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

Risk Communication Effectiveness During COVID-19 Pandemic Among General Population in Saudi Arabia

Purpose

The novel coronavirus (COVID-19), declared a pandemic by WHO in March 2020, is an unprecedented occurrence in our recent history. Effective risk communication by health authorities, through relaying reliable and authoritative information, is imperative in combating the spread of the outbreak. We aimed to measure the effectiveness of risk communication campaign and overall awareness during COVID-19 pandemic among the general population in Saudi Arabia.

Patients and Methods

A cross-sectional survey of 5472 individuals in Saudi Arabia was conducted to assess several factors regarding the risk communication messages during the COVID-19 pandemic, including the knowledge and response of the general population toward COVID-19 and MoH efforts. The questionnaire was divided into five main sections: general knowledge of COVID-19, channels and social media platforms used perceived risk and stress or panic toward COVID-19, satisfaction and community perception, most trusted source of information, and type of information received.

Results

A total of 5472 individuals participated in the study residing in Saudi Arabia. Overall knowledge of COVID-19 was determined to be above average (0.58 + 0.159). Of the general population, 57.1% perceived that the risk of getting sick with COVID-19 is low, while nearly half of the respondents (45.7%) have a high level of stress and panic toward COVID-19. The majority of responders to the questionnaire reinforced that MoH was their most trusted source of information for the COVID-19 pandemic (91.7%).

Conclusion

This study showed that the risk communication campaign by healthcare authorities during the COVID-19 pandemic has improved the awareness among the general population in Saudi Arabia, where the overwhelming majority placed high trust in the MoH as its main reference for COVID-19 information.

Mourning and Management of the COVID-19 Health Emergency in the Priestly Community: Qualitative Research in a Region of Northern Italy Severely Affected by the Pandemic

Background: The COVID-19 pandemic is causing major social changes to which significant psychological effects are linked. During the first phase of the pandemic wave in Italy, whilst there was insufficient information about the phenomenon and the strategies to safeguard the population against it, many categories of people, whose professions required constant contact with the public, were affected by the contagion. Aims: The literature has shown how religiousness can support the management of stress due to diseases and health risks. In relation to this, the current study wanted to investigate how priests managed the early stages of the pandemic. This work, therefore, aimed to investigate the psychological experiences related to the contagion and the eventual death of colleagues as well as the resilience strategies activated by the priests during the process. Participants: The research involved 12 Catholic priests, all male and aged between 42 and 63 years. They came from the same pastoral community in one of the regions in Northern Italy that were most affected during the first phase of the pandemic. Those ministers had been constantly in contact with the faithful of their parishes since the breakout of the virus. Methodology: A qualitative research design was adopted, and in-depth interviews were conducted. The dialogues aimed at investigating the deep, personal and relational experiences of the priests, together with their concerns and the tools they adopted to manage anxiety. The texts obtained from the interviews were subjected to thematic analysis. Results: The areas studied concerned the experiences of the participants during the lockdown, the implications of social distancing and lack of funeral rituality and, finally, the importance of prayer as a resilience factor. Conclusions: In the current scenario dominated by the pandemic, it is significant and stimulating to understand and reflect on the functions and roles of the experiences of faith, particularly the act of elaborating the process of mourning due to COVID-19.

Yoga an effective strategy for self-management of stress-related problems and wellbeing during COVID19 lockdown: A cross-sectional study

This cross-sectional research aims to study the effect of yoga practice on the illness perception, and wellbeing of healthy adults during 4-10 weeks of lockdown due to COVID19 outbreak. A total of 668 adults (64.7% males, M = 28.12 years, SD = 9.09 years) participated in the online survey. The participants were grouped as; yoga practitioners, other spiritual practitioners, and non-practitioners based on their responses to daily practices that they follow. Yoga practitioners were further examined based on the duration of practice as; long-term, mid-term and beginners. Multivariate analysis indicates that yoga practitioners had significantly lower depression, anxiety, & stress (DASS), and higher general wellbeing (SWGB) as well as higher peace of mind (POMS) than the other two groups. The results further revealed that the yoga practitioners significantly differed in the perception of personal control, illness concern and emotional impact of COVID19. However, there was no significant difference found for the measure of resilience (BRS) in this study. Yoga practitioners also significantly differed in the cognitive reappraisal strategy for regulating their emotions than the other two groups. Interestingly, it was found that beginners -those who had started practicing yoga only during the lockdown period reported no significant difference for general wellbeing and peace of mind when compared to the mid- term practitioner. Evidence supports that yoga was found as an effective self- management strategy to cope with stress, anxiety and depression, and maintain wellbeing during COVID19 lockdown.

A symptom-based definition of resilience in times of pandemics: patterns of psychological responses over time and their predictors

Background: It has been suggested that resilience is best conceptualized as healthy and stable functioning in the face of a potentially traumatic event. However, most research on this field has focused on self-reported resilience, and other patterns of response when facing adversity, in cross-sectional designs. Objective: Alternatively, we aimed to study changing patterns of psychological responses to the COVID-19 pandemic in the general population, based on patterns of symptoms, and factors contributing to those patterns. Method: A national representative sample of Spain (N = 1,628) responded to an internet-based survey at two assessment points, separated by 1 month (April and May 2020), during the official national confinement stage. Based upon whether participants exhibited absence/presence of distress (i.e., significant trauma-related, depression, or anxiety symptoms) at one or two of the assessment times, patterns of psychological responses were defined by categorizing individuals into one of the four categories: Resilience, Delayed distress, Recovered, and Sustained distress. Results: Analyses of the levels of disturbance associated with the symptoms provided support to that four-fold distinction of patterns of responses. Furthermore, resilience responses were the most common psychological response to the pandemic. Multinomial regression analyses revealed that the main variables increasing the probability of resilience to COVID-19 were being male, older, having no history of mental health difficulties, higher levels of psychological well-being and high identification with all humanity. Also, having low scores in several variables (i.e., anxiety and economic threat due to COVID-19, substance use during the confinement, intolerance to uncertainty, death anxiety, loneliness, and suspiciousness) was a significant predictor of a resilient response to COVID-19. Conclusion: Our findings are consistent with previous literature that conceptualizes resilience as a dynamic process. The clinical implications of significant predictors of the resilience and the rest of psychological patterns of response are discussed.

Psychological responses during the COVID-19 outbreak among university students in Bangladesh

Mental health problems in students are considered a public health challenge. We assessed the prevalence of depression, anxiety, and stress (DAS) with the DASS-21, as well as associated factors, among university students in Bangladesh early in the COVID-19 outbreak. We hypothesized high levels of DAS and their associations with previously reported factors (e.g., poor sleep, lack of exercise, heavy internet use) and those linked to disadvantage (e.g., low monthly family income). We also enquired about participants' satisfaction with their pursuit of their academic studies while living under COVID-19 restrictions. An internet-based survey was conducted during the month of April 2020, involving 3,122 Bangladeshi university students aged 18 to 29 years (59.5% males; mean age 21.4±2 years). Prevalence estimates of depression, anxiety and stress were, respectively, 76.1%, 71.5% and 70.1% for at least mild symptoms, 62.9%, 63.6% and 58.6% for at least moderate symptoms, 35.2%, 40.3%, and 37.7% for at least severe symptoms and 19.7%, 27.5% and 16.5% for at least very severe symptoms. The present estimates of DAS were more prevalent than in previous pre-COVID-19 studies among Bangladeshi university students. Regression analyses with DASS-21-score as a dependent variable revealed associations with factors mostly as hypothesized. The largest effect size on DAS symptoms was related to students' satisfaction with their academic studies during the pandemic. As this survey used cross-sectional and self-reported methods, causality cannot be inferred. Mental health monitoring of students attempting to cope with the impacts of the COVID-19 outbreak may be useful and feasible.

The reverse buffering effects of social support on the relationships between stresses and mental health: a survey of Chinese adults during the COVID-19 lockdown

BACKGROUND

People lived through different types of stresses during the COVID-19 pandemic, and stresses from different sources are believed to associate differently with mental health.

OBJECTIVES

The current study aims to examine the relationship between types of stresses and mental health among the general Chinese adult population, and further explore the moderating role of social support in these relationships.

METHODS

This study was conducted from 1 to 10 February 2020, and 2441 participants were recruited through an online cross-sectional survey from 31 provinces in China. We used multiple linear regression analyses to examine the associations among stresses' types, social support, and mental health.

RESULTS

The study revealed that all types of stresses were associated with more mental health symptoms. Stresses from lockdown policy presented stronger associations with mental health symptoms (Beta = 0.387 for depressive symptoms and Beta = 0.385 for post-traumatic stress symptoms (PTSS)) than stresses from pandemic fear (Beta = 0.195 for depressive symptoms and Beta = 0.221 for PTSS). Moreover, greater social support enhanced the positive associations between stresses and mental health symptoms.

CONCLUSIONS

Stresses from lockdown policies during the early stage of the COVID-19 epidemic are worthy of more attention. We urge more interventions are required to reduce the side-effect of lockdown policies, and also discuss implications for mental health promotion.

Adjustment disorder, traumatic stress, depression and anxiety in Poland during an early phase of the COVID-19 pandemic

Background: The current COVID-19 pandemic is associated with a variety of stressors. Preliminary research has demonstrated that general public are experiencing a range of psychological problems, including stress-related disturbances. However, to date, there is not much research on the prevalence of adjustment disorder during the current pandemic. Objectives: This study aimed to assess the prevalence and severity of symptoms of adjustment disorder compared to posttraumatic symptoms, depression and generalized anxiety in a large sample of adult Poles, in the first phase of the current pandemic. Method: Self-report data from a web-based sample (N = 1,742) was collected between March 25 and April 27, just after the introduction of nationwide quarantine measures in Poland. Results: The current COVID-19 pandemic was a highly stressful event for 75% of participants and the strongest predictor of adjustment disorder. Increased symptoms of adjustment disorder were reported by 49%, and they were associated with female gender and not having a full-time job. However, after exclusion of co-occurring symptomatology, 14% of the sample were finally qualified as meeting diagnostic criteria of adjustment disorder. A substantial proportion of the sample screened also positive for generalized anxiety (44%) and depression (26%); the rate for presumptive PTSD diagnosis was 2.4%. Conclusions: High rates of negative mental health outcomes were found in the Polish population in the first weeks into the COVID-19 pandemic and lockdown measures. They indicate the intense current stress-related symptoms in the early phase of the pandemic and warrant further monitoring on population's mental health.

PTSD in the COVID-19 Era

BACKGROUND

In December 2019, Wuhan City in Hubei Province, China witnessed an outbreak of a novel type of coronavirus (COVID-19), named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The sharp rise in the number of infected cases and the surge spike in fatalities worldwide prompted the World Health Organization (WHO) to declare this rapid outbreak a global pandemic in March 2020. The economic, health, and social ramifications of COVID-19 induced fear and anxiety all over the world.

OBJECTIVE

The purpose of this review is to discuss how precautionary measures and restrictions imposed by governments, such as quarantines, lockdowns, and social distancing, have not only caused economic losses, but also a rise in mental health problems specifically post-traumatic stress disorder (PTSD).

METHODS

A deep comprehensive review of the relevant literature regarding the pandemic and its debilitating consequences on the psychological status of the public was performed.

RESULTS

This review illustrates that the pandemic had a traumatic impact on the psychological functioning of the public, particularly COVID-19 survivors, older adults, and healthcare workers, due to difficulties in coping with new realities and uncertainties.

CONCLUSION

In this review, we have discussed the psychological implications of this pandemic and we have provided an extensive background for understanding options regarding PTSD management in healthy individuals and those with preexisting conditions.

Health Literacy, Perceived Threat, and Posttraumatic Stress Disorder During the COVID-19 Pandemic in Saudi Arabia

Purpose

This study aimed to investigate the prevalence of and factors associated with posttraumatic stress disorder (PTSD) during the COVID-19 pandemic in Saudi Arabia.

Materials and Methods

This was a cross-sectional online survey that targeted adults over the age of 18 residing in Saudi Arabia. The data collection began June 1, 2020 and continued for four weeks. The Posttraumatic Stress Disorder Checklist-Specific, the Brief Illness Perception Questionnaire version BIP-Q5, and a 9-item health literacy measure were used.

Results

There were 1249 participants, of which 62.21% were under the age of 34. The prevalence of PTSD was 19.5% among all participants. The results showed that both the perception of threat (OR =1.17, 95% CI = 1.13−1.19) and health literacy (OR =0.97, 95% CI = 0.95−0.99) were associated with PTSD symptoms.

Conclusion

This study highlights important findings that the level of an individual’s perception of threat and health literacy is associated with symptoms of PTSD. Thus, an understanding of these constructs in the target population will enable the development of better measures designed to reduce the psychological impact of the COVID-19 pandemic.

Emotional reactions and subjective health status during the COVID-19 pandemic in Israel: the mediating role of perceived susceptibility

The general consensus is that COVID-19, the virus spreading rapidly across the globe, affects physical health but also mental health and mental well-being. This study aimed to assess the associations among emotional reactions toward COVID-19, knowledge about COVID-19, perceived susceptibility to this disease, and subjective health status. This study was a cross-sectional study conducted among 1,085 Israeli adults who completed an online survey between April 23 and May 5, 2020. The self-administered questionnaire included questions about emotional reactions to COVID-19, knowledge about COVID-19, perceived susceptibility, subjective health status, and sociodemographic variables. Participants (aged 18-96) reported high levels of emotional reactions to COVID-19. Most respondents were worried (77.4%), afraid (62.8%) or stressed (55.3%). Emotional reaction scores were higher among women than among men. In the regression model, emotional reactions were higher for older participants, those who rated their subjective health status as poorer, and those who were employed, with the final model explaining 11.6% of the variance in emotional reactions. Perceived susceptibility significantly mediated the relationship between subjective health status and emotional reactions. The high prevalence of emotional responses among women, older people and those with lower subjective health ratings points to the need for intervention programs primarily targeting these groups.

Behavioral and Psychological Correlates of Well-Being during COVID-19

The globe is currently experiencing the immense and devastating impact of SARS-CoV-2, the virus responsible for the COVID-19 disease. College students are being uniquely impacted by the pandemic as well as the lockdown procedures that are in place. The current study utilized survey methods to investigate the impact of the pandemic on college students with a focus on changes in alcohol consumption and correlates of psychological health. Results found that participants reported a significant increase in alcohol consumption as a result of the pandemic. Furthermore, this increase in consumption related to a decline in psychological health. Exploratory analyses found that a decline in psychological health correlated with negative impacts in several life areas (financial, resource, social, and academic) and a decline in time management skills. However, spending time on leisure activities and spending time in-person with family and friends negatively correlated with psychological decline. Interestingly, news exposure to did not relate to psychological health.

Measuring COVID-19 Related Anxiety in Parents: Psychometric Comparison of Four Different Inventories

BACKGROUND

The COVID-19 outbreak and the measures to contain the global pandemic can have an impact on the well-being and mental health status of individuals. Parents of young children are particularly at risk for high levels of parental stress due to the current public health crisis, which can impact parenting behaviors and children's well-being. Although different initial scales have been developed to measure COVID-19-related anxiety, they have not yet been tested sufficiently in parent samples. A brief measure of COVID-19-related anxiety is necessary for both quick assessment in practice and in larger epidemiological studies of parents.

OBJECTIVE

The purpose of this study is to compare the distributions, validities, and reliabilities of four different COVID-19 anxiety scales: Fear of COVID-19 Scale, Coronavirus Anxiety Scale, Pandemic Anxiety Scale, and one subscale of the COVID Stress Scales. Based on the psychometric properties of these scales, we aim to provide recommendations for a brief unidimensional inventory to assess COVID-19-related anxiety among parents.

METHODS

A cross-sectional web-based survey of 515 German-speaking parents (465 mothers, 90.3%) with at least one child aged 0-6 years was conducted during a 6-week period (June 29 to August 9, 2020). Half of the parents were recruited via Facebook parenting groups, while the other half were recruited through childcare centers. We psychometrically tested 25 items on COVID-19-related anxiety using the framework of classical test theory, including item analysis, correlational analysis of family variables, and exploratory factor analysis. Moreover, an item response theory approach was applied to estimate item discriminations and item difficulties.

RESULTS

Based on the psychometric properties, three items of the Pandemic Anxiety Scale were identified as a single unidimensional factor. The adapted scale demonstrated acceptable internal consistency (α=.79), moderate to high item discrimination, strong positive intercorrelation with two other COVID-19 anxiety scales, and a small positive association with parenting stress. Mothers and fathers did not differ in total scores (t513=-0.79, P=.42).

CONCLUSIONS

Factor analysis suggests that existing COVID-19-related anxiety scales measure different latent constructs of anxiety. Furthermore, all scales showed only small to moderate correlations with trait health anxiety, suggesting that COVID-19-related anxiety is distinct from general health anxiety. The adapted "disease anxiety" subscale of the Pandemic Anxiety Scale is an economical measure for assessing COVID-19-related anxiety in parents. Directions for future research are outlined.

COVID-19 and traumatic stress: The role of perceived vulnerability, COVID-19-related worries, and social isolation

The purpose of the present study was to propose and test two models to understand the relationship between perceived vulnerability to COVID-19 (PVC) and COVID-19-related traumatic stress (TS), as well as the variables that may mediate and moderate this relationship among individuals who have not yet been infected with COVID-19. Using an online survey, data were collected between late March and early April 2020. Participants were recruited through Amazon Mechanical Turk and included 747 adults living in the United States. Supporting our hypotheses, results indicated that both COVID-19-related worries and social isolation were significant mediators of the relationship between PVC and TS (Model 1). In addition, the results of a moderated mediation analysis indicated that the indirect effect of PVC on TS through COVID-19-related worries was stronger for participants who reported greater social isolation (Model 2). Although future research is needed, these findings suggest that both social isolation and disease-related worries may be important variables that can be targeted in interventions to reduce pandemic-related TS.

Measuring Psychosocial Reactions to COVID-19: The COVID Reaction Scales (COVID-RS) as a New Assessment Tool

Knowing and measuring the psychosocial reactions of people to the coronavirus crisis could be useful for predicting citizen responsibility and psychological well-being in the general population. In this research, we present the COVID Reaction Scales (COVID-RS), a new tool that can measure and quantify the psychopathological reactions of the population to the COVID-19 crisis. The sample consisted of 667 subjects. Explorative and confirmative factor analyses were applied to examine the validity and reliability of the COVID-RS. Five dimensions were extracted that predicted 35.08% of the variance of the psychopathological reactions: (1) disorganized behaviors, (2) avoidant behaviors, (3) maladaptive information consumption, (4) herd behaviors and (5) loneliness. The results indicated that social quarantine induces and increases psychopathological reactions. However, emotional loneliness is reduced for each person with whom the respective subject lives during the quarantine. Finally, we can conclude that the COVID-RS has satisfactory validity and reliability. Measuring dysfunctional reactions to COVID-19 can enable the prediction of citizen responsibility.

Mantram Repetition as a Portable Mindfulness Practice: Applications During the COVID-19 Pandemic

Objective

Mantram or holy name repetition has long been practiced in every major religious tradition. Repetition of a mantram as a mindfulness practice is helpful for stress management and resilience building. The objective of this article is to provide an overview of the key features of mantram and the Mantram Repetition Program (MRP) developed in the US Veterans Healthcare System, the evidence base for the MRP, and its applications.

Methods

MRP practices are portable and do not require an extended or regularized period of sitting, in contrast to most methods of meditation. Core functions of MRP practices include focus shifting, frame activation, and fostering of mindfulness. We review scientific research, including multiple randomized trials, that has investigated the MRP.

Results

Research on the MRP has documented reductions in posttraumatic stress symptoms, insomnia, hyperarousal, and depression, as well as enhancement of quality of life, self-efficacy, and mindfulness. Mantram repetition may possess comparative advantages for managing symptoms of various mental health conditions, including posttraumatic stress disorder, HIV/AIDS, cancer, and chronic diseases.

Conclusions

MRP practices can be integrated into daily routines to manage stress and improve coping, safety, efficacy, calmness, and resilience. The inclusion of mantram repetition alongside conventional mindfulness-based practices for stress management will improve their cultural and religious inclusiveness, enabling societies and organizations to build greater collective resilience. Mantram repetition can be readily used in the COVID-19 pandemic, focusing on healthcare workers, patients, and the public.

Increased Psychological Distress during COVID-19 and Quarantine in Ireland: A National Survey

BACKGROUND

The emergence of the coronavirus pneumonia (COVID-19) resulted in a global pandemic. The psychological impact of an epidemic is multifaceted and acute, with long-term consequences.

METHODS

A cross-sectional online survey-based design was employed, assessing the psychological impact of COVID-19 on members of the Irish public during the quarantine period of COVID-19 in Ireland. Participants were invited to complete the Depression, Anxiety, and Stress Scale-21 (DASS-21) retrospectively (prior to quarantine) and during the quarantine period, as well as measures of illness perceptions, well-being, and a bespoke measure (the Effects of COVID Questionnaire, ECQ), which assessed perceptions of COVID-related stresses associated with personal concerns, caring for children, caring for aging parents, as well as gratitude.

RESULTS

A total of n = 1620 entered the survey platform, with a total of n = 847 surveys completed by members of the Irish public. Entry into COVID-19 quarantine was associated with significant increases in clinically significant symptoms of depression, stress, and anxiety. The ECQ reliably assessed a range of COVID-19-related stresses and had large and significant correlations with the DASS-21.

CONCLUSIONS

The COVID-19 quarantine was associated with stresses and significant increases in symptoms of depression, anxiety, and stress in a national Irish cohort. The public require increased access to mental health services to meet this increase in COVID-19-related psychological distress.

Concerns, perceived impact, and preparedness of oral healthcare workers in their working environment during COVID-19 pandemic

OBJECTIVE

The aim of the study was to evaluate the oral healthcare workers' concerns, perceived impact, and preparedness in COVID-19 pandemic.

METHODS

This cross-sectional study was carried out at 10 different dental hospitals in Pakistan from March to June 2020. A 35 items valid and reliable questionnaire was used to assess the concerns, perceived impact, and preparedness of oral healthcare workers (OHCW) in COVID-19 pandemic. Chi-squared test and logistic regression were used for analysis.

RESULTS

A total of 583 OHCW participated in this study. The odds of having the awareness about the risk of exposure and fear of getting infected, were greater in the clinical than non-clinical OHCW (OR: 52.6; OR: 15.9). For social network concerns, the clinical OHCW were more likely to be concerned about their colleagues (OR: 6.0). The clinical OHCW have greater odds of worrying about telling the family/friends about the risk exposed to (OR: 2.55), being avoided because of the job (OR: 3.20) and more likely to be feeling stressed (OR: 4.31). Less than 50% of the participants felt that their institutions are well prepared and only 12.6% had attended an infection control training session. Most participants practiced self-preparation such as buying masks and disinfection (94.3%, 98.3%).

CONCLUSION

The majority of OHCW felt concerned about their risk of exposure to infection and falling ill from exposure and infecting friends/family. There is a need for training of infection control and PPE and minimizing fear and psychological impact on OHCW should be the priority in any preparedness and planning for combating COVID-19.

COVID-19 Pandemic in the Italian Population: Validation of a Post-Traumatic Stress Disorder Questionnaire and Prevalence of PTSD Symptomatology

Since December 2019, the COVID-19 pandemic has attracted worldwide attention for its rapid and exponential diffusion. The long-term psychological impact, of both the spread of the virus and the restrictive policies adopted to counteract it, remains uncertain. However, recent studies reported a high level of psychological distress and Post-Traumatic Stress Disorder (PTSD) symptoms. The purpose of this study is to assess the psychometric properties of a new questionnaire, to evaluate PTSD risk related to the COVID-19 emergency. A total of Italian people completed a web-based cross-sectional survey broadcasted through different social-media. Demographic data and some psychological dimensions, such as general distress and sleep disturbance, were collected. A new self-report questionnaire (COVID-19-PTSD), consisting of 19 items, was developed starting from the PTSD Check List for DSM-5 (PCL-5) questionnaire, and it was administered in order to analyze its psychometric properties. The results highlighted the adequate psychometric properties of the COVID-19-PTSD questionnaire. The confirmatory factor analysis indicated that a seven-factor model (Intrusion, Avoidance, Negative Affect, Anhedonia, Dysphoric arousal, Anxious arousal and Externalizing behavior) best fits the data. Significant correlations were found among COVID-19-PTSD scores, general distress and sleep disturbance. A high percentage of PTSD symptomatology (29.5%) was found in the Italian population. COVID-19-PTSD appears to be effective in evaluating the specific stress symptoms related to the COVID-19 pandemic in the Italian population. These results are relevant from a clinical point of view because they suggest that the COVID-19 pandemic could be considered as a traumatic event. Psychological interventions to counteract short- and long-term psychopathological effects, consequent to the COVID-19 pandemic, appear to be necessary.

Impact of Social Isolation on the Behavioral, Functional Profiles, and Hippocampal Atrophy Asymmetry in Dementia in Times of Coronavirus Pandemic (COVID-19): A Translational Neuroscience Approach

The impact of COVID-19 on the elderly is devastating, and nursing homes are struggling to provide the best care to the most fragile. The urgency and severity of the pandemic forces the use of segregation in restricted areas and confinement in individual rooms as desperate strategies to avoid the spread of disease and the worst-case scenario of becoming a deadly trap. The conceptualization of the post-COVID-19 era implies strong efforts to redesign all living conditions, care/rehabilitation interventions, and management of loneliness forced by social distance measures. Recently, a study of gender differences in COVID-19 found that men are more likely to suffer more severe effects of the disease and are over twice as likely to die. It is well-known that dementia is associated with increased mortality, and males have worse survival and deranged neuro-immuno-endocrine systems than females. The present study examines the impact of long-term isolation in male 3xTg-AD mice modeling advanced stages of Alzheimer's disease (AD) and as compared to age-matched counterparts with normal aging. We used a battery of ethological and unconditioned tests resembling several areas in nursing homes. The main findings refer to an exacerbated (two-fold increase) hyperactivity and emergence of bizarre behaviors in isolated 3xTg-AD mice, worrisome results since agitation is a challenge in the clinical management of dementia and an important cause of caregiver burden. This increase was consistently shown in gross (activity in most of the tests) and fine (thermoregulatory nesting) motor functions. Isolated animals also exhibited re-structured anxiety-like patterns and coping-with-stress strategies. Bodyweight and kidney weight loss were found in AD-phenotypes and increased by isolation. Spleen weight loss was isolation dependent. Hippocampal tau pathology was not modified, but asymmetric atrophy of the hippocampus, recently described in human patients with dementia and modeled here for the first time in an animal model of AD, was found to increase with isolation. Overall, the results show awareness of the impact of isolation in elderly patients with dementia, offering some guidance from translational neuroscience in these times of coronavirus and post-COVID-19 pandemic. They also highlight the relevance of personalized-based interventions tailored to the heterogeneous and complex clinical profile of the individuals with dementia and to consider the implications on caregiver burden.

A Network Analysis of Post-traumatic Stress Disorder Symptoms and Correlates During the COVID-19 Pandemic

Background and Objective: The coronavirus disease 2019 (COVID-19) outbreak has been suggested as a collective trauma, which presents a continuing crisis. However, the specific post-traumatic implication of this crisis has not been adequately studied yet. The current study was aimed to ascertain the most central symptom and the strong connections between symptoms of post-traumatic stress disorder (PTSD). At the same time, exploring the relationship between covariates and the network of PTSD symptoms, by taking sex, anxiety, depression, suicidal ideation, quality of life, and social support as covariates, may help us to know the arise and maintenance of PTSD symptoms and give specified suggestions to people under the shadow of COVID-19. Method: The Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), was used to assess the PTSD symptoms extent of 338 healthy participants over the past month. Networks were analyzed using state-of-the-art regularized partial correlation models. In addition, the centrality of the symptoms and the robustness of the results were analyzed. Results: The network analysis revealed that the especially strong connections emerged between avoidance of thoughts and avoidance of reminders, hypervigilance and exaggerated startle response, intrusive thoughts and nightmares, flashbacks and emotional cue reactivity, and detachment and restricted affect. The most central symptoms were self-destructive/reckless behavior. Incorporation of covariates into the network revealed the strong connections path between self-destructive/reckless behavior and loss of interest and depression. Conclusion: Self-destructive/reckless behavior was the most central symptom in the network of PTSD symptoms related to the COVID-19 pandemic, which as an important target of interfere may have great benefits.