Risk factors for post-injury mental health problems

Psychological assessment of adults with burn injuries in Lebanon

BACKGROUND AND OBJECTIVES

Burned patients are frequently diagnosed with psychiatric disorders. This study aimed to determine the prevalence of probable post traumatic stress disorder (PTSD), and to assess growth and self-esteem among burned patients.

SUBJECTS AND METHODS

A cross-sectional quantitative study was performed, investigating the prevalence of probable PTSD among burned inpatients or outpatients over six years compared to a control group. 230 adult participants of whom 133 were burned patients and 97 non-burned subjects participated in the study.

RESULTS

Inpatients exhibited higher PTSD Checklist for DSM-5 (PCL-5) scores (49.80 ± 23.44) when compared to outpatients (34.64 ± 31.15) and to the control group (42.73 ± 25.66) but regression analysis failed to show a statistical significance among the different groups. 18 % of burned patients met probable PTSD status based on the PCL-5. 10 % (10/102) of burned inpatients, 7 % (2/31) of burned outpatients and 9 % (9/97) of control group reported low self-esteem. Outpatients had significantly higher Rosenberg self-esteem scores (22.09 ± 4.53) compared to inpatients (18.38 ± 3.90) and the control group (p-value = 0.000). A lower educational level was associated with higher probable PTSD and a younger age was associated with higher post-traumatic growth.

CONCLUSION

Burned patients may develop low self-esteem, but they have been found to have high resilience and well-established personal growth.

Gatekeeper training for suicide prevention: a systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

Gatekeeper training (GKT) aims to enhance suicide gatekeepers' (GKs) abilities in assessing suicide risk, identify those at-risk and refer them. However, existing randomized controlled trials (RCTs) on GKT have not produced definitive results. This study reviewed RCTs on GKT to provide evidence for developing effective suicide prevention strategies.

METHODS

We conducted a systematic search of MEDLINE, PubMed, Web of Science, PsycINFO, CINAHL, Embase, Google Scholar, Medrxiv, and Ebsco for English-language RCTs published between January 1, 2000, and December 31, 2024. Two authors independently screened studies, extracted data, and assessed the risk of bias using the Cochrane risk-of-bias tool. Standardized mean differences (SMD) with 95% confidence intervals were calculated using a random-effect model. Heterogeneity was assessed by using I2 statistic, and publication bias was evaluated through funnel plots and Egger's regression. We stratified participants into subgroups by characteristics and categorized interventions by delivery mode (online vs. offline). Post-test and follow-up data were integrated into a unified model, with follow-ups classified as short-term (1-5 months) or long-term (> 5 months). All analyses were performed using R version 3.4.0, following the PRISMA guidelines (registration number: CRD42024507513).

RESULTS

Sixteen studies were included. Compared to the control group, gatekeepers showed increased suicide knowledge (SMD = 0.72, 95% CI: 0.32 - 1.13) and enhanced self-efficacy (SMD = 0.73, 95% CI: 0.33 - 1.13) for suicide prevention. For knowledge, the improvements were sustained in the short-term (SMD = 0.64, 95% CI: 0.22 - 1.06) but diminished in the long-term (SMD = 0.25, 95% CI: 0.05 - 0.45). Online interventions showed a significant improvement in self-efficacy (SMD = 1.02, 95% CI: 0.73 - 1.32), while offline interventions demonstrated a potential but non-significant improvement (SMD = 0.53, 95% CI: -0.08 - 1.17). Preparedness also showed a significant improvement (SMD = 0.69, 95% CI: 0.31 - 1.07).

CONCLUSION

This meta-analysis demonstrated GKT's effectiveness in enhancing knowledge and self-efficacy (moderate effect) for suicide prevention. However, the positive effects tend to decrease over time. Online training offers significant benefits, making it a viable option for widespread implementation. Additionally, the selection of gatekeepers plays a crucial role in ensuring the effectiveness of online GKT programs.

Workplace Injury and Mental Health Outcomes

Importance

Workplace injury is a widespread problem that impacts mental health and quality of life and places a substantial burden on employers and the health care system.

Objective

To determine whether mental disorder rates differ following workplace injury compared with injuries outside the workplace.

Design, Setting, and Participants

This retrospective cohort study assessed individuals hospitalized for an injury requiring surgery between January 1, 2002, and December 31, 2018, with a 2-year follow-up period using population-based administrative data in Manitoba, Canada. Analyses were completed June to July 2021. This study compared 2 cohorts: individuals with a workplace injury matched 1:5 on sex, age, geographical region, and surgical procedure code with individuals with a nonworkplace injury in the general population.

Exposure

Traumatic physical injury that required surgery with anesthetic.

Main Outcomes and Measures

The outcome of interest was a diagnosis of mental disorder (anxiety, depression, substance abuse, suicide attempt, and any mental disorder), measured 2 years prior to and following injury.

Results

In this cohort study, 7556 individuals (mean [SD] age, 44.8 [13.3] years; 5721 [75.7%] male; 4624 individuals [61.2%] with urban residence; 4545 individuals [60.1%] with low income) with a workplace injury were compared with 28 901 matches from the general population. The workplace cohort had lower rates of all mental disorders (anxiety: adjusted rate ratio [ARR], 0.82; 95% CI, 0.77-0.87; depression: ARR, 0.78; 95% CI, 0.72-0.84; substance abuse: ARR, 0.63; 95% CI, 0.55-0.72; suicide attempt: ARR, 0.28; 95% CI, 0.11-0.70; and any mental disorder: ARR, 0.82; 95% CI, 0.78-0.86; all P < .0006) before their injury and for depression (ARR, 0.89; 95% CI, 0.82-0.95) and substance abuse (ARR, 0.83; 95% CI, 0.73-0.94) after their injury. The group × care period interaction term was significant for anxiety (P < .0001) and any mental disorder (P < .0001), suggesting that individuals with workplace injuries had worse mental disorder outcomes over time than individuals with nonworkplace injuries.

Conclusions and Relevance

This cohort study found that the mental health trajectory from the preinjury to postinjury period was worse for individuals with a workplace injury compared with those injured outside the workplace. These findings suggest that there may be features unique to the workplace and/or injury claims and compensation processes that contribute to this pattern, which warrant further examination.

Association of childhood maltreatment and adverse lifetime experiences with post-injury psychopathology: evidence from the China Severe Trauma Cohort

BACKGROUND

Adverse life experiences have been associated with increased susceptibilities to psychopathology in later life. However, their impact on psychological responses following physical trauma remains largely unexplored.

METHODS

Based on the China Severe Trauma Cohort, we conducted a cohort study of 2937 patients who were admitted to the Trauma Medical Center of West China Hospital between June 2020 and August 2023. Adverse life experiences, including childhood maltreatment (5 subtypes, measured by Childhood Trauma Questionnaire-Short Form) and adverse lifetime experiences (17 subtypes, by Life Events Checklist) were assessed. Generalized linear mixed models were used to examine the associations of childhood maltreatment and adverse lifetime experiences with symptoms of psychopathology measured at multiple time-points after the index injury (i.e., at recruitment, 1-, 3-, 6-, and 12-month follow-ups), adjusted for important confounders. We further stratified the analyses by level of genetic predisposition to a given psychological symptom quantified by polygenic risk score (PRS) based on publicly available GWAS summary statistics. Mediation analyses were performed to assess the role of adverse lifetime experiences in connecting childhood maltreatment and post-injury psychopathology.

RESULTS

The mean age of participants was 47.95 years with a predominance of males (61.39%). During the whole follow-up period, the incidence of symptoms of stress-related disorders, anxiety, and depression was 13.86%, 29.89%, and 36.57%, respectively. We observed associations between the cumulative number of those studied adversities and increased risk of post-injury psychopathology, particularly stress-related disorder (odds ratio [OR] = 2.78, 95% confidence interval [CI] 1.87-4.12 for ≥ 2 vs no childhood maltreatment; 2.65 [1.67-4.20] for ≥ 4 vs 0-1 adverse lifetime experiences). By subtype, positive associations were observed for most studied life adversities, with the most pronounced estimates for childhood emotional abuse (ORs = 1.71-2.52) and lifetime life-threatening illness/injury (ORs = 1.87-2.89). We found basically comparable estimates among traumatized individuals with different PRSs for studied psychopathology. Moreover, adverse lifetime experiences may partially (mediation proportion: 22.52-27.48%) explain the associations between various childhood maltreatment and post-injury psychopathology.

CONCLUSIONS

Both childhood maltreatment and adverse lifetime experiences were associated with post-injury psychopathology, irrespective of genetic susceptibility. Such findings highlight the importance of close surveillance and timely psychological interventions for injury patients with adverse life experiences.

Psychological Assessment and Intervention at the Boston Marathon

The Boston Marathon is a highly regarded event in the running world, not just for its prestige and challenging course, but also for its implementation of a psychology team to support runners. The 2013 Boston Marathon bombings underscored the essential role that mental health support plays at this event, prompting the development and expansion of its innovative care model. This review critically outlines, evaluates, and analyzes the approach and effectiveness of the psychological care model provided to runners on race day as part of the Boston Marathon medical team, including the standard of care, how it functions, and best practices for other marathons. The implications for this review contribute to the increasing trend of providing psychological care in marathon and other athletic settings, and to provide a framework for standardizing assessment and intervention procedures for both elite and novice runners.

Medical traumatic stress: Integrating evidence-based clinical applications from health and trauma psychology

Medical events in both childhood and adulthood, including components of the illness or injury and subsequent medical intervention, recovery, and disability, are increasingly being recognized as potentially traumatic. There has been an increased focus on scholarly work related to medical trauma and medically induced posttraumatic stress disorder (PTSD). Existing evidence suggests that trauma-focused treatment can promote both physical and psychological recovery. However, there continues to be a dearth of clinical guidance on how to (a) best identify and treat prior trauma exposure that complicates adjustment to illness and increases the risk for medically induced PTSD and (b) address medically induced PTSD while concurrently targeting health-related concerns (e.g., pain, adjustment to illness, acquired disability) that may negatively impact recovery. Originally presented as a premeeting institute at the 2023 Annual Meeting of the International Society for Traumatic Stress Studies, this paper describes the biopsychosocial impacts of medical trauma on adults and considerations for assessment and intervention in both traditional trauma and integrated care settings. This includes clinical applications, including assessment, case conceptualization, and health and rehabilitation interventions, that can promote health-related adjustment and coping within the context of trauma-focused treatment.

Unravelling the impact of prior depression and trauma-related cognitive processes on depression following trauma: A 2-year prospective study of burn survivors

OBJECTIVE

Individuals with severe burn injuries may develop depression, yet knowledge about psychological risk factors for depression following trauma is limited. This study investigated the prospective impact and interplay of prior depression and trauma-related cognitive processes (posttraumatic negative appraisals and trauma-related rumination) to depressive symptoms between 6 and 24 months after burn injury.

METHOD

Taiwanese adult survivors of burn (N = 118) participated in surveys immediately post-burn and at 6-, 12-, and 24-months follow-up. Participants were 7 5% men, with an average age of 41.8 years and an average of TBSA of 18.3%.

RESULTS

A total of 8.5%, 5.9%, and 4.2% met criteria for probable major depression at 6, 12, and 24 months post-burn, respectively. The prevalence increased to 23.7%, 11.0%, and 5.9% using the cutoff on the PHQ-9. Prior depression and trauma-related cognitive processes immediately post-burn explained 13.5%, 20.5%, and 18.6% of the variance in depressive symptoms at 6, 12, and 24 months post-burn, respectively. Posttraumatic negative appraisals strongly predicted depressive symptoms post-burn across follow-ups. Moreover, posttraumatic negative appraisals significantly mediated the effect of prior depression on subsequent depressive symptoms across follow-ups. Prior depression significantly moderated the effect of trauma-related rumination on depressive symptoms at 6 months post-burn.

CONCLUSIONS

Our results are the first to demonstrate the role and interplay of prior depression and trauma-related cognitive processes in post-burn depression. Findings highlight that pre-and post-trauma psychological factors jointly affect depression following trauma, broadening the applicability of cognitive theories of PTSD.

Clinical Education: Addressing Prior Trauma and Its Impacts in Medical Settings

Prior trauma exposure significantly increases the risk of developing PTSD following medical stressors and may contribute to the development of medically induced PTSD. However, healthcare systems often overlook the interaction between prior trauma and current medical stressors, contributing to negative psychosocial and health-related outcomes for patients. Integration of both trauma-informed and trauma-focused practices into psychosocial programming in medical settings may be key to effectively addressing the needs of trauma-exposed patients. Yet, there is a lack of practical guidance on how clinical psychologists in medical settings can respond to trauma's effects in routine clinical practice. This paper aims to provide an overview of trauma-focused theory, assessment, and treatment considerations within medical settings, emphasizing the importance of incorporating trauma-focused intervention into integrated psychosocial programming to address prior trauma and its impacts on care in order to improve patient outcomes.

The relationship between the psychological resilience and post-traumatic growth of college students during the COVID-19 pandemic: a model of conditioned processes mediated by negative emotions and moderated by deliberate rumination

BACKGROUND

The mental health of university students during the COVID-19 pandemic has attracted the attention of researchers. For the present study researchers constructed a mediation model to explore the relationship between psychological resilience and post-traumatic growth, the mediating role of negative emotions and the moderating role of deliberate rumination in students.

METHODS

The Psychological Resilience Scale, Posttraumatic Growth Inventory, Depression-Anxiety-Stress Scale (DASS-21) and Event Related Rumination Inventory were used in a survey of 881 college students. The data were analyzed using SPSS 26.0 and the PROCESS plugin (version 3.3).

RESULTS

(1) Psychological resilience is positively related with post-traumatic growth. Deliberate rumination is positively related to psychological resilience, posttraumatic growth, and negative emotions. Psychological resilience, post-traumatic growth and negative emotions are negatively related. (2) Negative emotions mediated the relationship between psychological resilience and post-traumatic growth. (3) Deliberate rumination plays a moderating role in psychological resilience affecting negative emotions. Deliberate rumination plays a moderating role in the extent to which psychological resilience influences PTG through negative emotions.

CONCLUSIONS

Psychological resilience affects post-traumatic growth directly and also indirectly through negative emotions. With the increase of mental resilience, the level of negative emotion tended to decrease. When individuals are experiencing negative emotions, high levels of active rumination are more likely to promote post-traumatic growth. This study helps to explore the factors affecting the mental health of college students during the epidemic, thus providing guidance for appropriate mental health interventions.

The Short- and Long-Term Outcome Priorities of a Western Australian Adult Burn Population

To optimize patient recovery, understanding which outcomes are most important to burn patients is key. However, research to determine what outcomes are patient priorities is limited. Therefore, we assessed what outcomes are most important to Western Australian burn patients, separately in the short-term (<6 months) and long-term (6-24 months) after injury. Adult patients who had a burn injury 3-36 months ago completed a survey, rating the importance of 36 short- and long-term outcomes. The survey items were ranked according to the number of patients reporting the outcome as "very important." Results were compared between subgroups based on age, gender, burn size, and number of surgeries. Ninety-three patients were included. In the short-term, "not having a wound infection" (87.1%), "good wound healing" (83.9%), and "walking or moving around" (74.7%) were the most important outcomes. "Lifting or moving something" (67.6%), "walking or moving around" (66.2%), and "being independent" (66.2%) were reported as most important in the long-term. Scar-related outcomes were more important to females and to patients with multiple surgeries; mental health outcomes were priorities for females and patients with major burns; walking and moving around to males and older patients; and social and financial outcomes were rated highly by patients with major burns and multiple surgeries. In conclusion, the most important outcomes were consistent across time periods, indicating the importance of core outcomes in longitudinal follow-up. The wide range of priority outcomes and differences between subgroups underlines the need for multidisciplinary care and a patient-centered approach to support patients.

To Study the Distress, Anxiety, Depression, and Sleep Effects of the COVID-19 Pandemic on Essential Workers

Essential care workers like police personnel, social workers, and office and administrative staff of health institutions are also at increased risk of coronavirus disease 2019 (COVID-19) exposure along with healthcare workers. The present study aims to estimate the distress, anxiety, depression, and sleep impact of COVID-19 pandemic on essential workers through an online survey. This cross-sectional study (included 369 participants) was conducted in Chandigarh through an online survey using three psychological scales: Peritraumatic Distress Inventory (PDI), Insomnia Severity Index, and Depression Anxiety Stress Scale. Three-hundred-sixty-nine frontline warriors from hospital and community settings were included in the study. The respondents include police personnel (274; 73.66%), office staff (24; 6.45%), social workers (53; 14.24%), and media staff (21; 5.65%). Maximum distress was reported by media/transport officials on duty (85.7%). The majority of them scored high (>14), and slightly less than one-fourth (23.8%) scored significantly abnormal (>23) on PDI. About 42.9% reported moderate insomnia, 52.4% exhibited severe anxiety, and 33.3% of media/transport participants reported severe depression. Psychological morbidity is high in media/transport and social workers working in the community during the COVID-19 pandemic.

Correlates of Longitudinal Trajectories of Depressive Symptoms in Adolescents With Traumatic Brain Injuries

OBJECTIVE

Depression poses a significant threat to the health and well-being of adolescents with traumatic brain injury. Existing research has limitations in longitudinal follow-up period, consideration of sample heterogeneity, and outcome measurement modeling. This study aimed to address these gaps by applying the second-order growth mixture model (SO-GMM) to examine the 10-year post-injury depression trajectories in adolescents with TBI.

METHODS

A total of 1,989 adolescents with TBI 16-21 years old from the Traumatic Brain Injury Model System National Data Bank were analyzed up to 10 years post-injury. Depressive symptoms were measured by Patient Health Questionnaire-9. Covariates included age, sex, race/ethnicity, employment, Functional Independence Measure Cognition, TBI severity, pre-injury disability, and substance use. Longitudinal measurement invariance was tested at the configural, metric, and scalar levels before SO-GMM was fit. Logistic regression was conducted for disparities in depression trajectories by covariates.

RESULTS

A 2-class SO-GMM was identified with a low-stable group (85% of the sample) and a high-increasing group (15% of the sample) on depression levels. Older age, being a Native American, and having Hispanic origin was associated with a higher likelihood of being in the high-increasing class (odds ratios [ORs] = 1.165-4.989 and 1.609, respectively), while patients with higher education and being male were less likely to be in the high-increasing class (ORs = 0.735 and 0.557, respectively).

CONCLUSIONS

This study examined the disparities in depression among two distinct longitudinal groups of adolescents with TBI 10 years post-injury. Findings of the study are informative for intervention development to improve long-term mental health in adolescents with TBI.

Stress, resilience, and moral distress among health care providers in oncology during the COVID-19 pandemic

Background

The coronavirus pandemic has potential implications for stress levels and resilience among oncology healthcare professionals (HCPs). This study aims to assess perceived stress, resilience, and moral distress levels among oncology HCPs in Jordan during the pandemic and identify associated risk factors.

Methods

An online cross-sectional survey was conducted among oncology HCPs in Jordan using three validated tools: Perceived Stress Scale (PSS), Connor-Davidson Resilience Scale (CD-RSIC), and Moral Distress Thermometer (MDT). Seven items were used to assess sources of stress.

Results

A total of 965 participants enrolled with a 74% response rate. The participants' ages ranged from 20 to 74 (mean = 32.74, SD = 5.197), with 79.1% males, 45.1% were physicians, 32.6% were public hospital workers, 57.1% were married, and 56.6% had children below 18 years. Findings indicated moderate perceived stress (Mean = 15.87, SD = 5.861), low resilience (Mean = 29.18, SD = 5.197), and high moral distress (Mean = 4.72, SD = 2.564). Females, unmarried individuals, and younger age groups exhibited higher PSS (p = 0.009, p < 0.001, and P<0.001) and lower resilience (p = 0.024, p = 0.034, and p = 0.001). Not having children below 18 years correlated with higher perceived stress (P < 0.001). In linear regression analysis, age and gender emerged as significant predictors of both perceived stress and resilience. Female participants reported stress related to the risk of contracting COVID-19 (p = 0.001), transmitting it to others (p = 0.017), social isolation (P < 0.001), and having children at home due to school closures (p = 0.000). A cohort of 239 participants repeated the survey within a two-month interval, revealed a statistically significant decrease in the CD-RISC scores (p < 0.001).

Conclusion

Oncology HCPs in Jordan experienced moderate stress, high moral distress, and poor resilience during the COVID-19 pandemic. These factors may negatively affect the quality of oncology care. Urgent measures are necessary to support HCPs in coping with unforeseen circumstances in the future.

Generalized Anxiety Disorder Associated With Gastroesophageal Reflux Disease Among the Saudi Population

Objectives In Saudi Arabia, the prevalence of generalized anxiety disorder (GAD) was reported to be 29%. As a result, our goal was to examine the association between GAD and gastroesophageal reflux disease (GERD) within the general Saudi Arabian population, as well as to access the risk factors for GAD in order to gain a better understanding. Method This cross-sectional study involved 4,224 participants who completed a questionnaire. Anxiety was assessed using the General Anxiety Disorder-7 (GAD-7) scale, and the GerdQ tool was used to evaluate GERD. Result The prevalence of anxiety among participants was 29% at cutoff 10, with 73% of anxiety-positive participants being female and only 26.9% being male. Furthermore, the associations between anxiety and GERD were significant as 31.4% of participants with anxiety had GERD, compared to 15.0% of those without anxiety. Conclusion In our finding, there was a significant association between anxiety and GERD among the general Saudi population. In terms of anxiety risk factors, female, younger age, social status, body mass index, eating fried food, caffeinated drinks, diabetes miletus, high blood cholesterol, NSAID use, antidepressants, and anti-anxiety medication were found to have a significant association.

Investigating social determinants of child health and their implications in reducing pediatric traumatic injury: A framework and 17-year retrospective case-control study protocol

INTRODUCTION

Traumatic physical injuries are the number one cause of hospitalization and death among children in Canada. The majority of these injuries are preventable. The burden from injury can be reduced through prevention programs tailored to at-risk groups, however, existing research does not provide a strong explanation of how social factors influence a child's risk of injury. We propose a theoretical framework to better understand social factors and injury in children and will examine the association between these social factors and physical traumatic injury in children using large population-wide data.

METHODS AND ANALYSIS

We will examine data from 11,000 children hospitalized for traumatic physical injury and 55,000 matched uninjured children by linking longitudinal administrative and clinical data contained at the Manitoba Centre for Health Policy. We will examine 14 social determinants of child health measures from our theoretical framework, including receipt of income assistance, rural/urban status, socioeconomic status, children in care, child mental disorder, and parental factors (involvement with criminal justice system, education, social housing, immigration status, high residential mobility, mother's age at first birth, maternal Axis I mental disorder, maternal Axis II mental disorder and maternal physical disorder) to identify groups and periods of time when children are at greatest risk for traumatic physical injury. A conditional multivariable logistic regression model will be calculated (including all social determinant measures) to determine odds ratios and adjusted odds ratios (95% confidence interval) for cases (injured) and controls (non-injured).

ETHICS AND DISSEMINATION

Health Information Privacy Committee (HIPC No. 2017/2018-75) and local ethics approval (H2018-123) were obtained. Once social measures have been identified through statistical modelling, we will determine how they fit into a Haddon matrix to identify appropriate areas for intervention. Knowing these risk factors will guide decision-makers and health policy.

COVID-19-associated impact and post-traumatic stress symptoms 39 days after pandemic in a sample of home-quarantined Chinese college students: the mediating effecting of past stressful events, psychological resilience, and social support

BACKGROUND

During the COVID-19 outbreak, most Chinese college students were home-quarantined to prevent the spread of the virus. COVID-19-associated impact has been shown to be a risk factor for the development of post-traumatic symptoms disorder (PTSD). However, little is known about the psychological processes that mediate this association. This study investigated the association between COVID-19-associated impact and PTSD and examined whether past stressful events, psychological resilience, and social support have mediating effects on this association.

METHODS

The 12,397 valid responses from 31cities in China via an online survey assessed PTSD symptoms, past stressful events, psychological resilience, social support and social-demographic variables. AMOS was used to test the hypotheses of mediating effects.

RESULTS

On the 39th day of the declared COVID-19 epidemic in China, 6.75% of the surveyed sample showed PTSD symptoms. A positive mediating effect of past stressful events was found between COVID-19-associated impact and PTSD, whereas psychological resilience and social support had negative mediating effects. The fit indices for the path model were found to be significant (β = 0.28, p < 0.001), COVID-19-associated impact indirectly affects the risk of PTSD through mediating pathways (past stressful events → psychological resilience → social support) on PTSD.

CONCLUSIONS

Attention should be paid to the effects of past stressful events of Chinese college students who were home-quarantined during the COVID-19 epidemic, and strategies should also be implemented to improve social support and develop psychological resilience.

TRIAL REGISTRATION

The study was approved by the ethics committee of the Southwest Minzu University.

Psychological consequences of the COVID-19 pandemic in people with type 1 diabetes: A systematic literature review

OBJECTIVE

A comprehensive picture of the data on the impact of COVID-19 on the mental health of individuals with type 1 diabetes (T1D) is currently lacking. The purpose of this systematic review was to synthesize extant literature reporting on the effects of COVID-19 on psychological outcomes in individuals with T1D and to identify associated factors.

METHODS

A systematic search was conducted with PubMed, Scopus, PychInfo, PsycArticles, ProQuest, and WoS using a selection procedure according to the PRISMA methodology. Study quality was assessed using a modified Newcastle-Ottawa Scale. In all, 44 studies fulfilling the eligibility criteria were included.

RESULTS

Findings suggest that during the COVID-19 pandemic, people with T1D had impaired mental health, with relatively high rates of symptoms of depression (11.5-60.7%, n = 13 studies), anxiety (7-27.5%, n = 16 studies), and distress (14-86.6%, n = 21 studies). Factors associated with psychological problems include female gender, lower income, poorer diabetes control, difficulties in diabetes self-care behaviors, and complications. Of the 44 studies, 22 were of low methodological quality.

CONCLUSIONS

Taking appropriate measures to improve medical and psychological services is needed to support individuals with T1D in appropriately coping with the burden and difficulties caused by the COVID-19 pandemic and to prevent mental health problems from enduring, worsening, or having a long-term impact on physical health outcomes. Heterogeneity in measurement methods, lack of longitudinal data, the fact that most included studies did not aim to make a specific diagnosis of mental disorders limit the generalizability of the findings and have implications for practice.

Evaluating a Digital Mental Health Intervention (Wysa) for Workers' Compensation Claimants: Pilot Feasibility Study

OBJECTIVE

This study examines the feasibility and acceptability of an AI-led digital mental health intervention in a Workers' Compensation (WC) program, Wysa for Return to Work.

METHODS

Self-reported demographic data and responses to psychosocial screening questions were analyzed alongside participants' app usage through which four key outcomes were measured: recruitment rate, onboarding rate, retention, and engagement.

RESULTS

The data demonstrated a high need for psychosocial interventions among injured workers, especially women, young adults, and those with high severity injuries. Those with more psychosocial risk factors had a higher rate of onboarding, retention, and engagement, and those with severe injuries had higher retention.

CONCLUSIONS

Our study concluded that Wysa for Return to Work, the AI-led digital mental health intervention that delivers a recovery program using a digital conversational agent, is feasible and acceptable for a return-to-work population.

Psychological Distress of Healthcare Workers in 4 Hospitals Compared to General Population During the First Italian Wave of COVID-19 Pandemic

COVID-19 caused important consequences on public health, economy, physical, and mental health of people. The aim of this study was to evaluate the impact of COVID-19 on frontline workers, comparing them with their colleagues who had no contact with the patients and with the general population, by administering an online questionnaire based on the Distress Questionnaire-5 (DQ5). The study was carried out during the first Italian wave of COVID-19 pandemic from 1st to 30th of April. Participants were divided in 3 groups: group 1 is general population group that includes the general population which are quarantined but not isolated, group health care staff not working in COVID-19 hospitals, and group 3 healthcare staff group working in COVID-19 hospitals. The survey was carried with the Distress Questionnaire-5 (DQ5) as a tool to detect the psychological distress and mental health problems. A total of 2983 people participated in this survey. Seven hundred and twenty four out of 1123 (64%) were employers of the 4 hospitals included in this study. Particularly among the respondents, 2259 (75.7%) were general population, 502 (16.8%) were health care staff not working in COVID-19 hospitals, while 222 (7.4%) were health care staff working in covid-19 hospitals. Health care personnel working in COVID-19 hospitals (DQ-5 = 13, 10-16) had less psychological distress compared with health care staff not working in COVID-19 hospitals (DQ-5 = 14, 11-16) and general population (DQ-5 = 14, 11-17; P = .04). The regression model showed that people aged 26 to 35 (OR: 2.06, 95% CI: 1.21-3.48) and female (OR: 2.35, 95% CI: 1.95-2.83) were significantly at risk to develop a DQ-5 ≥ 11. During the first Italian wave of COVID-19 pandemic, healthcare personnel working in COVID-19 hospitals had less psychological distress compared with health care staff not working in COVID-19 hospitals and general population, probably because they were prepared to face situations like outbreak or emergencies.

Post-traumatic stress disorders among children and adolescents in conflict-affected zones of Amhara region, February 2022

Background

To date, conflict is causing extreme social crises worldwide, with children representing the most vulnerable group, often experiencing severe trauma and violence in conflict-ridden areas. Posttraumatic stress disorders (PTSDs) are the most widely reported psychological problem in the aftermath of conflict. However, less attention has been given to children living in conflict-prone areas of the world.

Objective

The present study aimed to assess posttraumatic stress disorders among children and adolescents in conflict-affected zones of the Amhara region in Ethiopia from January to February 2022.

Method

A community-based cross-sectional study was employed from January to February 2022. A multistage random sampling technique was employed to recruit the study participants. A structured interviewer-administered questionnaire was designed to collect the desired data. Data were verified, coded, and entered into EpiData version 3.1 and analyzed using SPSS version 24 statistical software.

Result

A total of 846 children with a response rate of 94.33% were screened for trauma. Subsequently, 557 (69.80%) children had experienced trauma. Of these 557 children who had experienced trauma, 203 (36.45%) developed posttraumatic stress disorders. Based on these results, this study recommends that mass screening of children and adolescents for posttraumatic stress disorders and rehabilitation services be undertaken, including resilience training and psychosocial support.

Psychological Distress Related to the COVID-19 Pandemic: The Protective Role of Hope

The COVID-19 outbreak and the worldwide lockdown measures had an impact on the global mental health and psychological well-being of the general population. Several studies attempted to investigate the protective and risk factors for psychological distress related to the pandemic. However, to date, little is known about the role of hope in this context. The aim of this study was to determine the relationship between hope and psychological distress related to the COVID-19 outbreak in the general population. The sample consisted of 504 Pakistani people who completed cross-sectionally the COVID-19 Peritraumatic Distress Index (CPDI) and the Adult Hope Scale (AHS). Bivariate Pearson correlation analysis was run to measure the relationship between hope and psychological distress; hierarchical regression analysis was run to investigate the association between demographics and hope with psychological distress. Higher levels of hope predicted lower levels of psychological distress. Being female, being older, lower level of education, urban residence, being married and living in nuclear family systems were associated with higher levels of psychological distress. The study highlights the protective role of hope on psychological distress related to COVID-19, contributing to knowledge on factors promoting positive mental health during emergency times and providing useful information for implementing effective public health policies and programmes.

Psychological Distress Impact of Coronavirus Disease (COVID-19) Outbreak on Three Continents: A Systematic Review and Meta-analysis

BACKGROUND

The dire state of coronavirus disease (COVID-19) outbreak has had a substantial psychological impact on society.

METHODS

A systematic search was performed through Medline, PubMed, Embase, Scopus, and Web of Science, to investigate the impact of the COVID-19 pandemic on the psychological health of individuals in various countries. Subgroup analyses considered gender and classification of countries into three continents of America, Europe, and Asia. Only studies that used the COVID-19 Peritraumatic Distress Index (CPDI) questionnaire as a tool to assess mental distress were included in this meta-analysis. Heterogeneity among studies was assessed by I² statistic, and the random-effects model was utilized to obtain the pooled prevalence.

RESULTS

This pooled analysis included a large data sample of 21 studies consisting of 94,414 participants. The pooled prevalence of the psychological distress during the time of COVID-19 pandemic by CPDI for the continent of Asia was 43% (34.6% mild-to-moderate and 8.4% severe) which was greater than that for Europe (35%; 30% mild-to-moderate and 5% severe) but lower than that for America (64.3%; 45.8% mild to moderate and 18.5% severe). In addition, the prevalence of psychological distress according to CPDI was higher in females (48%; 40% mild to moderate, 13% severe) compared with males (59%; 36% mild to moderate and 5% severe).

CONCLUSIONS

Our findings suggest that psychological distress in the Americas is a larger problem than in Asia and European continents. Females appear to be more vulnerable and may therefore require further attention in terms of preventive and management strategies. Implementation of both digital and molecular biomarkers is encouraged to increase objectivity and accuracy of assessing the dynamic changes in mental health in the current and future pandemics.

Impact of the Las Vegas Mass Shooting Event on the Graduate Medical Education Mission: Can There Be Growth from Tragedy?

INTRODUCTION

Our aim was to determine the psychological and educational impact of the 2017 Las Vegas mass shooting on the graduate medical education (GME) mission within two cohorts of resident physicians and attending faculty at two nearby academic trauma centers.

METHODS

A cross-sectional survey assessed 55 resident physicians and attending faculty involved in the acute care of the patients from the mass shooting. We measured the psychological impact of the event, post-traumatic growth, team cohesion, social support, and known risk factors for post-traumatic stress disorder (PTSD). Additionally, we assessed the impact of the event on GME-specific tasks.

RESULTS

Attending faculty and physicians in training in GME residencies evaluated over 300 penetrating trauma patients in less than 24 hours, and approximately 1 in 3 physicians had a patient die under their care. Despite this potential for psychological trauma, the majority of clinicians reported minimal distress and minimal impact on GME activities. However, 1 in 10 physicians screened positive for possible PTSD. Paradoxically, the minority of physicians who sought psychological counseling after the event (20%) were not those who reported the highest levels of distress. Residents generally assessed the event as having an overall negative impact on their educational goals, while attendings reported a positive impact. Psychological impact correlated inversely with social support and the amount of prior education relating to mass casualty incidents (MCI) but correlated directly with the degree of stress prior to the event.

CONCLUSION

Despite the substantial level of exposure, most resident physicians did not report significant psychological trauma or an impact on their GME mission. Some reported post-traumatic growth. However, a minority reported a significant negative impact; institutions should consider broad screening efforts to detect and assist these individuals after a MCI. Social support, stress reduction, and education on MCIs may buffer the effects of future psychologically traumatic events on physicians in training.

Effects of psychological intervention on empathy fatigue in nurses: A meta-analysis

Objective

The purpose of this meta-analysis is to systematically assess the effects of psychological intervention on empathy fatigue among nursing staff.

Method

Five electronic databases are searched separately from their establishment to April 8th, 2022. The research team independently performs paper selection, quality assessment, data extraction and analysis for all included studies. PRISMA guidelines are used to report this meta-analysis.

Results

A total of seven randomized controlled trials (RCTs) covering 513 nursing staff are included. The meta-analysis results show that the empathy fatigue score (SMD = -0.22, 95% CI: -0.42~-0.02, P = 0.03) and burnout (SMD = -0.37, 95% CI: -0.56~-0.19, P < 0.001) are lower than the control group. The empathy satisfaction score of the psychological intervention group is higher than that of the control group (SMD = 0.45, 95% CI: 0.27-0.63, P < 0.001). The differences are statistically significant (P < 0.05). Subgroup analysis finds significant heterogeneity in the impact of different departments on psychological intervention at ≥6 weeks (I ² = 71%, P = 0.01) and <6 weeks (I ² = 0%, P = 0.75) (P = 0.05). Different departments also show significant heterogeneity in the effects of psychological intervention: ICU (I ² = 73%, P = 0.02), pediatric (I ² = 53%, P = 0.14) and other departments (I ² = 0%, P = 0.63). The differences are statistically significant (P = 0.0007). Besides, the results show that both mindfulness intervention (SMD = 0.50, 95% CI: 0.24-0.77, P = 0.0002) and other interventions (SMD = 0.41, 95% CI: 0.16-0.65, P = 0.001) are statistically significant difference in the level of empathy satisfaction between the psychological intervention group and the control group.

Conclusion

Psychological intervention has a coordinated improvement effect on empathy fatigue, empathy satisfaction and burnout, and can also improve the quality of life of nursing staff.

Psychosocial Determinants of Loneliness in the Era of the COVID-19 Pandemic-Cross-Sectional Study

BACKGROUND

The COVID-19 pandemic affected the mental health and social behavior of people around the world. Due to epidemiological restrictions, the period of forced isolation contributed to the feeling of loneliness. The aim of the research is to identify factors and conditions associated to the feeling of loneliness in the era of the COVID-19 pandemic.

METHODS

The survey was conducted among 262 people from the north-eastern Polish area, using an online survey. The diagnostic survey method was used, using the De Jong Gierveld Loneliness Measurement Scale, the Generalized Self-Efficacy Scale (GSES), the WHOQoL-Bref questionnaire.

RESULTS

A statistically significant relationship was observed between the feeling of loneliness and areas of quality of life, especially psychological and social, generalized self-efficacy and marital status and way of living (p < 0.05). Higher levels of stress, social distancing, restrictions at work, health status were significantly correlated with an increase in loneliness. Remote work was associated with a lower assessment of the quality of life in the psychological field (p < 0.05).

CONCLUSIONS

Higher levels of loneliness were significantly more likely to affect people living alone and not in a relationship. Higher levels of loneliness were significantly associated with lower quality of life in the social and psychological domains, lower levels of self-efficacy, and remote work.

The impact of the social isolation in elderly Brazilian mental health (anxiety and depression) during the COVID-19 pandemic

The impact of social isolation in the pandemic context on elderly Brazilian mental health is little known, especially about the occurrence of depressive symptoms. In this study, we evaluated elderly people undergoing social isolation in order to identify factors associated with depression and which of these are more important to characterize elderly Brazilians with depression. In a cross-sectional, exploratory, and analytical study of a quantitative nature, the mental profile of elderly individuals subjected to social isolation during the COVID-19 pandemic period was used. A total of 450 participants was divided into normal and depressive groups, and a form covering sociodemographic data, opinions/perceptions about the pandemic, and a Reduced Geriatric Depression Scale was used to assess participants' mental health. To assess the statistical significance between the variables, chi-square test was applied, considering the p-value <0.05. The effect size was analyzed to identify the magnitude of the difference between groups. To identify the most important characteristics to define the groups Multilayer Perceptron algorithm were applied. We found that elderly people with a depressive profile are (in Multilayer Perceptron rank order) (1) showing signs of anxiety during the COVID-19 pandemic, (2) of low education, (3) being divorced, (4) having more than one mental disorder, (5) reading, watching, or listening to information about COVID-19, and (6) being previously diagnosed with depression. In conclusion, elderly Brazilians in social isolation tend to develop depressive disorders during quarantine. Thus, we can consider that the pandemic requires effective and safe gerontological care and monitoring, especially with regard to mental health.

Depression, anxiety and stress among people infected with COVID-19 in Dhaka and Chittagong cities

Background

Covid-19 is an acute respiratory infectious disease caused by novel coronavirus 2019. Many individuals have suffered or are experiencing psychological symptoms due to feelings of isolation, insecurity and instability triggered by Covid-19. This study aimed to explore the perceived psychological distress and associated factors among people infected with Covid-19 in Dhaka and Chittagong cities.

Methods

Using the face-to-face interview method, a survey was conducted from 23 April to 22 May 2021 on a questionnaire on depression, anxiety and stress scale (DASS-21), socio-demographic, economic and health factors. Among those who had ever been infected with Covid-19, a total of 2092 respondents (1180 from Dhaka and 912 from Chittagong) were randomly selected and interviewed.χ 2 test for independence of attributes was employed to observe the association of various socioeconomic, cultural, demographic and health factors with psychological distress. Moreover, multinomial logistic regression analysis was performed to explore the factors that contributed to psychological distress.

Results

Among participants from Dhaka, of three mental health conditions, the prevalence was higher for anxiety (80.0%), followed by stress (64.2%) and depression (59.8%), respectively. Anxiety was also more prevalent (57.3) among respondents in Chittagong, followed by depression (47.7%) and stress (39.5%). As the coexistence of symptoms, 52.8% of respondents in Dhaka, 34.4% in Chittagong experienced depression, anxiety and stress simultaneously. Moreover, in both Dhaka and Chittagong, all three psychological symptoms were strongly correlated in pairs. Multivariate analysis revealed that the most consistent factors associated with mild to moderate (MM), and severe to extremely severe (SES) depression were respondents from Chittagong who were illiterate or primary educated (OR = 0.166, CI: 0.076-0.364 for MM and OR = 0.041, CI: 0.013-0.131 for SES), male (OR = 0.999, CI: 0.666-1.496 for MM and OR = 0.395, CI: 0.249-0.625 for SES), single (OR = 0.393, CI: 0.157-0.982 for MM and OR = 0.121, CI: 0.049-0.303 for SES) and married (OR = 0.403, CI: 0.177-0.916 for MM and OR = 0.075, CI: 0.033-0.167 for SES), had a family of size ≤ 4 (OR = 0.253, CI: 0.140-0.458 for MM and OR = 0.114, CI: 0.059-0.218 for SES) and a family of size 5-6 (OR = 0.151, CI: 0.084-0.272), and no family members at risk being infected with Covid-19 (OR = 0.699, CI: 0.487-1.002 for MM and OR = 0.332, CI: 0.199-0.522 for SES). The analysis yielded similar findings for the other two mental health subscales, such as anxiety and stress. For respondents in Dhaka, the effect of factors other than sex on psychological distress was the opposite in Chittagong. Overall, psychological distress during the outbreak was greater among respondents in Dhaka than in Chittagong if respondents were not classified based on various characteristics.

Conclusion

This study showed that in both Dhaka and Chittagong, a substantially large portion of Covid-19-infected respondents experienced all three psychological distress (e.g., depression, anxiety and stress). Regardless of the dissimilarity between the results in Dhaka and Chittagong, better mental health support was needed for women in both cities.

A comparative study of the psychological impacts of tasks related and unrelated to COVID-19 on nurses: a cross-sectional study

BACKGRUOUND

This study assessed the psychological impact of the outbreak of coronavirus disease 2019 (COVID-19) on university hospital nurses. It provides an assessment of mental health issues, including depression, anxiety, distress, and burnout of nurses dealing directly and indirectly with COVID-19.

METHODS

In a web-based, cross-sectional study, 111 nurses from Daegu Catholic University Hospital in Korea were enrolled from August 4 to August 9, 2020. Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Impact of Event Scale-Revised, and Maslach Burnout Inventory were used to assess the psychological symptoms of depression, anxiety, psychological distress, and burnout among the study participants.

RESULTS

Of 111 nurses, 35 (31.5%), nine (8.1%), 26 (23.4%), and 49 (44.1%) experienced depression, anxiety, distress, and burnout, respectively. Nurses who performed COVID-19-related tasks were more likely to have moderate depression (related vs. unrelated, 52.0% vs. 25.6%; p=0.037). There were no differences in anxiety, distress, and burnout between nurses with and without COVID-19-related tasks. More than 50% of the participants showed receptive and positive attitudes toward caring for COVID-19 patients.

CONCLUSION

Nurses who performed COVID-19-related tasks had a higher risk of depression. There were no significant differences in anxiety, distress, and burnout between the two groups. Since nurses who perform COVID-19-related tasks are more prone to psychological distress, continued psychiatric interventions are required for infectious disease outbreaks with a high mortality rate for healthcare workers who are emotionally vulnerable.

The COVID-19 Stress Perceived on Social Distance and Gender-Based Implications

The COVID-19 pandemic is an unprecedented event entailing long-term consequences on population health and welfare. Those who contracted the coronavirus may have suffered from both physical and mental health issues that unfold the need for tailored intervention strategies. Hence, our study aims to investigate the psychological and social consequences of COVID-19 on a sample of 86 participants, encompassing 43 patients (clinical group; 25 women; mean age = 50.4 ± 10.1 years) recruited from Bari University Hospital, 19 of whom were hospitalized due to the disease. The remaining 43 were individuals not fallen ill with COVID-19 to date (control group; 25 women; mean age = 50.4 ± 10.1 years). The investigation yielded significant gender differences in post-traumatic stress symptoms, depression, and representation of interpersonal distance (IPD), evaluated through the IES-R, the BDI-II, and the IVAS task, respectively. This pattern of results was not replicated in the control group. In general, participants who reported having experienced the most intense post-traumatic symptoms also presented a greater mood deflection and, more specifically, within the clinical group women obtained the highest scores on both scales. Women reported higher IES-R and BDI-II scores compared to men, that could indicate that women who have contracted COVID-19 are more exposed to post-traumatic and depressive symptoms. Our results also showed a significant effect of COVID-19 on IPD with a tendency of disease-experienced individuals to increase their preferred IPD from adults, children, and elderly people. Regarding gender differences in mood and proxemic behavior, a correlation between depressive symptoms and probable PTSD and a further correlation between probable PTSD and greater IPD were found in women from both clinical and control group. Overall, these findings might contribute to a better understanding of gender-based implications of the current pandemic on mental health, also leading to the development of integrated yet personalized intervention strategies.

COVID-19 Anxiety in among the People of North Iran and its Relationship with Some Factors in 2020–2021

Introduction & Objective: COVID-19 infection is a highly contagious disease that has affected a large population worldwide. The total number of deaths due to this virus is more than the cases caused by any of its predecessors. As there is little information about this disease, it causes anxiety in the community. Due to the lack of research in this field to assess mental health concerns during the disease, the present study was conducted to assess COVID-19 Anxiety in among the people of northern Iran and its Relationship with Some Factors   Materials and Methods: This cross-sectional (descriptive-analytical) study was conducted in Gorgan in 2020. Sampling was done using Convenience sampling method and a sample size of 400 people was obtained. Data were collected online using the Coronavirus Anxiety Scale (CAS). The collected data were analyzed using Spearman, Mann-Whitney U, and Kruskal-Wallis tests by SPSS version 23. In order to deduce quantitative responses, normality was first measured. Statistical significance level was considered at P=0.05.   Results: The results showed that COVID-19 anxiety in the people of Gorgan was 15.76±9.34. Most of the participants (n=243, 60.8%) had low levels of anxiety. Also, COVID-19 anxiety in mental dimension (11.32±5.5) was higher than anxiety in physical dimension (4.44±4.78) in the people of Gorgan. Non-parametric Kruskal-Wallis test also showed that the mean score of anxiety was significantly correlated with education level (P=0.01) and different occupation levels (P<0.001). Regarding gender, Mann-Whitney U test showed that there was a statistically significant difference in the mean score of anxiety between men and women (P=0.003).   Conclusion: The results indicate that following the COVID-19 pandemic as an emerging disease, although the anxiety of the people of Gorgan was generally at a low level, but this anxiety was more in the mental dimension than in the physical dimension. Therefore, in order to maintain and promote the mental health of people in the community, it is suggested to pay more attention to the mental dimensions caused by the disease. Adopting programs to promote mental health can also be helpful.

The Impact of COVID-19 on Social Workers: An Assessment of Peritraumatic Distress

SUMMARY

There is broad consensus that COVID-19 has had a pernicious impact on social work, in general, and among social work practitioners, more specifically. However, at present, very few, if any, empirical examinations of this impact exist. This exploratory study examined peritraumatic distress among a sample of social workers (N = 3920) in one southeastern state in the United States.

FINDINGS

Analysis suggests that distress is impacted by several variables. In general, participants identifying as male, married, reporting good physical and mental health, working in microcontexts, and who were finically secure tended to experience less COVID-19 associated distress. In addition, social workers identifying as LGBTQ* and who had been working mostly remotely experienced higher levels of distress.

APPLICATIONS

Overall, findings indicate the need to provide adept support to social workers practicing during the pandemic. Data suggest the need for targeted support initiatives, typically for those who are from underrepresented groups (e.g., LGBTQ*) or experiencing financial or mental/physical health issues. Certainly, researchers should continue to examine the impact of COVID-19 on social work practitioners and service delivery.

Environmental scan of mental health supports across Canadian burn centers: A healthcare providers’ perspective

BACKGROUND

Early mental health care and psychosocial support after burn injury provided by a variety of specialists and non-mental health professionals is instrumental in prevention of long-term mental health sequalae such as post-traumatic stress, depressive or substance use disorders. Diversity of mental health supports available to burn survivors vary across geography, resulting in variation of long-term mental health outcomes following burn injury.

METHODS

A mixed-methods study utilizing a semi-structured questionnaire to explore resources available for burn survivors in Canada as an inpatient, outpatient, and more broadly in the aftercare community. Interviews were completed with 17 Canadian burn centers, with a variety of burn care professionals.

RESULTS

In the continuum of burn care, a lack of available mental health professionals in certain regions and in the outpatient and community phases was observed. Emerging themes demonstrated the need for regular screening for mental health concerns among burn survivors and providing up to date discharge resources. In addition, increasing educational opportunities available to burn care staff with respect to burn survivor mental health was emphasized. Lastly, the importance of proactive and prolonged psychological support for burn survivors as they progress through an outpatient, rehabilitation and community setting was underlined.

CONCLUSIONS

Identification of burn care practices and resources across Canada provides the opportunity to compare, unify and improve gaps in care that exist across the Canadian burn network.

A Comparative Cross-Sectional Study of the Consequences of the COVID-19 Lockdown on Women's Health Behaviors in Spain

Changes in health habits were observed during the COVID-19 pandemic. An unequal distribution of responsibilities may have generated unequal levels of stress in men and women, and, therefore, this may have led to different impacts on their health habits during lockdown. This study aimed to analyze the changes in eating habits, physical activity, sleep, and body weight in women, compared to men, because of lockdown. A comparative cross-sectional study was carried out. 2834 Spanish volunteers aged 19 to 76 completed an online survey on health habits. Descriptive and inferential analyses were performed using a cross-sectional methodology to explore gender differences. Results showed that men maintained their health habits to a greater extent, performing the same physical activity, while maintaining the quantity and quality of sleep, the quality of the diet, the quantity of the intake, and their mealtimes and body weight, whereas women's eating habits changed in relation to the quality of their diet and mealtimes, as their food intake and weight increased, and their sleep was poorer in quality and duration than it was before lockdown. This could be due to the higher levels of anxiety experienced by women as a result of working on essential jobs in addition to taking on more unpaid work associated with care and housework.

Stress and depressive symptoms among Italian mental health nurses during the COVID-19 pandemic, a cross-sectional study

This study used the cross-sectional web survey methodology to assess how the COVID-19 pandemic affected Italian psychiatric nurses in terms of stress levels and depressive symptoms. A total of 266 nurses belonging to the Italian Mental Health Departments were interviewed and they were subjected to two validated scales respectively PSS-10 (for the evaluation of stress) and PHQ-9 (for the evaluation of depressive symptoms). Statistical analysis showed moderate stress levels and a prevalence of sub-threshold (borderline) depressive symptoms among responding nurses. Logistic regression analysis reported that frontline nurses on COVID-19 positive patients are at greater risk of reporting higher levels of stress and major depressive symptoms, as are female nurses and juvenile nurses. age. Monitoring and managing the psychological well-being of nursing staff are to be considered among the priorities of mental health service managers and are part of a process that aims to increase individual and organizational well-being but above all to improve the outcomes resulting from assistance.

Retrospective Recall of Psychological Distress Experienced During the First COVID-19 Lockdown in Italy: Results From the ALT RISCOVID-19 Survey

Objectives: To estimate psychological distress experienced during the Italian lockdown (March-May 2020) by assessing, in the transition period of the pandemic (June-September 2020), participants’ recalling of their psychological state.

Methods: Cross-sectional analysis on 1,880 adults (mean age 48.9 ± 14.5 years) from the web-based ALT RISCOVID-19 survey. Participants were asked to retrospectively recall their psychological state during lockdown concerning symptoms of depression (Patients’ Health Questionnaire), anxiety (General Anxiety Disorder), stress (Perceived Stress Scale) and post-traumatic stress (Screening Questionnaire for Disaster Mental Health).

Results: Experienced symptoms of depression, anxiety and post-traumatic stress was recalled by 15.8, 15.3 and 13.1% of respondents, respectively. These psychometric scales tended to decrease during the 4-month period of assessment (p < 0.05), while perceived stress levels did not (p = 0.13). Men and older individuals reported lower symptoms of depression (β = −0.42 and β = −0.42; p < 0.0001, respectively), anxiety (β = −0.41 and β = −0.45; p < 0.0001, respectively), stress (β = −0.36 and β = 0.50; p < 0.0001, respectively) and post-traumatic stress (β = −0.42; p < 0.0001, men vs women).

Conclusion: Recalled psychological distress experienced during COVID-19 lockdown tended to decrease during the transition period of the pandemic, except for stress. Women and younger people were at higher risk to recall psychological distress.

Depression and anxiety symptoms and perceived stress in health professionals in the context of COVID-19: Do adverse childhood experiences have a modulating effect?

BACKGROUND

Adverse childhood experiences (ACE) have a great impact on mental health outcomes of adults. However, little is known whether ACE may act as modulators of the mental health of health professionals caring for patients with COVID-19.

METHODS

Data were collected through an online cross-sectional survey administered to health professionals in Lima (Peru) between May and July 2020. The survey included standardized self-assessment instruments for anxiety, depression, acute stress (AS) and history of ACE.

RESULTS

A total of 542 health professionals completed the survey. Caring for patients with COVID-19 was significantly associated with depression and anxiety and when caring for patients with COVID-19 was combined with a history of early sexual abuse, its effect on the risk of anxiety increased (OR = 7.71, p = .010). Mental health problems were associated with female gender in almost all the analyses and with the majority of ACEs.

CONCLUSIONS

Health workers in the context of the COVID-19 pandemic presented a high risk of mental health disorders. Antecedents of sexual abuse acted as a potentiating factor of anxiety in professionals providing COVID-19 care. These findings suggest that the burden of ACE modulates mental health problems in health professionals during the pandemic.

Mental health impacts of COVID-19 on healthcare workers in the Eastern Mediterranean Region: a multi-country study

BACKGROUND

Healthcare workers (HCWs) fighting against the COVID-19 pandemic are under incredible pressure, which puts them at risk of developing mental health problems. This study aimed to determine the prevalence of depression, anxiety, and stress among HCWs responding to COVID-19 and its associated factors.

METHODS

A multi-country cross-sectional study was conducted during July-August 2020 among HCWs responding to COVID-19 in nine Eastern Mediterranean Region (EMR) countries. Data were collected using an online questionnaire administered using KoBo Toolbox. Mental problems were assessed using the Depression, Anxiety, and Stress Scale (DASS-21).

RESULTS

A total of 1448 HCWs from nine EMR countries participated in this study. About 51.2% were male and 52.7% aged ≤ 30 years. Of all HCWs, 57.5% had depression, 42.0% had stress, and 59.1% had anxiety. Considering the severity, 19.2%, 16.1%, 26.6% of patients had severe to extremely severe depression, stress, and anxiety, respectively. Depression, stress, anxiety, and distress scores were significantly associated with participants' residency, having children, preexisting psychiatric illness, and being isolated for COVID-19. Furthermore, females, those working in a teaching hospital, and specialists had significantly higher depression and stress scores. Married status, current smoking, diabetes mellitus, having a friend who died with COVID-19, and high COVID-19 worry scores were significantly associated with higher distress scores.

CONCLUSIONS

Mental problems were prevalent among HCWs responding to COVID-19 in EMR. Therefore, special interventions to promote mental well-being among HCWs responding to COVID-19 need to be immediately implemented.

COVID-19 pandemic and mental health of a sample of Brazilian caregivers of people with dementia

Social distancing policies adopted in the COVID-19 pandemic generated a negative psychological impact on the general population and can affect caregivers of people with dementia more severely.

Anxiety about COVID-19 Infection, and Its Relation to Smartphone Addiction and Demographic Variables in Middle Eastern Countries

This study explores the level and frequency of anxiety about COVID-19 infection in some Middle Eastern countries, and differences in this anxiety by country, gender, workplace, and social status. Another aim was to identify the predictive power of anxiety about COVID-19 infection, daily smartphone use hours, and age in smartphone addiction. The participants were 651 males and females from Jordan, Saudi Arabia, the United Arab Emirates, and Egypt. The participants’ ages ranged between 18 and 73 years (M 33.36, SD = 10.69). A questionnaire developed by the authors was used to examine anxiety about COVID-19 infection. Furthermore, the Italian Smartphone Addiction Inventory was used after being translated, adapted, and validated for the purposes of the present study. The results revealed that the percentages of participants with high, average, and low anxiety about COVID-19 infection were 10.3%, 37.3%, and 52.4%, respectively. The mean scores of anxiety about COVID-19 infection in the four countries were average: Egypt (M = 2.655), Saudi Arabia (M = 2.458), the United Arab Emirates (M = 2.413), and Jordan (M = 2.336). Significant differences in anxiety about COVID-19 infection were found between Egypt and Jordan, in favor of Egypt. Significant gender differences were found in favor of females in the Jordanian and Egyptian samples, and in favor of males in the Emirati sample. No significant differences were found regarding workplace and social status. The results also revealed a significant positive relationship between anxiety about COVID-19 infection, daily smartphone use hours, and age on the one hand, and smartphone addiction on the other. The strongest predictor of smartphone addiction was anxiety about COVID-19 infection, followed by daily use hours. Age did not significantly contribute to the prediction of smartphone addiction. The study findings shed light on the psychological health and cognitive aspects of anxiety about COVID-19 infection and its relation to smartphone addiction.

A cross-sectional study on generalized anxiety disorder and its socio-demographic correlates among the general population in Saudi Arabia

BACKGROUND

Generalized anxiety disorder (GAD) is often described than define as a psychological illness that is characterized by excessive worry. Little attention has been given to anxiety disorders by the medical community in Saudi Arabia. This study was carried out to screen for GAD among adults and determine the correlation of anxiety disorder with other comorbidities.

METHODOLOGY

This study was a cross-sectional observational study carried out among adults aged 18 years and above in the general population in Saudi Arabia. The people were screened by using an Arabic validated version of General Anxiety Disorder-7 (GAD-7) questionnaire that was sent as a Google link via emails or different social media (Twitter, Facebook, WhatsApp, and Telegram groups) of the general population. The study was approved by the hospital research committee and the Institutional Review Board (HlRI-05-Apr21-01).

RESULTS

We collected 338 participants in response to our questionnaire where 60.7% of them were females and 54.5% were aged between 25 and 34 years old. hypersensitivity, rheumatoid arthritis (RA), hypertension and diabetes mellitus (DM) were the main medical conditions represented by 7.6%, 4.8%, 3.7%, and 3.4%. According to GAD-7 questionnaire, prevalence of any degree of anxiety was 62.1% where 33.1% of the total sample had mild anxiety, 15.7% had a moderate degree of anxiety and 13.3% had severe anxiety. Anxiety was related to age, residency, occupation, and some medical conditions.

CONCLUSION

We found high prevalence of anxiety among our population which was the highest among younger participants, and students. Moreover, we found that prevalence and severity of anxiety were higher in patients with chronic conditions and depressed patients.

Fear of COVID-19 in Patients with Acute Myocardial Infarction

A marked decline in myocardial infarction (AMI) hospitalizations was observed worldwide during the COVID-19 outbreak. The pandemic may have generated fear and adverse psychological consequences in these patients, delaying hospital access. The main objective of the study was to assess COVID fear through the FCV-19S questionnaire (a self-report measure of seven items) in 69 AMI patients (65 ± 11 years, mean ± SD; 59 males). Females presented higher values of each FCV-19S item than males. Older subjects (>57 years, 25th percentile) showed a higher total score with respect to those in the first quartile. The percentage of patients who responded "agree" and "strongly agree" in item 4 ("I am afraid of losing my life because of the coronavirus") and 3 ("My hands become clammy when I think about the coronavirus") was significantly greater in the elderly than in younger patients. When cardiovascular (CV) patients were compared to a previously published general Italian population, patients with CV disease exhibited higher values for items 3 and 4. Measures should be put in place to assist vulnerable and high CV risk patients, possibly adding psychologists to the cardiology team.

Attitudes of a geriatric population towards risks about COVID-19 pandemic: in the context of anxiety and depression

BACKGROUND

A curfew for elderly people was announced in Turkey to protect the geriatric population during the COVID-19 pandemic. Although this may have the beneficial effect of preventing infection, psychological distress may also increase with prolongation of the pandemic.

METHODS

Geriatric patients were interviewed by telephone due to the ongoing curfew. Demographical characteristics, comorbidities, personal risk perception of COVID-19, common concerns related to COVID-19, and experiences of delayed hospital admission due to the pandemic were recorded. The Hospital Anxiety and Depression Scale (HADS) was used to assess psychological distress, anxiety, and depression.

RESULTS

Participants (n = 136; 82 females, 60.3%) had a mean age of 73.4 ± 5.9 years. The most common comorbidity was hypertension (75%). Approximately 80% of the participants reported a decrease in physical activity during the curfew period. The HADS scores indicated rates of anxiety as 25.7% and depression as 16.9%. Anxiety was significantly more common in females than males (P = 0.002). Sleep problems (P = 0.000), fatigue (P = 0.000), and hopelessness (P = 0.000) were more common in participants with depression and anxiety. Logistic regression analyses showed an association between a delay in hospital admission and the presence of depression (P = 0.0029, R²  = 0.146). Personal risk perception of COVID-19 was statistically significantly higher among patients with anxiety (P = 0.0027, R²  = 0.157).

CONCLUSION

Decreased adaptation to external and internal factors among older individuals may facilitate unfavourable outcomes of the pandemic. These results indicate that the geriatric population was mentally and physically affected by the restrictions and isolation.

Anxiety and depression symptoms in older adults during coronavirus disease 2019 pandemic: A community-based cross-sectional study

OBJECTIVES

The coronavirus disease 2019 pandemic has caused high morbidity and mortality in older adults over the world. Because the coronavirus disease 2019 pandemic greatly affects older adults who have a preexisting health condition, they are generally susceptible to a high incidence of severe symptoms of anxiety and depression. Therefore, we aimed to assess the prevalence of anxiety and depression symptoms in older adults during the coronavirus disease 2019 pandemic.

METHODS

Community-based cross-sectional study was completed in August 2020. Standardized and pretested General Anxiety Disorder-7 and Geriatric Depression Scale were used to screen the symptoms of anxiety and depression, respectively. Data were entered into EpiData (version 4.3.2) and transferred to SPSS (version 24) for further analysis. Bivariate and multivariate logistic regression analyses were carried out to determine the significantly associated variables with a 95% confidence interval at p < 0.05.

RESULTS

Of the total older adults interviewed, 68.7% had developed symptoms of anxiety and 59.9% had symptoms of depression during the coronavirus disease 2019 pandemic. Female participants, having a chronic disease and poor knowledge of the coronavirus disease 2019 pandemic, were significantly associated with anxiety symptoms. Age category of 81 to 90 and above 90, lack of social support, and having a chronic disease were significantly associated with symptoms of depression.

CONCLUSION

The symptoms of anxiety and depression among older adults in the North Shoa Zone during coronavirus disease 2019 were higher than before the coronavirus disease 2019 happened. The results were evidence points for developing a psychological intervention to tackle the older adults' mental health needs in the community during and after the coronavirus disease 2019 pandemic.

A Study of the Association between the Stringency of Covid-19 Government Measures and Depression in Older Adults across Europe and Israel

Background: The COVID-19 pandemic is having major adverse consequences for the mental health of individuals worldwide. Alongside the direct impact of the virus on individuals, government responses to tackling its spread, such as quarantine, lockdown, and physical distancing measures, have been found to have a profound impact on mental health. This is manifested in an increased prevalence of anxiety, depression, and sleep disturbances. As older adults are more vulnerable and severely affected by the pandemic, they may be at increased psychological risk when seeking to protect themselves from COVID-19. Methods: Our study aims to quantify the association between the stringency of measures and increased feelings of sadness/depression in a sample of 31,819 Europeans and Israelis aged 65 and above. We hypothesize that more stringent measures make it more likely that individuals will report increased feelings of sadness or depression. Conclusions: We found that more stringent measures across countries in Europe and Israel affect the mental health of older individuals. The prevalence of increased feelings of sadness/depression was higher in Southern European countries, where the measures were more stringent. We therefore recommend paying particular attention to the possible effects of pandemic control measures on the mental health of older people.

Mental Health States Experienced by Perinatal Healthcare Workers during COVID-19 Pandemic in Italy

BACKGROUND

The ongoing COVID-19 pandemic has had an impact on mental health status in a variety of populations.

METHODS

An online non-probability sample survey was used to assess psychological distress symptoms and burnout among perinatal healthcare professionals (PHPs) during the pandemic in Italy. The questionnaire included the Depression, Anxiety, and Stress Scale-21 (DASS-21) and the Maslach Burnout Inventory (MBI). Demographic and occupational factors associated with stress, anxiety, and depression symptoms were analyzed.

RESULTS

The sample size was 195. The estimated self-reported rates of moderate to severe anxiety symptoms, depression symptoms, and perceived stress levels were 18.7, 18.7, and 21.5%, respectively. Furthermore, 6.2% of respondents reported burnout. One factor associated with all three self-reported psychological distress issues was suffering from trauma unrelated to the pandemic (aOR: 7.34, 95% CI: 2.73-20.28 for depression; aOR: 6.13, 95% CI: 2.28-16.73 for anxiety; aOR: 3.20, 95% CI: 1.14-8.88 for stress). Compared to physicians, psychologists had lower odds of developing clinically significant depressive symptoms (aOR: 0.21, 95% CI: 0.04-0.94) and high stress levels (aOR: 0.19, 95% CI: 0.04-0.80).

CONCLUSIONS

High rates of self-reported symptoms of depression and anxiety, as well as perceived stress, among PHPs were reported during the COVID-19 pandemic. Health authorities should implement and integrate timely and regular evidence-based assessment of psychological distress targeting PHPs in their work plans.

Depressive State in the Emergency Department During COVID-19: A National Cross-Sectional Survey in China

Chinese emergency department (ED) staff encountered significant mental stress while fighting the coronavirus disease 2019 (COVID-19) pandemic. We sought to investigate the prevalence and associated factors for depressive symptoms among ED staff (including physicians, nurses, allied health, and auxiliary ED staff). A cross-sectional national survey of ED staff who were on duty and participated in combating the COVID-19 pandemic was conducted March 1-15, 2020. A total of 6,588 emergency medical personnel from 1,060 hospitals responded to this survey. A majority of respondents scored above 10 points on the PHQ-9 standardized test, which is associated with depressive symptoms. Those aged 31-45, those working in the COVID-19 isolation unit, and those with relatives ≤ 16 or ≥70 years old at home all had statistically significant associations with scoring >10 points. Depressive symptoms among Chinese emergency medical staff were likely quite common during the response to the COVID-19 pandemic and reinforce the importance of targeted ED staff support during future outbreaks.

Anxiety and associated factors among Ethiopian health professionals at early stage of COVID-19 pandemic in Ethiopia

Introduction

In late 2019, a new coronavirus disease known as COVID-19 (novel coronavirus disease 2019) was identified. As there is no any drug to treat this pandemic, the healthcare professionals are disproportionately at higher risk. The mental health outcome is expected to be high. Anxiety is expected to have a significant impact on health professionals, especially among those who work without adequate resources for self-protection.

Objectives

The objectives of this research was to assess self-reported anxiety symptoms and associated factors among Ethiopian healthcare professionals in the early stages of the pandemic.

Methods

We have conducted an online cross-sectional study to collect information from healthcare professionals in Ethiopia during the early stage of the outbreak from April 7, 2020 to May 19, 2020. GAD-7 was used for measurement of anxiety. We have used a cut of point of 10 and above to report anxiety symptoms. We have used Google Forms for online data collection and SPSS-22 for analysis. To determine associated factors for anxiety, a binary logistic regression model was used. Variables with p-value < 0.2 during the bivariable binary logistic regression were exported for further analysis in the multivariable binary logistic regression. Finally, variables with p-value <0.05 were considered as significantly associated with the outcomes.

Results

Three hundred and eighty-eight healthcare professionals filled the online questionnaire; Majority (71.1%) were males. Significant number of respondents (78.9%) reported lack of adequate personal protective equipment (PPE) at the work place. The prevalence of anxiety was 26.8%.

Being female (AOR: 1.88; 95% C.I:1.11, 3.19), visiting/treating 30–150 patients per day (AOR: 3.44; 95% C.I:1.51, 7.84), those employed at private healthcare institutions (AOR: 2.40; 95% C.I:1.17, 4.90), who do not believe that COVID-19 is preventable (AOR: 2.04; 95% C.I:1.04, 4.03) and those who reported lack of PPE (AOR: 1.98; 95% C.I:1.04, 3.79) were more likely to be anxious.

Conclusions

The anxiety prevalence among healthcare professionals in Ethiopia during early stage of COVID-19 pandemic was high. This study shows that lack of preventive equipment, being female, contact with many patients, low self-efficacy and working in private health facilities were risk factors for anxiety. Anxiety prevention among health professionals during COVID-19 pandemic requires a holistic approach including provision of sufficient PPE, improving self-efficacy and addressing problems both at public and private institutions and focusing more on female health professionals.