Psychological distress related to COVID-19 - The contribution of continuous traumatic stress

A network analysis of daily stressors, subjective well-being, psychological distress and psychological capital during the COVID-19 pandemic

BACKGROUND

There is already considerable evidence suggesting the potential existence of a comprehensive system that reflects how individuals utilize psychological capital (PsyCap) to preserve mental health amid daily stressors during the COVID-19 pandemic. To explore the underlying mechanism of this system, the current study is the first to use network analysis showing the dimension-level correlation patterns of daily stressors, subjective well-being (SWB), psychological distress and PsyCap during the pandemic.

METHOD

We recruited 1556 participants in China and assessed daily stressors, SWB, psychological distress, and PsyCap through self-report questionnaires. A dimension-level network analysis was conducted to identify key dimensions and their associations. Relative importance analysis examined the contribution of each PsyCap dimension to SWB and psychological distress.

RESULT

Depression, anxiety and stress demonstrated high strength, and life satisfaction exhibited the highest bridge strength in the network. The great majority dimensions of daily stressors had positive connections with stress and anxiety, while financial restrictions and dissatisfaction with education/occupation had negative connections with life satisfaction. Self-efficacy and optimism were positively connected with life satisfaction. Hope and resilience were negatively connected with stress, as well as hope and optimism were negatively connected with depression. Optimism and self-efficacy made the highest contribution to SWB, while resilience made the highest contribution to psychological distress among PsyCap dimensions.

CONCLUSION

The findings elucidate the intricate relationship between daily stressors, SWB, psychological distress and PsyCap during the pandemic. Targeted interventions focusing on the specific PsyCap dimensions may enhance mental health outcomes in the post-COVID-19 era.

Real-world predictors of severe psychological distress during the COVID-19 pandemic in Japan: Insights from a large-scale internet-based cohort study

AIM

The COVID-19 pandemic has had negative physical and psychological impacts worldwide. However, there has been a lack of real-world evidence concerning the predictors of severe psychological distress (SPD) among the general population in Japan during the COVID-19 pandemic. The aim of this study was to examine predictors of SPD during the COVID-19 pandemic.

METHODS

We investigated the predictors of new-onset SPD in the general Japanese population using data from a large-scale internet-based cohort study.

RESULTS

We included 16 489 study participants (age range = 16-81, mean age = 52.7, percentage of male = 50%) in the analysis. Over the course of 1 year from baseline, the estimated proportion of participants who experienced SPD was 5.2% with inverse probability weighting. The predictors of SPD included younger age, being never married, being unemployed, having a higher education background, scoring higher on the Fear of Coronavirus-19 Scale, experiencing more adverse childhood experiences, reporting poorer subjective health status, and COVID-19 with oxygen therapy. Our internet-based survey of the Japanese population may have selection bias, limiting the generalizability to other countries and cultures.

CONCLUSION

This study revealed that being afflicted with COVID-19 requiring oxygen therapy is the most significant predictor of SPD. In addition, we found that vulnerability to social isolation, such as never being unmarried, anxiety toward COVID-19, and susceptibility to stress, are predictors of the emergence of SPD. Therefore, the implementation of online support systems and ensuring access to accurate information may protect against SPD during the COVID-19 pandemic in Japan.

The Shield of Self-Esteem: Buffering against the Impact of Traumatic Experiences, Fear, Anxiety, and Depression

BACKGROUND

Adverse life occurrences (e.g., severe accidents, violence/abuse, organic disorders such as COVID-19) can elicit traumatic responses that heighten fear, anxiety, and depression. However, scientific research has shown that certain variables, such as self-esteem, based on theories like terror management theory (TMT) and the anxiety-buffering hypothesis (ABH), can mitigate the negative effects of trauma. This study aimed to test the ABH by assessing the buffering role of self-esteem in the relationships among the impact of traumatic experiences, fear, anxiety, and depression.

METHOD

An observational research design was used. This study involved 321 participants who experienced COVID-19 as a traumatic experience. A sequential multiple-mediation model with observed variables (path analysis) was used to test the impact of the traumatic experience on fear, anxiety, and depression, examining the protective role of self-esteem.

RESULTS

A path analysis revealed that fear and anxiety mediated the relationship between the impact of the traumatic experience of COVID-19 and depression. Additionally, in line with the ABH, self-esteem was found to mediate the relationship between the predictors and their adverse psychological consequences. This suggests that self-esteem played a buffering role, mitigating the negative impact of traumatic experiences on mental health outcomes.

CONCLUSIONS

These findings underscore the central mediating role of self-esteem, as well as fear and anxiety, in the pathway from trauma-related factors to depression. These insights advocate for evidence-based interventions aimed at alleviating the psychological suffering associated with traumatic experiences, fostering adaptation, and supporting psychological health.

The role of prior trauma exposure and subsequent posttraumatic stress disorder in reactions to the COVID-19 pandemic: A qualitative study

OBJECTIVE

A growing body of literature suggests that the COVID-19 pandemic is a traumatic stressor capable of causing posttraumatic stress symptoms. People with a history of trauma, particularly those with posttraumatic stress disorder (PTSD), may be particularly vulnerable to the negative mental health impacts of the pandemic. However, qualitative research exploring potential differences in the lived experiences of and reactions to COVID-19 between people with and without PTSD is lacking.

METHOD

Semistructured interviews were conducted with 31 women (n = 15 women with probable PTSD, n = 16 women without probable PTSD) recruited from an ongoing U.S.-based cohort study. Themes were identified using inductive thematic analysis.

RESULTS

The majority of women with PTSD described their level of fear or perceived safety related to COVID-19 as a major factor influencing their mental health during the pandemic. In contrast, women without PTSD indicated that their level of distress was largely driven by pandemic-related restrictions on normal activities and family events. Many women with PTSD also described feeling anger or frustration toward people they perceived as not taking the COVID-19 pandemic seriously. Only one participant without PTSD expressed similar feelings.

CONCLUSIONS

This study found notable differences in reactions to the COVID-19 pandemic between people with and without PTSD, with findings that are likely relevant to future disasters. These findings can inform the development of preparedness policies for future disasters, pandemics, or other collective traumas to prevent distress and improve mental health, particularly for vulnerable populations such as individuals with preexisting PTSD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effects of perceived risk of COVID-19 on fear among visiting workers: Mediating role of perceived stress

With the creation of a social distancing policy due to coronavirus disease 2019 (COVID-19), home visit workers are under mental stress as they are treated as the source of infection for COVID-19. Since door-to-door rental equipment examiners and gas inspectors must perform their duties even in the COVID-19 situation, they are being discriminated against so severely. The purpose of study was to examine the mediating role of perceived stress on the relationship between risk perception and fear. Data was collected data through labor unions among 275 home visiting workers who examine rental home appliance equipment or inspecting gas. On-line survey was conducted to assess COVID-19 risk perception, fear, perceived stress, and demographic characteristics. The data was analyzed using PROCESS Macro (Model 4). The results of the study showed that stress plays an important role in increasing COVID-19 fears when COVID-19 risk perception increases. Meanwhile, it was found that COVID-19 fear decreased when the level of perceived stress decreased. To reduce the impact of COVID-19 risk perception on COVID-19 fears, appropriate educational programs to reduce stress should be developed for home visit workers. Policymakers need to develop online or mobile Infectious disease education programs for COVID-19 risk at work and establish policies to apply legal education.

Adapting Minds: Exploring Cognition to Threatened Stimuli in the Post-COVID-19 Landscape Comparing Old and New Concerns about Pandemic

The global population has been significantly affected by the pandemic in terms of physical and mental health. According to transactional theory, individuals have undergone an adaptation process influenced by cognitive control abilities. Emotional responses to COVID-19-related stimuli may interfere with top-down attentional processes, thereby hindering adaptation. This study aimed to investigate the impact of COVID-19-related stimuli on attentional processing and to determine whether psychological factors could modulate these effects. A sample of 96 healthy undergraduate students participated in an emotional Stroop task in which they were presented with a series of stimuli, including both neutral and negative COVID-19-related as well as non-COVID-19 stimuli. COVID-19-related PTSD, as an index of distress (PTSS), and trait anxiety were evaluated. Results showed that participants were more accurate in identifying COVID-19-related stimuli compared to non-COVID-19 stimuli. Being female and having higher retrospective PTSS scores related to COVID-19 were predictive of faster reaction times for both neutral and negative COVID-19-related stimuli. This heightened attentional bias toward COVID-19-related stimuli suggests that individuals may be more sensitive to stimuli associated with the pandemic. The results suggest that the association between COVID-19 stimuli and attentional biases extends beyond emotional valence, being retrospectively influenced by mental health, suggesting potential pathways to future mental health challenges.

Psycho-emotional impact of the COVID-19 pandemic on nursing professionals in Ecuador: a cross-sectional study

AIM AND OBJECTIVES

To analyse the levels of anxiety, depression, post-traumatic stress, and burnout among nursing professionals working in the Imbabura region of Ecuador during the COVID-19 pandemic and identify the contributing socio-occupational factors.

BACKGROUND

The high demand for care of COVID-19 patients led to increased work pressure on nurses, owing to increased demands for care and shortages of medical supplies and protective equipment.

DESIGN

A cross-sectional study was conducted from September to December 2022 using a self-administered questionnaire addressed to nursing professionals who cared for COVID-19 patients.

METHODS

The questionnaire included socio-demographic characteristics, the Spanish adaptation of Hospital Anxiety and Depression Scale (HADS-Spanish), Impact of Event Scale-Revised (IES-R) for the evaluation of post-traumatic stress disorder (PTSD), and the Spanish adaptation of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS-Spanish) for burnout assessment. Univariate and multivariate analyses were performed.

RESULTS

Of the 782 participants, 88.6% had a high level of burnout (MBI-HSS-Spanish scale score > 27). Female nurses, nurses with eight-hour work shifts, and older professionals exhibited high levels of anxiety and depression. Prolonged working hours in COVID-19 patient care services were found to be a risk factor for burnout and post-traumatic stress.

CONCLUSIONS

Participating nurses presented with a high level of chronic work stress and exhibited signs of anxiety and depression during the period under consideration. Providing nurses with psychological support measures and performing liaison consultations will alleviate the psychological burden on nurses.

RELEVANCE TO CLINICAL PRACTICE

The study has shown that accounting for the environments where the emotional impact is greatest and how to reduce it would not only reduce anxiety, depression, and burnout in nurses but also improve the quality of care, not only in pandemic.

PATIENT OR PUBLIC CONTRIBUTION

Nurses contributed to the conduct of the study by participating in the data collection via questionaries.

Long-Term Efficacy of a Mobile Mental Wellness Program: Prospective Single-Arm Study

BACKGROUND

Rising rates of psychological distress (symptoms of depression, anxiety, and stress) among adults in the United States necessitate effective mental wellness interventions. Despite the prevalence of smartphone app-based programs, research on their efficacy is limited, with only 14% showing clinically validated evidence. Our study evaluates Noom Mood, a commercially available smartphone-based app that uses cognitive behavioral therapy and mindfulness-based programming. In this study, we address gaps in the existing literature by examining postintervention outcomes and the broader impact on mental wellness.

OBJECTIVE

Noom Mood is a smartphone-based mental wellness program designed to be used by the general population. This prospective study evaluates the efficacy and postintervention outcomes of Noom Mood. We aim to address the rising psychological distress among adults in the United States.

METHODS

A 1-arm study design was used, with participants having access to the Noom Mood program for 16 weeks (N=273). Surveys were conducted at baseline, week 4, week 8, week 12, week 16, and week 32 (16 weeks' postprogram follow-up). This study assessed a range of mental health outcomes, including anxiety symptoms, depressive symptoms, perceived stress, well-being, quality of life, coping, emotion regulation, sleep, and workplace productivity (absenteeism or presenteeism).

RESULTS

The mean age of participants was 40.5 (SD 11.7) years. Statistically significant improvements in anxiety symptoms, depressive symptoms, and perceived stress were observed by week 4 and maintained through the 16-week intervention and the 32-week follow-up. The largest changes were observed in the first 4 weeks (29% lower, 25% lower, and 15% lower for anxiety symptoms, depressive symptoms, and perceived stress, respectively), and only small improvements were observed afterward. Reductions in clinically relevant anxiety (7-item generalized anxiety disorder scale) and depression (8-item Patient Health Questionnaire depression scale) criteria were also maintained from program initiation through the 16-week intervention and the 32-week follow-up. Work productivity also showed statistically significant results, with participants gaining 2.57 productive work days from baseline at 16 weeks, and remaining relatively stable (2.23 productive work days gained) at follow-up (32 weeks). Additionally, effects across all coping, sleep disturbance (23% lower at 32 weeks), and emotion dysregulation variables exhibited positive and significant trends at all time points (15% higher, 23% lower, and 25% higher respectively at 32 weeks).

CONCLUSIONS

This study contributes insights into the promising positive impact of Noom Mood on mental health and well-being outcomes, extending beyond the intervention phase. Though more rigorous studies are necessary to understand the mechanism of action at play, this exploratory study addresses critical gaps in the literature, highlighting the potential of smartphone-based mental wellness programs to lessen barriers to mental health support and improve diverse dimensions of well-being. Future research should explore the scalability, feasibility, and long-term adherence of such interventions across diverse populations.

Exploring COVID-19 Phobia among International Chinese College Students in South Korea Before Ending COVID-19 Restrictions

BACKGROUND

College students, considered to be the driving force of society, are highly vulnerable to COVID-19. At a time when facing a new pandemic wave in 2022, China's policy was in contrast with that of Korea. We investigated the phobia levels of international Chinese college students studying in Korea.

OBJECTIVE

This study aimed to investigate the relationship between the frequency of use and trust of information sources, and COVID-19 phobia (C19P) among Chinese college students studying in Korea before ending related restrictions.

METHODS

This study employed a cross-sectional design, conducting an online survey among Chinese college students studying in Korea from April 8-15, 2022 (before Korea ended the limitations due to COVID-19). Data about 319 respondents were analyzed, including socio-demographics, information variables, knowledge, attitudes, practices (KAP), and C19P. Hierarchical regression analysis with different models was used to examine the relationship between information trust, KAP, and C19P.

RESULTS

Results showed that students performed well in knowledge and preventive practices, had diverse sources of getting information related to COVID-19, and highly depended on the internet and news. Students who perceived a higher severity of infection showed higher levels of COVID-19 phobia. The tendency to wear masks with family/friends, avoid crowded places, and not agree with Korean government mitigation policies reported higher levels of COVID-19 phobia.

CONCLUSIONS

More authority and proactive communication strategies, such as consultations or education programs, are needed for international students to alleviate their phobias and psychological stress.

Impact of Home-Based Work during the COVID-19 Pandemic on Mental and Physical Health in a German Population-Based Sample

Background: The COVID-19 outbreak necessitated physical distancing, as part of secondary prevention, at a personal and professional level. Working from home (WFH) became increasingly important. In this study, the impact of the COVID-19 pandemic restrictions on physical and mental health is investigated, compared with pre-pandemic data, and with employees who WFH and are on-site. Methods: Data from the German Saxon longitudinal study population were used. Attitudes towards WFH as well as mental and physical health assessments during the COVID-19 pandemic were examined. Comparisons were made with corresponding pre-pandemic scores and between employees WFH and on-site in 2022. Results: In total, 319 participants with equal gender distribution were included. Of those, 86 worked from home stating better organizability of their work, more time for partnership, less stress, and greater work satisfaction. Compared to pre-pandemic data, the D-score, PHQ-4, G-Score, and PHQ-SSS-8 showed a significant increase. No difference in physical or mental health between employees WFH and on-site was observed. Conclusion: In general, COVID-19 restrictions had a negative impact on mental and physical health. Although WFH is well accepted, it did not show significant health benefits.

Self-compassion, childhood emotional neglect, and posttraumatic growth: Parental well-being during COVID-19

BACKGROUND

The CoronaVirus Disease 2019 (COVID-19) pandemic can be conceptualized as a trauma that created additional unique stressors for parents. Self-compassion might promote posttraumatic growth (PTG); however, parents with histories of childhood emotional neglect may struggle to practice self-compassion when their own affectional needs were unmet earlier in life, carrying implications for both parental and child well-being. The objective is to examine the relationship between childhood emotional neglect and pandemic-related PTG, and the moderating role of self-compassion.

METHODS

An online cross-sectional survey collected information from 436 parents (M = 37.62 years, SD = 9.31) across the U.S. on pandemic- and parenting-related stresses, childhood emotional neglect, self-compassionate behavior, psychological distress, and pandemic-related PTG. Multiple regression analyses were conducted to analyze relationships among childhood emotional neglect, self-compassionate behavior, and pandemic-related PTG.

RESULTS

Parents who reported greater frequency of self-compassionate behavior tended to report higher pandemic-related PTG. Childhood emotional neglect alone did not predict pandemic-related PTG; however, for parents who reported less frequent self-compassionate behavior, greater childhood emotional neglect predicted lower pandemic-related PTG.

LIMITATIONS

The cross-sectional design and sample homogeneity limit both causal inference and generalizability. Limitations in operationalization of PTG and self-compassion constructs are discussed.

CONCLUSIONS

Findings emphasize the utility of self-compassionate behavior in promoting pandemic-related PTG, especially for adults with histories of childhood emotional neglect. Self-compassion is a freely accessible practice that individuals can implement successfully with minimal instruction. In terms of clinical relevance, therapists may be able to identify points of intervention wherein self-compassion may stimulate pandemic-related PTG.

The Case for Trauma-Informed Chronic Disease Care: Exploring Trauma Among Adults With Obesity On Dialysis

This study describes how U.S. dialysis patients with obesity experience trauma and manage it and co-occurring chronic diseases. We interviewed 40 adult hemodialysis patients and 20 physicians and dietitians. Transcripts were inductively coded using trauma theory. Patients described trauma that impacted their ability to manage co-morbidities. Providers characterized patient trauma and their own vicarious trauma while working in dialysis care. Nearly all patients reported trauma, most with characteristics of chronic, emotional, and/or medical trauma, and many described trauma from systems and vicarious trauma across relationships. Complex intersecting trauma exacerbates chronic disease burdens and may impact treatment effectiveness, successful management of co-morbidities, and patients' relationships. Results demonstrate the need for trauma interventions within chronic disease treatment and community settings.

Risk factors associated with depression and anxiety among the Chinese general population after retracting the dynamic zero-COVID policy: A network analysis

BACKGROUND

Recent studies have evidenced the negative psychological consequences of the COVID-19 pandemic and sociodemographic vulnerability among the general population, while limited information was available on which factors make the greatest contribution to psychological distress when these factors were considered concurrently. Herein, we aimed to investigate the pathways that underlie psychological distress in the context of retracting dynamic zero-COVID policy.

METHODS

We employed the mixed graphical model to construct the network of depression (PHQ-9), anxiety (GAD-7), and pandemic-related factors in a general population sample (N = 1610). Then, we re-examined the network by adding sociodemographic variables to further explore the influence of sociodemographic factors. Additionally, we repeated the analyses in the second sample (N = 620) collected in the same period to assess the replicability.

RESULTS

The relationships between the pandemic factors and anxiety and depressive symptoms exhibited a tendency to decrease after adding demographic variables, and income became the most important node and shared edge weights with all anxiety and depressive symptoms. These findings were replicable with the second sample. No significant difference in the network properties was detected between the two samples.

LIMITATIONS

The cross-sectional design limits the ability to observe longitudinal changes in these risk factors and their relationship with psychological distress.

CONCLUSIONS

Income level, rather than the pandemic-related factors, acted as a vital role in the psychological distress of the general population, implying that livelihood issues may be the critical intervention targets for mental health during the post-pandemic period.

Psychological and social determinants of adaptation: the impact of finances, loneliness, information access and chronic stress on resilience activation

Background

Many people who face adversity, such as disasters, demonstrate resilience. However, less is known about reactions to large scale disasters with longer recovery periods. The concern is that protracted disasters may result in more chronic or accumulated stressors with an uncertain or unknown end point and can exhaust the natural coping methods and ability to rebound. Thus, understanding patterns of longer-term disaster recovery, inclusive of resilience, is needed. Further resilience is not individual specific rather social determinants, such as support networks and available resources, are contributing factors.

Methods

The purpose of this study is to improve understanding of mental health and resilience during increased stress, we aim to identify profiles of adaptation and psychological and social determinants that predict membership within predominant symptom groupings. We conducted an exploratory cross-section study (N = 334) with two phases of multivariate analysis. Latent profile models were estimated to identify groups based on depression, anxiety, and resilience scores. The second phase included a step-wise multinomial logistic regression to predict class membership.

Results

We identified four distinct groups: 33% of participants were categorized as anxious, 18% depressed, 9% comorbid, and 40% with above average levels of resilience. Psychosocial factors such as demographics, trauma history, information access, loneliness, and lack of financial resources predicted poorer mental health outcomes and lower resilience.

Conclusion

This study identified factors that contribute to overall wellbeing despite chronic stressors. Social determinants of adaptation, found in this study population, include loneliness, finances, and information access. The findings from this study support the need for both psychological and social adaption supports, inclusive of mental health treatment, to strengthen resilience activation.

Trauma history predicts depression and posttraumatic stress symptoms better than a psychiatric diagnosis: Comparing wartime, routine time, and early COVID-19 in Israel

Individuals with a psychiatric diagnosis and those with a history of trauma are at high risk for depression and posttraumatic stress symptoms (PTSS) following exposure to new traumatic events. Nevertheless, research is scarce on how having both a psychiatric diagnosis and a trauma history affect reactions to new traumatic events, and how different trauma types may affect individuals with a psychiatric diagnosis. We thus examined whether different stressful contexts (War and COVID-19) affected individuals with and without a psychiatric diagnosis differentially and whether results might be explained by prior trauma exposure. In the same cohort, we assessed depression and PTSS during wartime (2014), routine time (2016), and during the COVID-19 pandemic (2020) in a sample with (n = 89) and without (n = 104) a self-reported psychiatric diagnosis. This cohort was recruited during the 2014 Israel-Gaza War using social media, snowballing and outreach to mental health rehabilitation centres. We used a linear mixed modelling approach on data from the entire sample, as well as on the two study groups separately. We found that trauma history predicted PTSS and depression whereas a history of psychiatric diagnosis did not. Regarding trauma types, we found that individuals in the psychiatric diagnosis group relative to themselves had more symptoms during COVID-19 compared to war and routine time, while those without diagnosis had more PTSS and depression symptoms during wartime compared to routine time and COVID-19. In conclusion, a traumatic past may have an important influence on reactions to different types of traumatic events. Distinct traumatic events may affect individuals with or without a psychiatric diagnosis differentially.

Cumulative trauma and perceived community resilience: A serial mediation model

Communities affected by cumulative trauma can experience negative psychological reactions but also posttraumatic growth and community resilience, which promote adaptation and preparation for future traumatic events. This study aims to investigate the mechanisms that mediate the relationship between traumatic events and perceived community resilience. Participants were 118 Italian adults who experienced cumulative trauma and were recruited to complete an online survey. A serial multiple mediation model was estimated to assess whether the impact of the Morandi bridge collapse and posttraumatic growth mediated the relationship between the psychological impact of the Covid-19 pandemic and perceived community resilience. The impact of the collapsed bridge and posttraumatic growth in serial partially mediated the relationship between the impact of the Covid-19 pandemic and perceived community resilience. The impact of cumulative trauma can be considered through an ecological perspective that considers the consequences of these events in relation to community resilience.

The long-term effects of consecutive COVID-19 waves on mental health

BACKGROUND

Although several studies have documented the impact of the COVID-19 pandemic on mental health, the long-term effects remain unclear.

AIMS

To examine longitudinal changes in mental health before and during the consecutive COVID-19 waves in a well-established probability sample.

METHOD

An online survey was completed by the participants of the COVID-19 add-on study at four time points: pre-COVID-19 period (2014-2015, n = 1823), first COVID-19 wave (April to May 2020, n = 788), second COVID-19 wave (August to October 2020, n = 532) and third COVID-19 wave (March to April 2021, n = 383). Data were collected via a set of validated instruments, and analysed with latent growth models.

RESULTS

During the pandemic, we observed a significant increase in stress levels (standardised β = 0.473, P < 0.001) and depressive symptoms (standardised β = 1.284, P < 0.001). The rate of increase in depressive symptoms (std. covariance = 0.784, P = 0.014), but not in stress levels (std. covariance = 0.057, P = 0.743), was associated with the pre-pandemic mental health status of the participants. Further analysis showed that secondary stressors played a predominant role in the increase in mental health difficulties. The main secondary stressors were loneliness, negative emotionality associated with the perception of COVID-19 disease, lack of resilience, female gender and younger age.

CONCLUSIONS

The surge in stress levels and depressive symptoms persisted across all three consecutive COVID-19 waves. This persistence is attributable to the effects of secondary stressors, and particularly to the status of mental health before the COVID-19 pandemic. Our findings reveal mechanisms underlying the surge in mental health difficulties during the COVID-19 waves, with direct implications for strategies promoting mental health during pandemics.

The mental health impacts of the COVID-19 pandemic among individuals with depressive, anxiety, and stressor-related disorders: A scoping review

OBJECTIVE

A scoping review of studies published in the first year of the COVID-19 pandemic focused on individuals with pre-existing symptoms of depression, anxiety, and specified stressor-related disorders, with the objective of mapping the research conducted.

ELIGIBILITY CRITERIA

(1) direct study of individuals with pre-existing depressive, anxiety, and/or specified stressor-related (i.e., posttraumatic stress, acute stress) disorders/issues; (2) focus on mental health-related pandemic effects, and; (3) direct study of mental health symptoms related to depression, anxiety, or psychological distress.

SOURCES OF EVIDENCE

Database-specific subject headings and natural language keywords were searched in Medline, Embase, APA PsycInfo, and Cumulative Index to Nursing & Allied Health Literature (CINAHL) up to March 3, 2021. Review of potentially relevant studies was conducted by two independent reviewers and proceeded in two stages: (1) title and abstract review, and; (2) full paper review.

DATA CHARTING

Study details (i.e., location, design and methodology, sample or population, outcome measures, and key findings) were extracted from included studies by one reviewer and confirmed by the Principal Investigator.

RESULTS

66 relevant articles from 26 countries were identified. Most studies adopted a cross-sectional design and were conducted via online survey. About half relied on general population samples, with the remainder assessing special populations, primarily mental health patients. The most commonly reported pre-existing category of disorders or symptoms was depression, followed closely by anxiety. Most studies included depressive and anxiety symptoms as outcome measures and demonstrated increased vulnerability to mental health symptoms among individuals with a pre-existing mental health issue.

CONCLUSION

These findings suggest that improved mental health supports are needed during the pandemic and point to future research needs, including reviews of other diagnostic categories and reviews of research published in subsequent years of the pandemic.

Perceived social support attenuates increased hostile reactions to traumatic threat

OBJECTIVE

Extant literature has seldom examined the naturalistic role of reaction to threat on downstream emotional distress while also considering buffers, such as perceived social support, to acute negative mental health outcomes. The present study examined how trauma symptoms, in reaction to a global stressor, predicted increased psychological distress via elevated emotional hostility and whether perceived social support modified such effects. We predicted a priori that increased exposure to trauma would be associated with increased hostility and global psychological distress, but that this path would be attenuated by greater levels of perceived social support, as individuals who report greater support exhibit greater emotional coping.

METHODS

We recruited 408 adults from a large university in the Midwestern United States to participate in a survey assessing past-week trauma, hostility, distress, and perceived social support following the initial COVID-19 lockdown. The survey was conducted in March 2020, directly after strict shelter-in-place orders were locally mandated. To test our hypotheses, we employed a moderated mediation analysis approach.

RESULTS

Results demonstrate that higher trauma predicted increased hostility, which in turn predicted increased distress, and trauma predicted distress via hostility (an indirect effect). As hypothesized, higher perceived social support attenuated the association between trauma and hostility.

CONCLUSION

Results support a hostile emotional pathway that may increase distress in the context of increased traumatic impact; however, social support likely buffers these effects, particularly in the face of new or novel threats and stressors. Findings suggest broad application for understanding the relation between the introduction of stressors, psychological distress, and social support.

Predicting anxiety and depression over 12 months of the COVID-19 pandemic: A machine learning study

OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic was associated with substantial increases in anxiety and depressive symptoms. To understand individual risk, we examined a large set of potential risk factors for anxiety and depression in the pandemic context.

METHODS

Adults in the United States (N = 1200) completed eight online self-report assessments over 12 months of the COVID-19 pandemic. Area under the curve scores summarized cumulative experiences of anxiety and depression over the assessment period. A machine learning approach to elastic net regularized regression was used to select predictors of cumulative anxiety and depression severity from a set of 68 sociodemographic, psychological, and pandemic-related baseline variables.

RESULTS

Cumulative anxiety severity was most strongly explained by stress and depression-related variables (such as perceived stress) and select sociodemographic characteristics. Cumulative depression severity was predicted by psychological variables, including generalized anxiety and depressive symptom reactivity. Being immunocompromised or having a medical condition were also important.

CONCLUSIONS

By considering many predictors, findings provide a more complete view than previous studies focused on specific predictors. Important predictors included psychological variables suggested by prior research and variables more specific to the pandemic context. We discuss how such findings can be used in understanding risk and planning interventions.

COVID-19 in Bangladesh: Wave-centric assessments and mitigation measures for future pandemics

The ongoing pandemic COVID-19 caused by Severe Acute Respiratory Coronavirus-2 (SARS-CoV-2) has wreaked havoc globally by affecting millions of lives. Although different countries found the implementation of emergency measures useful to combat the viral pandemic, many countries are still experiencing the resurgence of COVID-19 cases with new variants even after following strict containment guidelines. Country-specific lessons learned from the ongoing COVID-19 pandemic can be utilized in commencing a successful battle against the potential future outbreaks. In this article, we analyzed the overall scenario of the COVID-19 pandemic in Bangladesh from Alpha to Omicron variant and discussed the demographic, political, economic, social, and environmental influences on the mitigation strategies employed by the country to combat the pandemic. We also tried to explore the preparedness and precautionary measures taken by the responsible authorities, the choice of strategies implemented, and the effectiveness of the response initiated by the government and relevant agencies. Finally, we discussed the possible strategies that might help Bangladesh to combat future COVID-19 waves and other possible pandemics based on the experiences gathered from the ongoing COVID-19 pandemic.

Moderating Effect of eHealth Literacy on the Associations of Coronaphobia With Loneliness, Irritability, Depression, and Stigma in Chinese Young Adults: Bayesian Structural Equation Model Study

BACKGROUND

The COVID-19 pandemic has led to an increase in known risk factors for mental health problems. Although medical information available through the internet and smartphones has greatly expanded, people's ability to seek, eschew, and use reliable web-based medical information and services to promote their mental health remains unknown.

OBJECTIVE

This study aims to explore the associations between coronaphobia and 4 frequently reported mental health problems, loneliness, irritability, depression, and stigma, during the COVID-19 pandemic and to assess the moderating effects of eHealth literacy (eHL) on the adjustment of these relationships in Chinese young adults.

METHODS

The data used in this study were collected from a web-based survey of the general Chinese population, aged between 18 and 30 years, conducted in China between December 2022 and January 2023. A nonprobability snowball sampling method was used for data collection. A Bayesian structural equation model (BSEM) using parameter expansion was used to estimate the moderating effect of eHL on the relationship between coronaphobia and psychological problems. The posterior mean and 95% highest density intervals (HDIs) were estimated.

RESULTS

A total of 4119 participants completed the questionnaire and provided valid responses. Among them, 64.4% (n=2653) were female and 58.7% (n=2417) were rural residents. All measures showed statistically significant but minor-to-moderate associations (correlation coefficients ranged from -0.04 to 0.65). Significant heterogeneity was observed between rural and urban residents at the eHL level, and coronaphobia was observed. The BSEM results demonstrated that eHL was a significant moderator in reducing the negative effects of coronaphobia on loneliness (posterior mean -0.0016, 95% HDI -0.0022 to -0.0011), depression (posterior mean -0.006, 95% HDI -0.0079 to -0.004), stigma (posterior mean -0.0052, 95% HDI -0.0068 to -0.0036), and irritability (posterior mean -0.0037, 95% HDI -0.0052 to -0.0022). The moderating effects of eHL varied across the rural and urban subsamples.

CONCLUSIONS

Using BSEM, this study demonstrated that improving eHL can significantly mitigate the negative effects of coronaphobia on 4 COVID-19-related mental health problems in Chinese young adults. Future eHL initiatives should target rural communities to ensure equal access to information and resources that can help protect their mental health during the pandemic.

Psychological Toll of the COVID-19 Pandemic: An In-Depth Exploration of Anxiety, Depression, and Insomnia and the Influence of Quarantine Measures on Daily Life

The COVID-19 pandemic, on a global scale, has prompted multifaceted challenges, including a notable psychological toll on the general population. This study uses mixed-method approach for a nuanced exploration of these experiences. Using a phenomenological strategy, qualitative responses from 999 participants were analyzed regarding their pandemic-induced anxiety and the influence of quarantine measures on their lives. Quantitative measures, including the revised Impact of Event Scale (IES-R), patient health questionnaire-9 (PHQ-9), the seven-item generalized anxiety disorder assessment (GAD-7), and Insomnia Severity Index (ISI), were used to quantify trauma, depression, anxiety, and insomnia attributed to COVID-19. Partial least squares structural equation modeling (PLS-SEM) was utilized for quantitative data analysis. The anxiety-related responses were mainly clustered into four themes: life threats, support shortage, economic consequences, and disruptions to family and social life. Subthemes that addressed the perceived effects encapsulated disruptions to academic and professional lives, familial and social relationships, psychopathological stress, and movement limitations. The findings from quantitative analysis revealed the significant associations between COVID-19-related trauma and symptoms of anxiety, depression, and insomnia, as indicated by coefficients exceeding 0.10 (all z-values > 1.96; p-values < 0.05). In conclusion, the findings underscore COVID-19's role in escalating anxiety, influenced by various factors, and its disruptive effects on daily life due to quarantine measures. The strong associations between the pandemic and the symptoms of depression, anxiety, and insomnia underscore the urgency of comprehensive psychological and public health interventions to alleviate these impacts.

Factors associated with ICD-11 posttraumatic stress disorder and complex posttraumatic stress disorder among older adults during the COVID-19 pandemic

ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD have been understudied in the older population. The study focused on the associations between traumatic exposure before the pandemic, COVID-19 worries, depression, and loneliness with current PTSD and CPTSD among older adults. A random sample of five hundred and twelve Israeli older adults (Mage = 72.67 ± 3.81, range 68-87) was recruited using a Web-based survey company (Ipanel, Israel). Participants completed questionnaires of demographic details, self-rated health, COVID-19 worries, trauma exposure, depressive symptoms, level of loneliness, PTSD, and CPTSD. Univariate logistic regression revealed that trauma exposure, COVID-19 worries, depression, and loneliness were associated with PTSD. Multinomial regression revealed that only trauma exposure was associated with PTSD among older adults with PTSD compared with those not reaching the PTSD cutoff level. In the comparison between older adults suffering from CPTSD with those not reaching the PTSD cutoff level, being married, higher levels of trauma exposure, COVID-19 worries, depression, and loneliness were associated with a higher risk of CPTSD. Results suggest that specific factors may be significant psychological correlates of CPTSD symptoms among older adults during the COVID-19 pandemic. Identifying these factors could assist practitioners in tailoring more effective interventions.

Generic drugs use during the COVID-19 pandemic among Lebanese patients using psychotropics: An opportunity for generic drug promotion

Introduction

The Coronavirus disease of 2019 (COVID-19) pandemic has imposed several challenges leading to the shortage of medications due to the disruption of their supply chains. Among others, patients using psychotropics encountered difficulties finding their medication despite the efforts of investing in local production. Encouraging patients to use generic drugs can be an effective strategy to ensure sustainable access to medication.

Objectives

This study aimed to describe the consumption of psychotropic medications during the COVID-19 pandemic and the willingness together with the reasons for using generic drugs. It also assessed the association between generic drugs and the general characteristics of the patients.

Design

A cross-sectional study was performed over a period of 4 months (July-October 2021) targeting 128 patients using psychotropic drugs.

Results

The sample included more women than men with a mean age of 38 years. Antidepressants were the psychotropic medications mostly consumed followed by anti-anxiety medications. Almost 13% of the patients started using psychotropics either through self-prescription or a friend's advice and 73.4% used generic drugs. Fear of dependence, unavailability of the brand drug, and pharmacist's recommendation were the main reported reasons for using generic drugs.

Conclusion

During the COVID-19 pandemic, the consumption of psychotropics increased due to new prescriptions and self-medication. No differences were noted between using generics and the characteristics of the patients in contrast to previous studies which support the implementation of generic prescription and substitution policies.

Effects of psychological distress and life satisfaction on COVID-related traumatic stress: An international, cross-sectional study

BACKGROUND

This study examines the individual impacts of psychological distress (i.e., depression and anxiety) and life satisfaction on COVID-related traumatic stress in an international sample of heterosexual versus LGBQ+ adults.

METHOD

Between July and August 2020, a cross-sectional electronic survey (n = 2482) was launched in five countries (India, Italy, Saudi Arabia, Spain, and United States) assessing sociodemographic characteristics as well as psychological, behavioral, and social factors related to health outcomes during the COVID-19 pandemic.

RESULTS

Significant differences between LGBQ+ participants and heterosexual participants were found for depression (p < .001) and anxiety (p < .001). Depression was associated with COVID-related traumatic stress among heterosexual participants (p < .001) but not LGBQ+ participants. Both anxiety (p < .001) and life satisfaction (p = .003) were also associated with COVID-related traumatic stress in both groups. Hierarchical regression models demonstrated significant effects of COVID-related traumatic stress for adults outside the United States (p < .001); less than full-time employment (p = .012); and for greater levels of anxiety, depression, and life satisfaction, respectively (all ps < .001).

LIMITATIONS

Given the stigma of being LGBQ+ that remains in many countries, participants in may have been reluctant to identify as a sexual minority and therefore indicated a heterosexual sexual orientation.

CONCLUSION

The impact of sexual minority stress among LGBQ+ may play a role in COVID-related post-traumatic stress. Large-scale global disasters such as pandemics, contribute to disparities in psychological distress among LGBQ+ individual, however, sociodemographic factors such as country and urbanicity may play mediating or moderating roles.

Surviving COVID-19: Biopsychosocial Impacts, Death Anxiety, and Coping Strategies

As the COVID-19 pandemic erupted, attempts to contain the spread of the virus took two concurrent forms, including mobility restrictions (aka lockdowns) and the race to produce a vaccine. However, it is quite striking that, amidst both the lockdown and the race to produce a vaccine, the question of how COVID-19 survivors/patients coped with the disease has not received the degree of attention it deserved. To navigate this issue, we employed a sample consisting of 100 COVID-19 survivors; this paper explores the relationship between the biopsychosocial (BPS) impacts of COVID-19, death anxiety, and coping strategies. In this context, the mediating role of death anxiety is placed in the spotlight. The analysis reveals a significant positive association between the BPS impact of COVID-19 and death anxiety and a significant negative association between death anxiety and coping strategies among COVID-19 survivors. Thus, death anxiety mediates the relationship between the BPS impact and the coping strategies that COVID-19 survivors adopt. Given the general recognition of the validity of the BPS model in contemporary medical science and practice, a thorough examination of COVID-19 survivors and their experiences related to surviving is necessary to match the challenges of today, including the increased probability of pandemics.

Profiles of risk factors for depressive and anxiety symptoms during the COVID-19 pandemic: A latent class analysis

The COVID-19 pandemic has caused a high burden in the general population. The exposure to an accumulation of risk factors, as opposed to a single risk, may have been associated with higher levels of depressive and anxiety symptoms during the pandemic. This study aimed to (1) identify subgroups of individuals with distinct constellations of risk factors during the COVID-19 pandemic and (2) investigate differences in levels of depressive and anxiety symptoms. German participants (N = 2245) were recruited between June-September 2020 through an online survey (ADJUST study). Latent class analysis (LCA) and multiple group analyses (Wald-tests) were conducted to identify profiles of risk factors and examine differences in symptoms of depression (PHQ-9) and anxiety (GAD-2). The LCA included 14 robust risk factors of different domains, for example, sociodemographic (e.g., age), health-related (e.g., trauma), and pandemic-related (e.g., reduced income) factors. The LCA identified three risk profiles: High sociodemographic risk (11.7%), high social and moderate health-related risk (18.0%), and low general risk (70.3%). Individuals with high sociodemographic risk reported significantly higher symptom levels of depression and anxiety than the remaining groups. A better understanding of risk factor profiles could help to develop targeted prevention and intervention programs during pandemics.

The Pandemic Anxiety Inventory: A validation study

The Pandemic Anxiety Inventory (PAI) assesses anxiety symptoms individuals attribute to the presence of a pandemic. We conducted this study of 379 British adults during the COVID-19 pandemic and found that the PAI exhibited excellent reliability and solid criterion validity. Pandemic anxiety was associated with reduced social support, anticipated life changes, financial strain, job loss, economic insecurity, and the hospitalization or death of a close friend or relative. Using correlational and bifactor analyses, we found that the PAI demonstrated solid convergent and discriminant validity. The findings suggest that the PAI can be used in research and clinical practice.

Trajectory of suicidal ideation among medical students during the COVID-19 pandemic: the role of childhood trauma

BACKGROUND

The aim of this study was to understand the longitudinal trajectory of suicidal ideation (SI) among Chinese medical students and the role of childhood trauma (CT).

METHODS

Using a whole-group sampling method, we assessed SI in 2192 (male = 834, female = 1358) medical students on three occasions over a period of one year. The Suicidal Ideation Self-Assessment Scale (SISAS) and the Childhood Trauma Questionnaire-Short Form (CTQ-SF) were used to assess SI and CT. The growth mixture modeling (GMM) was used to classify the developmental trajectory of SI.

RESULTS

A greater number of medical students were experiencing suicidal ideation during the COVID-19 pandemic. The trajectory of SI among medical students was divided into two groups: a low risk, slowly rising group and a high risk, continuous group. The low risk, slowly rising group had a significant time effect (B = 1.57, p < 0.001) and showed a slowly increasing trend. Emotional neglect (EN), physical neglect (PN), emotional abuse (EA) and physical abuse (PA) all had significant positive predictive effects for the high risk, continuous group (B = 0.18-0.65, P < 0.01).

CONCLUSION

The trajectory of SI among medical students can be divided into a low risk, slowly rising group and a high risk, continuous group; the more EN, PN, EA and PA experienced during childhood, the more likely medical students are to develop a high risk, continuous state of SI.

Continuous Exposure to Terrorism during the COVID-19 Pandemic: A Moderated Mediation Model in the Israeli Context

This study tested the role of perceived social support as a moderating factor in the mediation of COVID-19-related concerns in the association between continuous traumatic stress (CTS) and depression. The study participants were 499 college students who responded to an anonymous online questionnaire. Measures included the assessment of prior continuous exposure to threats of terrorism, COVID-19-related distress, perceived social support and depressive symptoms. The results demonstrated that COVID-19-related concerns mediated the relationship between continuous exposure to threats of terrorism and depression symptoms, and that perceived social support moderated the association between COVID-19-related concerns and depression. The implications of the study highlight the role of prior exposure to traumatic stress as a risk factor for depression and the role of social support as a protective factor. These results point to the need to develop accessible and non-stigmatic mental health services for populations exposed to other types of continuous traumatic stress.

Latent profiles of psychological status among populations cumulatively exposed to a flood and the recurrence of the COVID-19 pandemic in China

Henan Province in Central China was hit by unprecedented, rain-triggered floods in July 2021 and experienced a recurrence of the COVID-19 pandemic. The current study aims to identify the latent profiles of psychological status and acceptance of change among Henan residents who have been cumulatively exposed to these floods and the COVID-19 pandemic. A total of 977 participants were recruited. Latent profile analysis (LPA) was used to explore underlying patterns of psychological status (i.e., perceived risk of the COVID-19 pandemic, post-traumatic stress symptoms, anxiety and rumination) and acceptance of change. The predictors were evaluated with multinomial logistic regression. LPA identified four patterns of psychological status and acceptance of change: high distress/high acceptance (5.1%), moderate distress/moderate acceptance (20.1%), mild distress/mild acceptance (45.5%), and resilience (29.3%). The additive impact of the floods and COVID-19 pandemic and negative emotion during the floods were the risk factors, while flood coping efficacy, trust, and a closer psychological distance change were the protective factors. The present study therefore provides novel evidence on psychological status after both a natural disaster and a major public health event. The cumulative effects of the floods and the COVID-19 pandemic may have heightened the risk of post-disaster maladaptation. A complex relationship between psychological outcomes and acceptance of change was also found. The findings of this study thus provide a foundation for both disaster management and psychological assistance for particular groups.

Examining the prevalence and health impairment associated with subthreshold PTSD symptoms (PTSS) among frontline healthcare workers during the COVID-19 pandemic

The COVID-19 pandemic has increased healthcare workers' (HCWs) risk for posttraumatic stress disorder (PTSD). Although subthreshold PTSD symptoms (PTSS) are common and increase vulnerability for health impairments, they have received little attention. We examined the prevalence of subthreshold PTSS and their relationship to physical health symptoms and sleep problems among HCWs during the pandemic's second wave (01/21-02/21). Participants (N = 852; 63.1% male; Mage = 38.34) completed the Short-Form PTSD Checklist (SF-PCL), the Cohen-Hoberman Inventory of Physical Symptoms, and the PROMIS Sleep-Related Impairment-Short-Form 4a. We created three groups with the SF-PCL: scores ≥11 = probable PTSD (5.5%); scores between 1 and 10 = subthreshold PTSS (55.3%); scores of 0 = no PTSS (39.2%). After controlling for demographics, occupational characteristics, and COVID-19 status, HCWs with subthreshold PTSS experienced greater physical health symptoms and sleep problems than HCWs with no PTSS. While HCWs with PTSD reported the greatest health impairment, HCWs with subthreshold PTSS reported 88% more physical health symptoms and 36% more sleep problems than HCWs with no PTSS. Subthreshold PTSS are common and increase risk for health impairment. Interventions addressing HCWs' mental health in response to the COVID-19 pandemic must include subthreshold PTSS to ensure their effectiveness.

The Polish Catholic Church in Martin Coronado, Buenos Aires, and its Role in the Life of the Argentinian Polish Community during the COVID-19 Pandemic

The objective of the article is to determine the role of the Catholic Church in the life of the Polish community in Argentina as exemplified by the Polish Catholic Centre in Martin Coronado during the pandemic caused by the SARS-Cov-2 coronavirus. The article presents opinions of the Polish community in Buenos Aires concerning the priestly service of the Bernardine friars during the pandemic. The research confirms that the Argentinian Polish community evaluates the work of the clergymen very highly and emphasises that thanks to their support, peace and constant contact through, inter alia, introduction of the broadcast of the masses in the Polish language, they felt the care and support of the priests, which was necessary during social isolation. The article will also present a proposal of the model of activities that Polish priests from Martin Coronado can implement during the COVID-19 pandemic so that the faithful feel even greater support and closeness to the Polish missionary centre in Argentina.

Psychosocial impacts of the COVID-19 pandemic on women with trauma histories: Study of Women's Health Across the Nation (SWAN)

Older adults, particularly those with trauma histories, may be vulnerable to adverse psychosocial outcomes during the COVID-19 pandemic. We tested associations between prepandemic childhood abuse or intimate partner violence (IPV) and elevated depressive, anxiety, conflict, and sleep symptoms during the pandemic among aging women. Women (N = 582, age: 65-77 years) from three U.S. sites (Pittsburgh, Boston, Newark) of the longitudinal Study of Women's Health Across the Nation (SWAN) reported pandemic-related psychosocial impacts from June 2020-March 2021. Prepandemic childhood abuse; physical/emotional IPV; social functioning; physical comorbidities; and depressive, anxiety, and sleep symptoms were drawn from SWAN assessments between 2009 and 2017. There were no measures of prepandemic conflict. In total, 47.7% and 35.3% of women, respectively, reported childhood abuse or IPV. Using logistic regression models adjusted for age; race/ethnicity; education; site; prepandemic social functioning and physical comorbidities; and, in respective models, prepandemic depressive, anxiety, or sleep symptoms, childhood abuse predicted elevated anxiety symptoms, OR = 1.67, 95% CI [1.10, 2.54]; household conflict, OR = 2.19, 95% CI [1.32, 3.61]; and nonhousehold family conflict, OR = 2.14, 95% CI [1.29, 3.55]. IPV predicted elevated sleep problems, OR = 1.63, 95% CI [1.07, 2.46], and household conflict, OR = 1.96, 95% CI [1.20, 3.21]. No associations emerged for depressive symptoms after adjusting for prepandemic depression. Aging women with interpersonal trauma histories reported worse anxiety, sleep, and conflict during the COVID-19 pandemic than those without. Women's trauma histories and prepandemic symptoms are critical to understanding the psychosocial impacts of the pandemic.

Causal Model Analysis of the Effect of Formalism, Fear of Infection, COVID-19 Stress on Firefighters' Post-Traumatic Stress Syndrome and Insomnia

As the front line of epidemic prevention, firefighters are responsible for the transportation of infected cases. Firefighters are under a lot of stress from the new COVID-19, especially the fear that they may contract the virus at work and spread the virus to their families. In particular, the framework of this study incorporates Riggs' formalism variables. When firefighters think that the epidemic prevention regulations are inconsistent with the actual epidemic prevention, it will increase their work pressure on COVID-19. In this study, firefighters from all over Taiwan were used as the respondents, and a total of 453 respondents were obtained. This study uses confirmatory factor analysis and structural equation modeling to test the established hypotheses. The findings confirm that formalism, fear of self and family infection are positively influencing COVID-19 stress. COVID-19 stress positively affects PTSD and insomnia. COVID-19 stress negatively affects problem-focused strategies. Problem-focused strategies negatively affect post-traumatic stress disorder.

The Impact of COVID-19 Traumatic Stressors on Mental Health: Is COVID-19 a New Trauma Type

COVID-19 is a new type of trauma that has never been conceptually or empirically analyzed in our discipline. This study aimed to investigate the impact of COVID-19 as traumatic stress on mental health after controlling for individuals' previous stressors and traumas. We utilized a sample of (N = 1374) adults from seven Arab countries. We used an anonymous online questionnaire that included measures for COVID-19 traumatic stress, posttraumatic stress disorder, anxiety, depression, and cumulative stressors and traumas. We conducted hierarchical multiple regression, with posttraumatic stress disorder, depression, and anxiety as dependent variables. In the first step, in each analysis, we entered the country, gender, age, religion, education, and income as independent variables (Kira, Traumatology 7(2):73-86, 2001; Kira, Torture, 14:38-44, 2004; Kira, Traumatology, 2021, https://doi.org/10.1037/trm0000305). In the second step, we entered cumulative stressors and traumas as an independent variable. In the third step, we entered either COVID-19 traumatic stressors or one of its subtypes (fears of infection, economic, and lockdown) as an independent variable. Finally, we conducted structural equation modeling with PTSD, depression, and anxiety as predictors of the latent variable mental health and COVID-19 as the independent variable. Results indicated that COVID-19 traumatic stressors, and each of its three subtypes, were unique predictors of PTSD, anxiety, and depression. Thus, COVID-19 is a new type of traumatic stress that has serious mental health effects.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11469-021-00577-0.

Risk and protective factors for posttraumatic stress disorder in trauma-exposed individuals during the COVID-19 pandemic - findings from a pan-European study

HIGHLIGHTS

N =  4,607 trauma-exposed adult participants were recruited from the general population during the first year of the COVID-19 pandemic.The prevalence for probable posttraumatic stress disorder was 17.7%.We identified risk factors (e.g. poor health condition) and protective factors (e.g. social contact) associated with posttraumatic stress disorder.

Male sexual health predictors during the Covid-19 outbreak: a multicenter study

Background

Pandemic-induced feelings of fear and worry are all psychological implications of the COVID-19 pandemic. The goal of this study was to see how the COVID-19 pandemic affected male Sexual Health and to look for plausible predictors.

Methods

Married males were asked to fill out an Arabic Sexual Health questionnaire. Before and during the lockdown. Additionally, generalized Anxiety Disorder-7 and International Index of Erectile Function-5 questionnaires.

Results

A multicenter study. The survey was completed by 281 men in total. Only 130 males (47.3%) were satisfied with their Sexual performance before lockdown, compared to 170 males (56.5%) who were not satisfied (P 0.000). Financial issues (P ≤ 0.000), smoking habit prior to lockdown (P ≤ 0.001), spots practice (P ≤ 0.001), smoking during lockdown (P ≤ 0.001), presence of depressive disorder on the PHQ-9 total score (P ≤ 0.001), diagnosis of anxiety on the GAD-7 score (P ≤ 0.001), and presence of ED on the IIEf-5 questionnaire (P ≤ 0.001) were all found to be significant on univariate analysis. On bivariate analysis, financial issues (odds ratio [OR]: 3.56, P ≤ 0.000), presence of anxiety on GAD-7 (OR: 6.40, P ≤ 0.001), PHQ score (OR: 2.50, P ≤ 0.001), and diagnosis of ED on the IIEF-5 scale (OR: 7.50, P ≤ 0.001) were significantly associated with Sexual relationship stress and Sexual Health.

Conclusion

During and after COVID-19 lockdown, the presence of anxiety on the GAD-7 scale, PHQ score, and the diagnosis of ED on the IIEF-5 scale were all independent predictors of Sexual Health.

Associations between trait and state perceived stress and daily moods: COVID-19 stressful experiences as a moderator

Drastically disrupting daily routines, the global pandemic of COVID-19 has posed critical mental health threats to adolescents and young adults worldwide. Many of the extant empirical findings, however, have focused on individuals' psychological adjustment during the initial phase of the pandemic. It is less clear how COVID-19 stressful experiences impact young people's daily lives in the post-pandemic "new normal." Drawing on 7-day diary reports, the present study fills this gap by examining: (1) how daily perceived stress impacted daily emotional adjustment; and (2) the moderating effects of COVID-19 stressful experiences on these associations among 582 Chinese young adults (M age = 18.12, SD = .65; 69% females). Results indicated that higher levels of both trait (i.e., average levels) and state (i.e., daily fluctuations) perceived stress were associated with greater negative and anxious moods, and that prior pandemic-related experiences exacerbated the adverse impact of both trait and state perceived stress on daily moods. Specifically, young adults reporting greater COVID-19 stressful experiences demonstrated poorer emotional adjustment (i.e., lower levels of positive mood and higher levels of negative mood) on days when they had more fluctuations in perceived stress; the aggravating impact was stronger when the average levels of perceived stress were higher. By illuminating the moderating effects of COVID-19 stressful experiences, this study contributes to the limited, but burgeoning, research examining the prolonged impact of the COVID-19 health crisis on daily emotional adjustment in post-pandemic life.

Hardiness moderates the effects of COVID-19 stress on anxiety and depression

The COVID-19 pandemic has led to sharp increases in mental health problems around the world, most notably in anxiety and depression. The present study examines hardiness and age as potential protective factors against the mental health effects of COVID-related stress. A sample of Canadians balanced across age and gender, completed an online survey including measures of COVID related stressors, hardiness, depression, and anxiety, along with age, gender, and other demographics. Conditional PROCESS analysis showed that COVID stressors led to significant increases in anxiety and depression. Hardiness moderated these relations, with those high in hardiness showing less anxiety and depression. Age was negatively related to anxiety and depression, with highest levels observed among the younger respondents. At the same time, a moderating effect of age was found with respect to depression, with older people showing sharper increases in depression as COVID-related stress goes up. Gender was not a significant factor in any of these relations, meaning that the results apply equally well to both women and men. This study provides evidence that younger people who are also low in hardiness are most vulnerable to developing anxiety and depression while under COVID stress, and so would likely benefit from preventive intervention strategies. While anxiety and depression symptoms are highest among the young, older age groups appear more vulnerable to increasing rates of depression symptoms related to COVID stress. Clinicians and practitioners should thus be especially vigilant for COVID related increases in depression among older people, and those low in psychological hardiness.

Framing the meaning of COVID-19 and the psychological responses to it: Insights gleaned from selected theoretical approaches

This viewpoint article reviews theoretical approaches that are relevant to studying COVID-19 and the psychological reactions to it. We suggest that the published research can be viewed from four major theoretical perspectives: as a stress situation, traumatic event, shared reality/shared trauma, and loss and grief situation. We detail the terms and the main theory/ies underlying each approach and suggest how COVID-19 characteristics and the its' psychological consequences may be conceptualized in accordance with each approach. Additionally, we discuss the challenges and facets of each theoretical conceptualization that should be addressed in further research, and the necessity of exploring implications for practice.

The association between COVID-19-related stressors and mental health outcomes for survivors of past interpersonal and non-interpersonal trauma

The mental health difficulties of trauma survivors during the COVID-19 pandemic have been under-reported. This study explored the moderating role of trauma history and trauma type (interpersonal and non-interpersonal) in the association between COVID-19-related stressors and depression, anxiety, and stress. A sample of n = 321 participants ages 19 to 71 (M = 36.63, SD = 10.36) was recruited from across the United States through MTurk. Participants reported the number of COVID-19-related stressors, trauma history and psychological symptoms. Hierarchical multiple regression analyses, controlling for age, race, ethnicity, gender, education, and income levels, were used to determine (a) whether COVID-19-related stressors are associated with adverse mental health outcomes; (b) whether trauma history and (c) trauma type moderated this association. Results revealed significant interactions; for those with a trauma history, exposure to COVID-19-related stressors was associated with higher levels of depression (β = .21, p < .05) and anxiety (β = .19, p < .05). For those with a history of interpersonal trauma specifically, COVID-19-related stressors were associated with depression (β = .16, p < .05) more so than for those without a trauma history. These findings highlight the vulnerability of trauma survivors to the unprecedented COVID-19-related stress.

Risk factors for depression and anxiety during COVID-19 in Israel: A two-wave study before and during the pandemic

Research indicates that mental health problems increased across the globe after the outbreak of the COVID-19 pandemic. However, there is a need for research examining specific risk factors for mental health problems, while accounting for symptoms before the pandemic. This study examined risk factors for depression and anxiety symptoms among Israeli adults following the first wave of the COVID-19 pandemic in Israel, above and beyond depression and anxiety symptoms reported 3 years before the pandemic. We performed a two-wave 3-year longitudinal study (W1 July-September 2017; W2 May-June 2020). The final sample included 578 participants who completed anxiety and depression self-report questionnaires at both waves. The W2 assessment additionally included being considered high-risk for COVID-19, and measures regarding loneliness, perceived stress, and COVID-19 worries. Both anxiety and depression symptoms were significantly higher at W2 during the pandemic. Worries related to COVID-19, perceived stress, loneliness, and prior mental health symptoms predicted depression and anxiety in W2. Additionally, being younger was associated with W2 anxiety. The current study highlights risk factors for psychological distress in light of the COVID-19 pandemic. Attention of clinicians and policy makers should be given to the important role of loneliness when screening and treating people during this pandemic.

Life orientation and psychological distress in COVID recovered patients-the role of coping as a mediator

The coronavirus disease (COVID-19) pandemic has not only brought the risk of death but has brought unbearable psychological pressures to the people. Mental health of COVID patients is expected to be affected by the continuous spread of the pandemic. This study aims to find the mediating role of coping styles in the relationship between life orientation and psychological distress among COVID recovered patients. It was hypothesized that: life orientation is likely to have a relationship with coping; coping is likely to have a relationship with psychological distress and coping is likely to mediate the relationship between life orientation and psychological distress among patients recovered from COVID. For this purpose, 378 COVID-10 recovered patients' men (190) and women (188). Urdu translations of the Life Orientation scale revised, Brief Coping Orientation to Problem Experienced (COPE) and Impact of event scales were used to collect data. Results show that emotion-focused and avoidant coping mediate the relationship between life orientation and psychological distress. The research has implications for mental health practitioners and individuals dealing with health-related issues.

Emotion Regulation and Distress During the COVID-19 Pandemic: The Role of Childhood Abuse

The COVID-19 pandemic may be experienced as traumatogenic and may fuel or exacerbate psychological distress and trauma-related symptoms. Based on trauma research, one might expect that survivors of childhood abuse would be susceptible to these negative outcomes during the pandemic, and that among this population a stronger relation between emotion regulation difficulties and symptomatology would be found. Aiming to explore these suppositions, an online survey was conducted among 710 Israeli adults. Of them, 370 were childhood abuse survivors. A history of childhood abuse, COVID-19-related stressors, overall psychological distress, and peritraumatic stress symptoms during the pandemic were assessed via self-report measures. Participants with a history of childhood abuse had elevated overall psychological distress as well as peritraumatic stress symptoms during the pandemic, compared to nonabused participants, above and beyond demographic characteristics and COVID-19-related stressors. Emotion regulation difficulties were related to elevated psychological distress and peritraumatic stress symptoms among both childhood abuse survivors and nonabused participants. Nonetheless, a history of childhood abuse moderated the relations between the emotion regulation difficulty of being unable to engage in goal-directed behaviors when distressed (on one hand) and mental outcomes (on the other): Although the associations between inability to engage in goal-directed behaviors, overall psychological distress, and peritraumatic stress symptoms were nonsignificant among nonabused participants, they were significant among childhood abuse survivors. The current findings suggest that a history of childhood abuse might be a risk factor for distress in the face of COVID-19, and that childhood abuse survivors would benefit from clinical interventions that promote emotion regulation skills during this ongoing global health crisis.

The Effect of COVID-19 Lockdown on PHQ Depression Screening Scores for High School Athletes

Adolescent behavioral health was in crisis before COVID-19. The shutdown and reopening of in-person learning and extracurricular activities may have worsened this crisis. We examined high school athletes’ depression before and during the pandemic. Data were collected as part of a pilot program incorporating Patient Health Questionnaire (PHQ) screenings during high school sports physicals before the COVID-19 lockdown and three timepoints after. Statistical comparisons were made using logistic regression. A total of 927 individual scores were analyzed: 385 from spring 2020; 145 from fall 2020; 163 from fall 2021; and 234 from spring 2022. Fall 2020 students were 3.7 times more likely to have elevated PHQ-2 scores than spring 2020 students (95% CI = 1.8, 7.6). Fall 2021 and spring 2022 scores did not differ significantly from pre-pandemic, although trends of elevated scores persisted (OR = 1.6; 95% CI = 0.7, 3.5, and OR = 1.2; 95% CI = 0.6, 2.4, respectively). A significant difference in PHQ-9 depression severity classification was detected over time (p < 0.01). Elevated PHQ scores were found after the onset of the COVID-19 pandemic. After the initial peak in fall 2020, scores decreased but did not reach pre-pandemic levels.

The relationship of COVID-19 traumatic stress, cumulative trauma, and race to posttraumatic stress disorder symptoms

The purpose of this study was to test if coronavirus disease 2019 (COVID-19) traumatic stress predicts posttraumatic stress disorder (PTSD) symptoms after cumulative trauma and whether there is a three-way interaction between COVID-19 traumatic stress, cumulative trauma, and race in the prediction of PTSD. Using a cross-sectional design, a diverse sample of 745 participants completed measures of cumulative trauma, COVID-19 traumatic stress, and PTSD. COVID-19 traumatic stress accounted for a significant amount of the variance in PTSD above and beyond cumulative trauma. A significant interaction effect was found, indicating that the effect of COVID-19 traumatic stress in predicting PTSD varied as a function of cumulative trauma and that the effects of that interaction were different for Asians and Whites. There were generally comparable associations between COVID-19 traumatic stress and PTSD at low and high levels of cumulative trauma across most racial groups. However, for Asians, higher levels of cumulative trauma did not worsen the PTSD outcome as a function of COVID Traumatic Stress but did at low levels of cumulative trauma.

Identifying potential mechanisms between childhood trauma and the psychological response to the COVID-19 pandemic in Germany: a longitudinal study

Childhood maltreatment (CM) has been associated with adverse psychosocial outcomes during the pandemic, but the underlying mechanisms are unclear. In a prospective online study using baseline and 10-week follow-up data of 391 German participants, we applied multiple mediation analyses to test to what extent COVID-19 perceived stressors mediate the association between CM and later adverse psychosocial outcomes compared to established mediators of rumination and insecure attachment. We also explored the relative importance of different COVID-19 related stressors in predicting adverse psychological trajectories using elastic net regression. Results showed that CM was longitudinally associated with all adverse psychosocial outcome. COVID-19 perceived stressors, rumination, and insecure attachment mediated this relationship and full mediation was observed for the outcomes anxiety, stress and psychological well-being. COVID-19-related concerns about the future was most strongly and consistently associated with adverse psychosocial functioning. These findings provide preliminary evidence that COVID-19 perceived stressors, in particular concerns about the future, may be a key mechanism underlying the development of adverse psychosocial outcomes in individuals with a CM history. Thus, COVID-19 perceived stressors may require a higher priority for prevention and treatment efforts in vulnerable groups. Our results warrant replication in more representative cross-cultural samples.