH symptom severity and impairment was evaluated using validated scales.

RESULTS

Overall, 1315 individuals (74% female, mean age: 42.9 + 16.4) in Canada, the United States, Brazil and Italy completed the survey. Nearly 26% met diagnostic thresholds for GAD and MDD; Italian respondents reported the lowest rates of disorder. Except for Canada, non-HCPs in each country reported higher symptom severity than HCPs. Amongst the HCPs, Canadian HCPs reported the highest rates of anxiety and depression as well as increases in alcohol and cannabis use, lower levels of perceived emotional support and more worry about themselves or their loved ones contracting COVID-19.

CONCLUSION

Despite key infrastructural and COVID-19 mortality differences between the countries, the MH effects appeared to be quite similar. HCPs, with the exception of Canada, reported less impact on their mental health compared to the general population, suggesting resilience in the face of adversity.Key pointsRates of current mental health disorders were similar across Canada, the USA and Brazil but lower in Italy, yet much higher than pre-pandemic ratesNon-Healthcare Practitioners (HCPs) reported significantly higher severity on all MH scales in the overall sample. This was consistent within the USA, Brazil and Italy, however in Canada, HCPs reported higher anxiety, depression and stress symptom severity compared to Canadian non-HCPs.Canadian HCPs reported significantly higher anxiety and depression symptom severity than all other countriesCanadian HCPs also reported significantly greater increases in alcohol and cannabis use, lower levels of perceived emotional support and more worry about themselves or their loved ones contracting COVID-19 compared to HCPs in the other countries.

Home-quarantine during the initial Covid-19 outbreak in Israel: parent perceived impact on children with ASD

Background

Studies have reported that Covid-19 home-quarantine periods have had mostly negative psychological impact on children with ASD and their families. Here we examined parent perceived impact of a 6-week quarantine period imposed in Israel at the beginning of the Covid-19 outbreak, in mid-March 2020.

Methods

An anonymous online questionnaire was completed by parents of 268 children with ASD. Parents rated deterioration/improvement in their child's behaviors, abilities, mood, sleep, and anxiety along with changes in their own mood, sleep, parenting skills, and family relationships. We performed t-tests and ANOVA analyses to assess the significance of perceived impact on each domain and potential differences in the impact across families with children of different ages, genders, and levels of required support as well as families that experienced different magnitudes of economic hardships.

Results

Parents reported significant deterioration in their mood and sleep along with significant improvements in relationships with their spouse and child with ASD, and in their parenting skills. Parents also reported significant increases in the severity of tantrums, anxiety, and restricted and repetitive behavior symptoms along with significant improvements in social and communication abilities of their child with ASD. Ratings were significantly lower in families of ASD children who regularly require more support and in families that experienced economic hardships.

Conclusions

While periods of home-quarantine create numerous hardships for families of children with ASD, they may also offer an opportunity for improving parenting skills, family relationships, and children's social communication abilities with potential relevance for improving remote services.

Stress, academic burnout, smartphone use types and problematic smartphone use: The moderation effects of resilience

Few studies have investigated stress in association with social and process smartphone use and how these types of use influence problematic smartphone use during the COVID-19 pandemic; furthermore, the moderation effects of resilience have been rarely tested in this model. For these, a cross-sectional survey was conducted involving 766 Chinese undergraduate students (74.4% female; M = 20.1 years, SD = 1.15) who were measured with their levels of stress, academic burnout, smartphone use types (social/process smartphone use), resilience, and problematic smartphone use. Based on the I-PACE theory, we built a structural equation model, and the results indicated that compared with social smartphone use, process smartphone use more related to problematic smartphone use; academic burnout fully mediated between stress and process smartphone use, and between stress and problematic smartphone use. Moreover, resilience moderated between stress and academic burnout, between academic burnout and process smartphone use, and between academic burnout and problematic smartphone use. We discuss the process smartphone use as a key indicator of problematic smartphone use and the role of academic burnout for linking stress and smartphone use behaviors. In addition, interventions for enhancing resilience should be launched in the future.