Public mental health under the long-term influence of COVID-19 in China: Geographical and temporal distribution

Evolving policies, enduring impacts: Cross-sectional surveys of mental health, risk-related perceptions, and coping behaviors throughout China's U-turn in its stringent zero-COVID policy

OBJECTIVE

China's early encounter with COVID-19 and protracted prevention policies, presents an ideal case to study psychological changes during a prolonged and evolving crisis. This study aims to examine the shifts in mental health symptoms, risk-related perceptions, and associated coping behaviors within two large-scale samples of Chinese respondents, spanning from the pandemic's onset to the relaxation of the zero-COVID policy. Moreover, the study strives to identify protective factors that could potentially mitigate the pandemic's impact.

METHODS

Two online surveys were conducted during China's initial pandemic phase (February 25-28, 2020) and the relaxation of the zero-COVID policy (March 30-April 18, 2023). Participants' mental health indicators, risk-related perceptions, and coping behaviors were assessed using the Depression, Anxiety, and Stress Scale-21 Items, the 9-item Bergen Burnout Inventory, and other adopted scales. Multivariable linear models were employed to examine the enduring psychological impact of the pandemic and identify potential protective factors.

RESULTS

Analysis of two datasets comprising 1946 and 1878 participants from the onset and the remission of China's COVID-19 pandemic revealed an upward trend in various mental health indicators of Chinese respondents between 2020 and 2023. Similarly, risk-related perceptions, encompassing perceived severity, susceptibility, and self-efficacy, and risk-related information sharing witnessed an increase. Being female, single, residing in rural areas, having higher education, and lacking acquaintances with COVID-19 are protective factors against mental health risks. Additionally, being female, married, over 30, living in big cities, having higher education, and lacking personal or acquaintances' infection history are associated with engaging in protective behaviors and reduced information avoidance.

CONCLUSION

The study investigated the changes in mental health symptoms, risk-related perceptions, and coping behaviors of Chinese respondents between 2020 and 2023 and identified protective factors against the pandemic's impact, including demographic (gender, age), social (education, marital status, residence), and exposure (infection history) elements. Understanding these fluctuations and protective elements is crucial for policymakers, as it can inform the development of targeted strategies to alleviate negative psychological impacts while effectively managing future pandemics.

Researching into Chinese university students' mental health in the post-pandemic era - problems and causes

Introduction

Mental health challenges have still been widely pervasive among Chinese university students after the outbreak of the COVID-19 pandemic. This article aims to explore mental health challenges encountered by Chinese university students in the post-pandemic era and explain causes to these challenges using a qualitative approach.

Methods

We conducted six focus group interviews with university students in Zhuhai, China, and altogether 61 students including 43 female students, and 18 male students participated in the study.

Results

Our results indicate that sleep difficulties, anxiety, and stress are the three primary mental health challenges experienced by students. Academic pressure, social influence including peer pressure and pursuit of social acceptance, and pandemic related policies and measures are the causes to the above mental health challenges.

Discussion

The results of this study will inform the development of mental health promotion, intervention, and education activities for university students to bolster their resilience and cope with mental health problems in the post-pandemic era. Meanwhile, our results could illuminate the services stakeholders provide to university students in the future.

Practical and psychological challenges faced by Wuhan graduates after COVID-19 was controlled

Introduction: This study seeks to understand the reality and psychological difficulties faced by university graduates in Wuhan after the COVID-19 epidemic was controlled. Methods: A total of 6,417 graduate students were surveyed through an online questionnaire from late May to early June 2020. The questionnaire asked questions on depression, anxiety, insomnia, and suicidal behavior. In addition, self-administered epidemic-related questionnaires consisting of eight items were collected from university graduates. Results: Participants' positive detection rates for depression, anxiety, insomnia, and suicidal behavior are 13.4%, 8.3%, 4.4%, and 12.1%, respectively. The three biggest challenges faced by graduates are future development, economic difficulties, and employment problems. Conclusion: The detectable rate of depression, anxiety, and insomnia is low, and the detectable rate of suicide symptoms should be given more attention. The biggest problem of this group is their future development, and what they want to solve the most is the economic difficulty.

A Fresh Perspective on Examining Population Emotional Well-Being Trends by Internet Search Engine: An Emerging Composite Anxiety and Depression Index

Traditional assessments of anxiety and depression face challenges and difficulties when it comes to understanding trends in-group psychological characteristics. As people become more accustomed to expressing their opinions online, location-based online media and cutting-edge algorithms offer new opportunities to identify associations between group sentiment and economic- or healthcare-related variables. Our research provides a novel approach to analyzing emotional well-being trends in a population by focusing on retrieving online information. We used emotionally enriched texts on social media to build the Public Opinion Dictionary (POD). Then, combining POD with the word vector model and search trend, we developed the Composite Anxiety and Depression Index (CADI), which can reflect the mental health level of a region during a specific time period. We utilized the representative external data by CHARLS to validate the effectiveness of CADI, indicating that CADI can serve as a representative indicator of the prevalence of mental disorders. Regression and subgroup analysis are employed to further elucidate the association between public mental health (measured by CADI) with economic development and medical burden. The results of comprehensive regression analysis show that the Import-Export index (-16.272, p < 0.001) and average cost of patients (4.412, p < 0.001) were significantly negatively associated with the CADI, and the sub-models stratificated by GDP showed the same situation. Disposable income (-28.389, p < 0.001) became significant in the subgroup with lower GDP, while the rate of unemployment (2.399, p < 0.001) became significant in the higher subgroup. Our findings suggest that an unfavorable economic development or unbearable medical burden will increase the negative mental health of the public, which was consistent across both the full and subgroup models.

Geographic differences in psychological symptoms, sleep quality, and quality of life in patients with inflammatory bowel disease: A multicenter study in China

OBJECTIVE

We aimed to explore the geographic differences in psychological symptoms, sleep quality, and quality of life (QoL) among adult patients with inflammatory bowel disease (IBD).

METHODS

A unified questionnaire was developed to collect data on psychological status and QoL of IBD patients from 42 hospitals across 22 provinces, municipalities, and autonomous regions in China's mainland from September 2021 to May 2022.

RESULTS

A total of 2478 patients with IBD were surveyed. The proportions of patients with anxiety (28.5% vs 23.1%), depression (32.3% vs 27.8%), and poor QoL (44.8% vs 32.2%) were significantly higher in patients from the northern region compared to the southern region (all P < 0.05). In the western region, the proportions of patients with anxiety (31.9% vs 23.0%), depression (37.7% vs 26.7%), sleep disturbances (64.5% vs 58.5%), and poor QoL (44.9% vs 34.8%) were significantly higher than in the eastern and central regions (all P < 0.01). Patients from inland regions had significantly higher rates of anxiety (27.1% vs 23.3%), depression (32.5% vs 26.0%), sleep disturbance (62.0% vs 57.7%), and poor QoL (43.5% vs 29.9%) compared to those from coastal regions (all P < 0.05). In economically underdeveloped areas, the proportions of patients with depression (33.1% vs 28.5%) and poor QoL (52.0% vs 32.4%) were significantly higher than in economically (relatively) developed areas (both P < 0.05).

CONCLUSION

There are significant geographic differences in psychological symptoms, sleep quality, and QoL among Chinese patients with IBD, which might provide valuable insights for global IBD research and clinical practice.

Symptoms of anxiety and depression in Denmark during the first year of the COVID-19 pandemic: A two-wave matched-control study

Subsequent to the restriction measures taken to curb the COVID-19 infection rate, researchers theorized these would have detrimental mental health consequences. This two-wave matched-control study investigates depression and anxiety symptoms during the first 12 months of the pandemic (March 2020-March 2021) in Denmark with data from the I-SHARE and Project SEXUS studies. The I-SHARE study includes 1,302 (Time period 1 only n = 914, Time period 2 only n = 304, both time periods 1 and2 n = 84) Danish participants, and the sex and birth year-matched control participants from the Project SEXUS study comprise 9,980 Danes. During the first year of the pandemic, the study populations' anxiety and depression symptom mean levels did not significantly differ from pre-pandemic matched controls. Younger age, female gender, fewer children in the same household (depression only), lower education level, and not being in a relationship (depression only) were associated with increased anxiety and depression symptom scores. The key COVID-19-related variable linked with significantly higher anxiety and depression symptom scores was COVID-19-related loss of income. Contrary to initial concerns, we did not find a significant effect of the pandemic on anxiety and depression symptom scores. However, the results underscore the importance of structural resources to prevent income loss to safeguard mental health during crises such as a pandemic.

Associations between parental well-being and early learning at home before and during the COVID-19 pandemic: observations from the China Family Panel Studies

Background

COVID-19-related lockdowns and preschool closures resulted in many young children spending all their time at home. Some parents had to manage child care while working from home, and increased demands may have led them to experience considerable stress. Evidence indicates that among parents with young children, those who had pre-existing mental and physical conditions adapted less well than other parents. We considered associations between parental well-being and the home learning environment for young children.

Method

We leveraged data from the nationally representative China Family Panel Studies. We analyzed longitudinal data collected before (2018) and during (2020) the pandemic. Participants were parents of 1,155 preschoolers (aged 3-5 years in 2020). Moderated mediation models were conducted. Maternal and paternal psychological well-being, depression, physical health, and physical illness in 2018 and 2020 were predictors. The frequency of marital and intergenerational conflicts in 2020 were mediators. Primary caregiver-reported engagement in home learning activities and family educational expenditure and parent-reported time spent on child care in 2020 were outcome variables. The number of COVID-19 cases in each province 3 months before the 2020 assessment was the moderator. Child, parental, and household characteristics and urbanicity were covariates.

Results

Controlling for covariates, improvements in parental psychological well-being predicted more home learning activities and increases in paternal depression predicted less time spent by fathers on child care. Negative changes in maternal physical health predicted less family educational expenditure and mothers spending more time on child care. Family conflicts mediated the association between maternal physical illness in 2018 and family educational expenditure. The number of COVID-19 cases in a province (i) was positively associated with mothers spending more time on child care, (ii) moderated the association of improvements in maternal physical health and mothers spending less time on child care, and (iii) moderated the association of family conflicts and more family educational expenditure.

Conclusion

The findings indicate that decreased parental psychological and physical well-being foretells reductions in monetary and non-monetary investment in early learning and care at home. Regional pandemic risk undermines maternal investment in early learning and care, especially for those with pre-existing physical conditions.

Suicidal thoughts and burnout among physicians during the first wave of the COVID-19 pandemic in Spain

BACKGROUND

The exact mechanisms through which the impact of the SARS-CoV-2 pandemic could influence the prevalence of suicidal thoughts are not yet known, both in the general population and in health workers. The objectives of the present study are to determine the prevalence of suicidal thoughts in the physician population and to detect sociodemographic and clinical variables associated with presenting suicidal thoughts during the first wave of COVID-19.

METHODS

Cross-sectional observational study via an online survey distributed in Spain in June 2020 via 52 Official Medical Associations. The sample is made up of all practicing and registered physicians in Spain (3,140 of the 270,235 registered physicians in Spain). An online questionnaire which included sociodemographic, professional and work variables, variables related to the pandemic, work data in relation to COVID-19 and clinical variables (medical-psychiatric history and previous suicidal behaviour) was distributed.

RESULTS

In our sample, the prevalence of serious suicidal thoughts was 6.31% and up to 17.32% of the subjects reported thoughts about killing themselves during the pandemic. Being female (Exp (B)= 1.989, p=0.001), presence of previous suicide attempts (Exp(B)= 6.127, p=<0.001), taking a psychotropic drug (Exp(B)= 2.470, p=<0.001) and working in a different area during the pandemic (Exp(B)= 1.751, p= 0.037) were associated with a higher risk of suicidal ideation. Cohabiting was a protective factor in the development of suicidal ideation although not in all our measures (Exp(B)=0.940, p=0.850 Vs Exp (B)= 0.620, p=0.018).

LIMITATIONS

The main limitation of this study is its cross-sectional nature, which prevents establishing a causal relationship. As a strength, it stands out that it is a large sample of the population studied and in a particularly complex context of the pandemic.

CONCLUSIONS

Suicidal thoughts among the Spanish registered physician population during the pandemic is high and mainly associated with socio-demographic factors, clinical mental health variables, and aspects of job satisfaction.

Depression, Anxiety, and Suicidality in Individuals With Chronic Traumatic Brain Injury Before and During the COVID-19 Pandemic: A National Institute on Disability, Independent Living, and Rehabilitation Research Traumatic Brain Injury Model Systems Study

OBJECTIVE

To examine the prevalence, severity, and correlates of depression, anxiety, and suicidal ideation in people with traumatic brain injury (TBI) assessed before and during the COVID-19 pandemic.

DESIGN

Retrospective cohort study using data collected through the Traumatic Brain Injury Model Systems (TBIMS) network at 1, 2, 5, 10, 15, 20, 25, or 30 years post TBI.

SETTING

United States-based TBIMS rehabilitation centers with telephone assessment of community residing participants.

PARTICIPANTS

Adults (72.4% male; mean age, 47.2 years) who enrolled in the TBIMS National Database and completed mental health questionnaires prepandemic (January 1, 2017 to February 29, 2020; n=5000) or during pandemic (April 1, 2022 to June 30, 2021; n=2009) (N=7009).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 questionnaire.

RESULTS

Separate linear and logistic regressions were constructed with demographic, psychosocial, injury-related, and functional characteristics, along with a binary indicator of COVID-19 pandemic period (prepandemic vs during pandemic), as predictors of mental health outcomes. No meaningful differences in depression, anxiety, or suicidal ideation were observed before vs during the COVID-19 pandemic. Correlations between predictors and mental health outcomes were similar before and during the pandemic.

CONCLUSIONS

Contrary to our predictions, the prevalence, severity, and correlates of mental health conditions were similar before and during the COVID-19 pandemic. Results may reflect generalized resilience and are consistent with the most recent findings from the general population that indicate only small, transient increases in psychological distress associated with the pandemic. While unworsened, depression, anxiety, and suicidal ideation remain prevalent and merit focused treatment and research efforts.

COVID-19 related stress during and one year after the first wave of the pandemic outbreak in China: The role of social support and perceptions of the pandemic

Introduction

COVID-19 related stress might vary with the pandemic changes, as well as other associated factors. This study aimed to compare the stress level during the first wave of the pandemic outbreak and 1 year later in China, and to explore the differential roles of social support and perceptions of this disease in affecting pandemic-related stress over time.

Methods

COVID-19 related stress, social support, and perceptions of the pandemic (perceived threat, perceived protection, and perceived controllability) were measured using the Impact of Event Scale-Revised for COVID-19, the Multidimensional Scale of Perceived Social Support, and the Self-Compiled Scale of COVID-19 Related Perception, respectively. Using an online survey, two independent samples were collected during the first wave of the COVID-19 outbreak (Time 1: March 2020, N = 430) and 1 year later (Time 2: April 2021, N = 512).

Results

Levels of COVID-19 related stress and social support were lower at Time 2. Furthermore, at both Time 1 and Time 2, more social support was associated with less stress. Perceived protection and controllability of COVID-19 also mediated the relationship between social support and COVID-19 at both time points. However, the perceived threat of COVID-19 only served as a mediator at Time 1.

Conclusion

These results indicate that Chinese people might experience lower COVID-19 related stress as the pandemic progresses. The perceived threat of COVID-19 played a more critical role in stress experienced at Time 1. These findings not only underscore the importance of social support under the context of Chinese society, but also have implications for developing specific interventions targeting different perceptions of COVID-19 to reduce pandemic-related stress during the different waves of this pandemic.

Seeking care where they can: A systematic review of global trends in online alcohol treatment utilization among non-veteran and veteran women

Background

Findings from a person-level meta-analysis of online alcohol intervention trials suggest that women disproportionately seek out such interventions (Riper et al., 2018). Although women may be a "hidden population" that is particularly drawn to online alcohol interventions, trial design features may explain women's apparent over-representation in these trials.

Methods

This systematic review examined associations between gender-tailored recruitment/inclusion criteria and proportions of women enrolled in online alcohol intervention trials, evaluated whether community samples have greater proportions of women than clinical samples, and compared country-specific average proportions of women in trials to country-specific proportions of women with Alcohol Use Disorder (AUD).

Results

Forty-four trials met inclusion/exclusion criteria, 34 community samples and 10 drawn from clinical settings; 4 studies included U.S. veterans and were examined separately. The average proportion of community-recruited women across the studies was 51.20% and the average proportion of clinically-recruited women was 35.81%, a difference that was statistically significant. Across the countries with relevant trials, the expected proportion of those with AUD who are women is 27.1% (World Population Review, 2022). Only 2 studies used targeted recruitment for women so no between-group tests were conducted. There was not a statistically significant difference in the proportion of women across trials that did and did not use gender-tailored alcohol inclusion criteria.

Conclusions

Results from this systematic review suggest that study design factors do not account for the marked over-representation of women in online alcohol interventions, indicating that women are indeed a "hidden population" whose needs should be understood and accommodated.

Topic modeling and sentiment analysis of Chinese people’s attitudes toward volunteerism amid the COVID-19 pandemic

The COVID-19 pandemic has created an urgent need for volunteers to complement overwhelmed public health systems. This study aims to explore Chinese people’s attitudes toward volunteerism amid the COVID-19 pandemic. To this end, we identify the latent topics in volunteerism-related microblogs on Weibo, the Chinese equivalent of Twitter using the topic modeling analysis via Latent Dirichlet Allocation (LDA). To further investigate the public sentiment toward the topics generated by LDA, we also conducted sentiment analysis on the sample posts using the open-source natural language processing (NLP) technique from Baidu. Through an in-depth analysis of 91,933 Weibo posts, this study captures 10 topics that are, in turn, distributed into five factors associated with volunteerism in China as motive fulfillment (n = 31,661, 34.44%), fear of COVID-19 (n = 22,597, 24.58%), individual characteristic (n = 17,688, 19.24%), government support (n = 15,482, 16.84%), and community effect (n = 4,505, 4.90%). The results show that motive fulfillment, government support, and community effect are the factors that could enhance positive attitudes toward volunteerism since the topics related to these factors report high proportions of positive emotion. Fear of COVID-19 and individual characteristic are the factors inducing negative sentiment toward volunteerism as the topics related to these factors show relatively high proportions of negative emotion. The provision of tailored strategies based on the factors could potentially enhance Chinese people’s willingness to participate in volunteer activities during the COVID-19 pandemic.

A cross-sectional study on the mental health of patients with COVID-19 1 year after discharge in Huanggang, China

OBJECTIVE

This study is aimed to investigate the mental health status of COVID-19 survivors 1 year after discharge from hospital and reveal the related risk factors.

METHODS

From April 11 to May 11, 2021, 566 COVID-19 survivors in Huanggang city were recruited through their primary doctors. A total of 535 participants (94.5%) admitted to participate in the survey and completed the questionnaires. Five scales were applied including 7-Items Generalized Anxiety Disorder Scale, Patient Health Questionnaire-9, Impact of Event Scale-Revised, Pittsburgh Sleep Quality Index, and Fatigue Scale-14. The chi-square and the Fisher's exact test were used to evaluate the classification data, multivariate logistic regression was used to explore the related factors of sleep quality, fatigue, anxiety, depression, and post-traumatic stress disorder (PTSD).

RESULTS

One year after being discharged, of the 535 COVID-19 survivors, 252 (47.1%) had poor sleep quality; 157 (29.3%) had the symptoms of fatigue; 84 (15.7%),112 (20.9%), and 130 (24.3%) suffered from symptoms of anxiety, depression, and PTSD, respectively. The logistic regression analysis showed that history of chronic disease was risk factor for poor sleep quality (OR 2.501; 95% CI, 1.618-3.866), fatigue (OR 3.284; 95% CI 2.143-5.033), PTSD (OR 2.323; 95% CI 1.431-3.773) and depression (OR 1.950; 95% CI 1.106-3.436) in COVID-19 survivors. Smoking contributed to the poor sleep quality (OR 2.005; 95% CI 1.044-3.850), anxiety (OR 4.491; 95% CI 2.276-8.861) and depression (OR 5.459; 95% CI 2.651-11.239) in survivors. Drinking influenced fatigue (OR 2.783; 95% CI 1.331-5.819) and PTSD (OR 4.419; 95% CI 1.990-9.814) in survivors. Compared with college-educated survivors, survivors with high school education were at higher risk for poor sleep quality (OR 1.828; 95% CI 1.050-3.181) and PTSD (OR 2.521; 95% CI 1.316-4.830), and survivors with junior high school education were at higher risk for PTSD (OR 2.078; 95% CI 1.039-4.155). Compared with overweight survivors (BMI ≥ 23.0), survivors with normal BMI (18.5-22.9) (OR 0.600; 95% CI 0.405-0.889) were at lower risk for fatigue. While being housewife (OR 0.390; 95% CI 0.189-0.803) was protective factor for fatigue and having more family members was protective factor for PTSD (OR 0.404 95% CI 0.250-0.653) in survivors.

CONCLUSIONS

One year after infection, poor sleep quality, fatigue, anxiety, depression, and PTSD, still existed in a relatively high proportion of COVID-19 survivors. Chronic disease history was an independent risk factor for poor sleep quality, fatigue, depression, and PTSD. Participants with low education levels were more likely to have mental problems than the others. We should focus on the long-term psychological impact of COVID-19 on survivors, and the government should apply appropriate mental health services to offer psychiatric support.

Exploring the Factors Associated with Mental Health Attitude in China: A Structural Topic Modeling Approach

Mental health attitude has huge impacts on the improvement of mental health. In response to the ongoing damage the COVID-19 pandemic caused to the mental health of the Chinese people, this study aims to explore the factors associated with mental health attitude in China. To this end, we extract the key topics in mental health-related microblogs on Weibo, the Chinese equivalent of Twitter, using the structural topic modeling (STM) approach. An interaction term of sentiment polarity and time is put into the STM model to track the evolution of public sentiment towards the key topics over time. Through an in-depth analysis of 146,625 Weibo posts, this study captures 12 topics that are, in turn, classified into four factors as stigma (n = 54,559, 37.21%), mental health literacy (n = 32,199, 21.96%), public promotion (n = 30,747, 20.97%), and social support (n = 29,120, 19.86%). The results show that stigma is the primary factor inducing negative mental health attitudes in China as none of the topics related to this factor are considered positive. Mental health literacy, public promotion, and social support are the factors that could enhance positive attitudes towards mental health, since most of the topics related to these factors are identified as positive ones. The provision of tailored strategies for each of these factors could potentially improve the mental health attitudes of the Chinese people.

COVID-19-associated liver injury: Clinical characteristics, pathophysiological mechanisms and treatment management

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has become a global epidemic and poses a major threat to public health. In addition to COVID-19 manifesting as a respiratory disease, patients with severe disease also have complications in extrapulmonary organs, including liver damage. Abnormal liver function is relatively common in COVID-19 patients; its clinical manifestations can range from an asymptomatic elevation of liver enzymes to decompensated hepatic function, and liver injury is more prevalent in severe and critical patients. Liver injury in COVID-19 patients is a comprehensive effect mediated by multiple factors, including liver damage directly caused by SARS-CoV-2, drug-induced liver damage, hypoxia reperfusion dysfunction, immune stress and inflammatory factor storms. Patients with chronic liver disease (especially alcohol-related liver disease, nonalcoholic fatty liver disease, cirrhosis and hepatocellular carcinoma) are at increased risk of severe disease and death after infection with SARS-CoV-2, and COVID-19 aggravates liver damage in patients with chronic liver disease. This article reviews the latest SARS-CoV-2 reports, focusing on the liver damage caused by COVID-19 and the underlying mechanism, and expounds on the risk, treatment and vaccine safety of SARS-CoV-2 in patients with chronic liver disease and liver transplantation.

The Frequency of Tobacco Smoking and E-Cigarettes Use among Primary Health Care Patients-The Association between Anti-Tobacco Interventions and Smoking in Poland

The aim of this study was to assess the prevalence of smoking and e-cigarette use among primary care patients during the COVID-19 pandemic and to assess the frequency of minimal anti-tobacco interventions by family doctors. A cross-sectional study was conducted from January 2020 to December 2021 encompassing 896 patients over 18 years of age who used primary health care in the city of Lodz, Poland. In total, 21.2% of the respondents were smokers, 11.6% were e-cigarette users, and 7.3% dual users. In addition, 68.4% of smokers had been asked about smoking, while 62.9% of non-smokers and 33.7% of smokers were advised to quit smoking; furthermore, 71.1% of e-cigarette users and 72.3% of dual users were asked about tobacco use, and 17.3% and 21.5%, respectively, had been advised to quit smoking. Multivariate logistic regression analysis found men and alcohol users to receive more minimal anti-tobacco advice than women and non-alcohol users (OR = 1.46; p < 0.05 and OR = 1.45; p < 0.05), socio-demographic and health correlates did not increase the chances of obtaining minimal anti-tobacco interventions among smokers. People with a medium level of education had a higher chance of receiving minimal anti-tobacco intervention from their family doctor when using e-cigarettes and when they were dual users (OR = 2.06; p < 0.05 and OR = 2.51; p < 0.05). Smokers were less likely to receive minimal anti-tobacco interventions than reported in previous studies. Measures should be implemented to increase the minimum interventions provided by GPs in their daily work among all patients, not only those who use tobacco. Non-smokers should be encouraged to abstain.

Location matters: Regional variation in association of community burden of COVID-19 with caregiver and youth worry

Our study characterized associations between three indicators of COVID-19's community-level impact in 20 geographically diverse metropolitan regions and how worried youth and their caregivers in the Adolescent Brain Cognitive Development℠ Study have been about COVID-19. County-level COVID-19 case/death rates and monthly unemployment rates were geocoded to participants' addresses. Caregivers' (vs. youths') COVID-19-related worry was more strongly associated with COVID-19's community impact, independent of sociodemographics and pre-pandemic anxiety levels, with these associations varying by location. Public-health agencies and healthcare providers should avoid adopting uniform "one-size-fits-all" approaches to addressing COVID-19-related emotional distress and must consider specific communities' needs, challenges, and strengths.

Changes in suicidal ideation and related influential factors in college students during the COVID-19 lockdown in China

This study aims to investigate the patterns and predictors of suicidal ideation (SI) trajectories among college students during extended lockdowns in China. A three-wave survey was conducted during the outbreak period, remission period, and prevention period of COVID-19. Distinct patterns of SI trajectories were established by grouping respondents based on temporal changes in SI. Multivariate logistic regressions were performed to examine predictors for delay-occurrence and persistent SI. From a total of 35,516 college students included in the study, rates of SI increased significantly from T1 to T2 (7.3% v. 9.4%) and from T2 to T3 (9.4% v. 12.6%). Five SI trajectories were observed: resilient (80.5% of the sample), recovery (3.6%), relapsing/remitting (4.8%), persistent dysfunction (2.3%) and delayed dysfunction (8.7%). Further, junior-year undergraduates, postgraduates, only-child families, mental health history, confirmed cases in the community of residence, depressive symptoms, and negative coping strategies were significant predictors of distinct SI trajectories, whereas greater social support, more positive coping strategies, and better family functioning were associated with a lower probability of developing delayed or persistent dysfunction during the lockdown period. These findings suggest that continuous preventive and intervening measures for college students during COVID-19 lockdowns are of global importance, particularly among vulnerable groups who experience the most distress.

Systematic review of changed smoking behaviour, smoking cessation and psychological states of smokers according to cigarette type during the COVID-19 pandemic

OBJECTIVES

Although the global COVID-19 pandemic has increased interest in research involving high-risk smokers, studies examining changed smoking behaviours, cessation intentions and associated psychological states among smokers are still scarce. This study aimed to systematically review the literature related to this subject.

DESIGN

A systematic review of published articles on cigarettes and COVID-19-related topics DATA SOURCES: Our search was conducted in January 2021. We used the keywords COVID-19, cigarettes, electronic cigarettes (e-cigarettes) and psychological factors in PubMed and ScienceDirect and found papers published between January and December 2020.

DATA SELECTION

We included articles in full text, written in English, and that surveyed adults. The topics included smoking behaviour, smoking cessation, psychological state of smokers and COVID-19-related topics.

DATA EXTRACTION AND SYNTHESIS

Papers of low quality, based on quality assessment, were excluded. Thirteen papers were related to smoking behaviour, nine papers were related to smoking cessation and four papers were related to psychological states of smokers.

RESULTS

Owing to the COVID-19 lockdown, cigarette users were habituated to purchasing large quantities of cigarettes in advance. Additionally, cigarette-only users increased their attempts and willingness to quit smoking, compared with e-cigarette-only users.

CONCLUSIONS

Owing to the COVID-19 outbreak, the intention to quit smoking was different among smokers, according to cigarette type (cigarette-only users, e-cigarette-only users and dual users). With the ongoing COVID-19 pandemic, policies and campaigns to increase smoking cessation intentions and attempts to quit smoking among smokers at high risk of COVID-19 should be implemented. Additionally, e-cigarette-only users with poor health-seeking behaviour require interventions to increase the intention to quit smoking.

Association Between Social Support and Perceived Stress: A Cross-Sectional Study on Staffs of the Epidemic Prevention During the Covid-19 Epidemic in China

Background

The Coronavirus Disease 2019 (COVID-19) lockdown considerably affects people's life in China, both physically and mentally. Staffs of the epidemic prevention and control in the community have played an irreplaceable role during community lockdown period in Wuhan. However, few studies have focused on their health status during epidemic prevention. This study aimed to appraise the available evidence of health conditions of them and explore the influencing factors.

Method

Used a multistage sampling method, we conducted a survey in staffs of the epidemic prevention and control in the community (N = 503). Descriptive analysis was used to characterize the respondents. T-test and analysis of variance were for group differences analysis. Confirmatory factor analysis (CFA) was used to verify the scale validity, correlation analysis and pathway analysis and Structural equation model (SEM) was used to study the relationship between stress perception, social support, mental resilience and sleep quality. Statistical analysis was performed with SPSS 26.0, R version 4.1.3 and Mplus 8.3.

Results

The mean Perceived Stress Scale (PSS) score of the respondents was 13.28 ± 7.31 and 51.1% had higher PSS score than the normal. In the absence of social support, people's sleeping quality and psychological resilience may decrease, their perceived stress may elevate and compromise mental health correspondingly. Social support could affect perceived stress directly, while Sleep quality and psychology resilience played significant partial mediating roles in social support affecting perceived stress. The mediating effects accounted for 50.8% of the total.

Conclusion

Staffs of the epidemic prevention and control in the community suffered from poor sleep quality and high level of stress perception. Establishment of good social support may effectively reduce their stress and this effect is mediated by sleep quality and psychological resilience. Physical health status would affect the staffs' mental health and they more attention should be paid to those with poor physical health.

Tobacco smoking changes during the first pre-vaccination phases of the COVID-19 pandemic: A systematic review and meta-analysis

Background

Globally, tobacco smoking remains the largest preventable cause of premature death. The COVID-19 pandemic has forced nations to take unprecedented measures, including 'lockdowns' that might impact tobacco smoking behaviour. We performed a systematic review and meta-analyses to assess smoking behaviour changes during the early pre-vaccination phases of the COVID-19 pandemic in 2020.

Methods

We searched Medline/Embase/PsycINFO/BioRxiv/MedRxiv/SSRN databases (January-November 2020) for published and pre-print articles that reported specific smoking behaviour changes or intentions after the onset of the COVID-19 pandemic. We used random-effects models to pool prevalence ratios comparing the prevalence of smoking during and before the pandemic, and the prevalence of smoking behaviour changes during the pandemic. The PROSPERO registration number for this systematic review was CRD42020206383.

Findings

31 studies were included in meta-analyses, with smoking data for 269,164 participants across 24 countries. The proportion of people smoking during the pandemic was lower than that before, with a pooled prevalence ratio of 0·87 (95%CI:0·79-0·97). Among people who smoke, 21% (95%CI:14-30%) smoked less, 27% (95%CI:22-32%) smoked more, 50% (95%CI:41%-58%) had unchanged smoking and 4% (95%CI:1-9%) reported quitting smoking. Among people who did not smoke, 2% (95%CI:1-3%) started smoking during the pandemic. Heterogeneity was high in all meta-analyses and so the pooled estimates should be interpreted with caution (I2 >91% and p-heterogeneity<0·001). Almost all studies were at high risk of bias due to use of non-representative samples, non-response bias, and utilisation of non-validated questions.

Interpretation

Smoking behaviour changes during the first phases of the COVID-19 pandemic in 2020 were highly mixed. Meta-analyses indicated that there was a relative reduction in overall smoking prevalence during the pandemic, while similar proportions of people who smoke smoked more or smoked less, although heterogeneity was high. Implementation of evidence-based tobacco control policies and programs, including tobacco cessation services, have an important role in ensuring that the COVID-19 pandemic does not exacerbate the smoking pandemic and associated adverse health outcomes.

Funding

No specific funding was received for this study.

[Drinking behavior at the beginning and during the SARS-CoV-2 pandemic: results of a literature review]

Background and objective

It is well known that alcohol consumption and abuse, as well as alcohol-induced problems, increase during difficult economic times. Previous studies showed increased alcohol consumption in the 2003 SARS outbreak in China. The review examines global changes in alcohol consumption under current SARS-CoV‑2 (severe acute respiratory syndrome coronavirus 2) pandemic.

Materials and methods

The databases PubMed, Ovid, Cochrane Library, Scopus, PsycINFO, and Web of Science with a cut-off date of 11 January 2022 were used. An initial hit count of 791 publications was found. After reading the title and abstract, 62 texts were still eligible. After reviewing the full text, 40 studies were included in this review.

Results

Study results were available from North and South America, Europe, Asia and Oceania. Increases as well as reductions in alcohol consumption were shown. Studies examining multiple waves of the pandemic found that alcohol consumption increased with duration of the pandemic. Binge drinking played a large role in this. There were very large regional differences in the increase in alcohol consumption: from about 10% of respondents to > 45%. In most studies, alcohol consumption was about the same for 40-50% of respondents and decreased for 30-40%.

Conclusions

Further study follow-ups under the continuing pandemic are relevant. Since the populations studied were predominantly of working age, occupational prevention measures of elevated stress levels for some of the respondents with increased alcohol consumption seem reasonable.

Influencing Factors of International Students’ Anxiety Under Online Learning During the COVID-19 Pandemic: A Cross-Sectional Study of 1,090 Chinese International Students

Objective

We conducted the following cross-sectional study to comprehensively assess the anxiety among Chinese international students who studied online during the COVID-19 pandemic and its influencing factors.

Methods

Questionnaires were distributed through “Sojump,” and a total of 1,090 valid questionnaires were collected. The questionnaire was divided into two parts: general situation and anxiety assessment of students. The former used a self-made questionnaire, and the international general GAD-7 scale was used to measure anxiety. Chi-square test was used to analyze the differences between groups, and logistic regression analysis was performed for the factors with differences.

Results

Anxiety was found in 707 (64.9%) of 1,090 international students. Chi-square test and multivariate Logistic regression analysis showed that the incidence of anxiety was higher in the group under 22 years of age than in the group over 22 years of age (68% vs. 61%, p = 0.015; OR = 1.186, 95% CI 1.045–1.347, p = 0.008); International students living in big cities had a higher incidence of anxiety than those living in rural areas (67% vs. 60%, p = 0.022; OR = 1.419, 95%CI 1.038–1.859, p = 0.011); international students who socialized 3 times or less monthly had a higher incidence of anxiety than those who socialized more than 3 times per month (68% vs. 58%, p = 0.003; OR = 1.52, 95%CI 1.160–1.992, p = 0.002); international students who expected purely online teaching had a higher incidence of anxiety than those who expected purely offline teaching or dual-track teaching (72% vs. 64%, p = 0.037; OR = 1.525, 95%CI 1.069–2.177, p = 0.02); international students with a subjective score of online learning experience of 6 or less had a higher incidence of anxiety than those with subjective scores of more than 6 (70% vs. 60%, p = 0.001, OR = 1.25, 95%CI 1.099–1.422, p = 0.001). However, gender, emotional status, BMI, major of study, vaccination status, and degree type had no significant difference in the incidence of anxiety among international students who studied online during the COVID-19 pandemic.

Conclusion

During COVID-19, international students who were younger, came from big cities, had low social frequency, expected purely online teaching, and had poor experience of online classes were risk factors for anxiety during online classes.

Sleep disturbances during the COVID-19 pandemic: A systematic review, meta-analysis, and meta-regression

This systematic review and meta-analysis evaluated the extent of sleep disturbances during the COVID-19 pandemic. Eleven databases and six preprint repositories were searched for the period from November 1, 2019, to July 15, 2021. The DerSimonian and Laird method was used to develop random-effect meta-analyses. Two hundred and fifty studies comprising 493,475 participants from 49 countries were included. During COVID-19, the estimated global prevalence of sleep disturbances was 40.49% [37.56; 43.48%]. Bayesian meta-analysis revealed an odds of 0.68 [0.59; 0.77] which translates to a rate of approximately 41%. This provides reassurance that the estimated rate using classical meta-analysis is robust. Six major populations were identified; the estimated prevalence of sleep problem was 52.39% [41.69; 62.88%] among patients infected with COVID-19, 45.96% [36.90; 55.30%] among children and adolescents, 42.47% [37.95; 47.12%] among healthcare workers, 41.50% [32.98; 50.56%] among special populations with healthcare needs, 41.16% [28.76; 54.79%] among university students, and 36.73% [32.32; 41.38%] among the general population. Sleep disturbances were higher during lockdown compared to no lockdown, 42.49% versus 37.97%. Four in every ten individuals reported a sleep problem during the COVID-19 pandemic. Patients infected with the disease, children, and adolescents appeared to be the most affected groups.

Location Is Back: The Influence of COVID-19 on Chinese Cities and Urban Governance

This article explores the short-term and (potential) long-term influences of COVID-19 on urban China and its governance, which was characterised by increasing mobilities and delocalised societies before the outbreak. Through the analysis of 18 observation reports in 16 cities, it is revealed that the outbreak enables the government to (re-)build a location-based urban management system with the participation of residents facing the pandemic as an external threat. A paradoxical combination of low physical mobility and high information mobility occurs. The location-based lifestyle and governance pattern has been “normalised” rather than just being a temporary response to the pandemic. The re-localisation in urban China differs from the localism in western societies as it results from the combination of the state-power-based governmental action and citizens’ participation aimed at regaining location-based ontological security. The normalisation of the re-localisation tendency may bring about fundamental changes to urban China, even “after” the pandemic.

A Modified LSTM Framework for Analyzing COVID-19 Effect on Emotion and Mental Health during Pandemic Using the EEG Signals

COVID-19, a WHO-declared public health emergency of worldwide concern, is quickly spreading over the world, posing a physical and mental health hazard. The COVID-19 has resulted in one of the world's most significant worldwide lockdowns, affecting human mental health. In this research work, a modified Long Short-Term Memory (MLSTM)-based Deep Learning model framework is proposed for analyzing COVID-19 effect on emotion and mental health during the pandemic using electroencephalogram (EEG) signals. The participants of this study were volunteers that recovered from COVID-19. The EEG dataset of 40 people is collected to predict emotion and mental health. The results of the MLSTM model are also compared with the other literature classifiers. With an accuracy of 91.26%, the MLSTM beats existing classifiers when using the 70-30 partitioning technique.

Subjective Changes in Tobacco Product Use among Korean Adults during the COVID-19 Pandemic

This study explored subjective changes in tobacco product use during the COVID-19 pandemic. The online survey included 828 tobacco product users and was implemented from 20 August to 27 August 2021. Participants were classified based on currently used products (cigarettes, heated tobacco products (HTPs), and e-cigarettes) and categorized as single, dual, or triple users. Subjective changes in product use over the past year were designated as “no chang”, “increase”, or “decreased”. Single use was most common, as reported by 447 participants (male 249, female 198), while 283 (male 164, female 119) and 98 (male 59, female 39) participants reported dual and triple use, respectively. Age, income, and triple use were associated with increased cigarette use, whereas living with family was associated with decreased use. Gender, age, income, and triple use were associated with the changed use of HTPs. No factors were significantly associated with an increase in e-cigarette use, whereas age and income were associated with decreased use. Similar to many COVID-19-related changes in cultural, social, and economic aspects of life, users’ patterns of tobacco product use have also changed. Increasing tobacco product taxes, effective messaging, and customized cessation services might help prevent or limit tobacco product usage.

Prevalence of stress and depression and associated factors among women seeking a first-trimester induced abortion in China: a cross-sectional study

OBJECTIVES

To determine the prevalence of stress and depression and associated factors among women seeking a first-trimester induced abortion in China.

METHODS

A cross-sectional study was conducted in a tertiary hospital in Beijing, from April 1st to Oct 31st, 2021. Women seeking termination of an intrauterine first-trimester pregnancy were invited to participate and complete a digital self-administered questionnaire. The survey included socio-demographic and health questions, Perceived Stress Scale-10 (PSS-10), and Patient Health Questionnaire-9 (PHQ-9). Descriptive analyses and binary logistic regression analyses were performed using SPSS 23.0.

RESULTS

A total of 253 women participated. Prevalence of high perceived stress (cut-off ≥ 20) and depressive symptoms (cut-off ≥ 10) was 25.3% and 22.5%, respectively. Women were more likely to suffer high stress if they reported low resilience (aOR = 16.84, 95% CI 5.18-54.79), were not-using contraceptives (aOR = 3.27, 95% CI 1.39-6.29), had low social support (aOR = 2.95, 95% CI 1.39-6.29), were non-local residents (aOR = 2.51, 95% CI 1.15-5.92), were dissatisfied with their intimate relationship (aOR = 2.44, 95% CI 1.15-5.16), or held pro-life attitudes towards abortion (aOR = 1.04, 95% CI 1.18-3.53). Odds of experiencing depression were higher among women who also reported high perceived stress (aOR = 19.00, 95% CI 7.67-47.09), had completed higher education (aOR = 12.28, 95% CI 1.24-121.20), and were non-local residents (aOR = 3.38, 95% CI 1.37-8.32).

CONCLUSIONS

The magnitude of perceived stress and depression was high among Chinese women seeking a first-trimester induced abortion. It is necessary to comprehensively evaluate the mental health of women seeking an abortion, especially those with high risk. Interventions to mitigate relevant associated factors could improve the psychological wellbeing of women.

Genetic Programming-Based Feature Selection for Emotion Classification Using EEG Signal

The COVID-19 has resulted in one of the world's most significant worldwide lock-downs, affecting human mental health. Therefore, emotion recognition is becoming one of the essential research areas among various world researchers. Treatment that is efficacious and diagnosed early for negative emotions is the only way to save people from mental health problems. Genetic programming, a very important research area of artificial intelligence, proves its potential in almost every field. Therefore, in this study, a genetic program-based feature selection (FSGP) technique is proposed. A fourteen-channel EEG device gives 70 features for the input brain signal; with the help of GP, all the irrelevant and redundant features are separated, and 32 relevant features are selected. The proposed model achieves a classification accuracy of 85% that outmatches other prior works.

Gender-specific estimates of sleep problems during the COVID-19 pandemic: Systematic review and meta-analysis

The outbreak of the novel coronavirus disease 2019 (COVID-19) changed lifestyles worldwide and subsequently induced individuals' sleep problems. Sleep problems have been demonstrated by scattered evidence among the current literature on COVID-19; however, little is known regarding the synthesised prevalence of sleep problems (i.e. insomnia symptoms and poor sleep quality) for males and females separately. The present systematic review and meta-analysis aimed to answer the important question regarding prevalence of sleep problems during the COVID-19 outbreak period between genders. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and Newcastle-Ottawa Scale checklist, relevant studies with satisfactory methodological quality searched for in five academic databases (Scopus, PubMed Central, ProQuest, Web of Science , and EMBASE) were included and analysed. The protocol of the project was registered in the International Prospective Register of Systematic Reviews (PROSPERO; identification code CRD42020181644). A total of 54 papers (N = 67,722) in the female subgroup and 45 papers (N = 45,718) in the male subgroup were pooled in the meta-analysis. The corrected pooled estimated prevalence of sleep problems was 24% (95% confidence interval [CI] 19%-29%) for female participants and 27% (95% CI 24%-30%) for male participants. Although in both gender subgroups, patients with COVID-19, health professionals and general population showed the highest prevalence of sleep problems, it did not reach statistical significance. Based on multivariable meta-regression, both gender groups had higher prevalence of sleep problems during the lockdown period. Therefore, healthcare providers should pay attention to the sleep problems and take appropriate preventive action.

Changes in alcohol use during COVID-19 and associations with contextual and individual difference variables: A systematic review and meta-analysis

OBJECTIVE

The present study meta-analyzed studies examining changes in alcohol consumption during the coronavirus disease (COVID-19) pandemic and systematically reviewed contextual and individual difference factors related to these changes.

METHOD

Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) protocol, studies were gathered via PsycINFO, PubMed/MEDLINE, and preprint databases (published April 29, 2021) that examined individual-level changes in consumption during the initial COVID-19 mitigation measures (before October 2020). Next, sample proportion increases and decreases in consumption, in addition to mean change in consumption variables from pre- to during-COVID, were meta-analyzed, and contextual and individual difference variables related to consumption changes during the pandemic were summarized.

RESULTS

One hundred and twenty-eight studies provided data from 58 countries (M n = 3,876; Mdn n = 1,092; aggregate sample n = 492,235). The average mean change in alcohol consumption was nonsignificant (Cohen's d = -0.01, p = .68); however, meta-analysis revealed that 23% of participants reported increases in consumption and 23% reported decreases. These changes were moderated by per capita gross domestic product and country. Narrative synthesis revealed multiple predictors of increased drinking, including contextual changes (e.g., children at home, income loss, working remotely), individual difference variables (being female, a young-to-middle aged adult, or Black), and mental health/alcohol-related risk factors (e.g., depression).

CONCLUSIONS

The identified factors associated with increased alcohol consumption should be considered in planning behavioral health services during future crisis events that abruptly alter everyday environments in ways that increase stress and decrease access to naturally occurring rewards. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Family socio-economic status and Chinese Preschoolers' anxious symptoms during the COVID-19 pandemic: the roles of parental investment, parenting style, home quarantine length, and regional pandemic risk

Using data from 16,161 families with target child of 3-6 years old in Hubei, China during COVID-19 pandemic, this study examined the association between family socio-economic status (SES) and preschoolers' anxious symptoms (PAS). Parental investment and parenting style were tested as mediators for this association. Home quarantine length was tested as a moderator for this direct association and for the associations between family SES and parenting processes, whereas regional pandemic risk was tested as a moderator for the entire model. Results support the utility of Family Stress and Family Investment Models in a Chinese context by identifying unique roles of parental investment and parenting style in mediating the link between family SES and PAS. Quarantine length moderated the link between family SES and authoritarian parenting: Strength of this negative association was stronger for families with longer quarantine than for those with shorter quarantine. Further, family SES was negatively associated with PAS through its negative association with authoritarian parenting, regardless of the quarantine length. Model comparison analyses between high-risk region versus low/medium-risk region groups indicated that the pandemic risk for living regions did not alter any pathway in the model. Such findings inform the designs of targeted interventions to help families cope with pandemic-related challenges. Promoting parental investment and adaptive patenting style represents an avenue to diminish consequences of family economic hardship for young children's mental health, regardless of macrolevel pandemic risk. Interventions should attend to home quarantine duration, as it contextualizes the links among family SES, parenting, and child well-being.

Trends in online searching toward suicide pre-, during, and post the first wave of COVID-19 outbreak in China

COVID-19 may increase the risk of suicide, but the conclusion is still unclear. This study was designed to assess the impact of COVID-19 on suicide pre-, during, and post the first wave of COVID-19 in China. It was reported that online public searching was associated with their offline thoughts and behaviors. Therefore, this study was designed to explore the online search for suicide pre-, during, and post-COVID-19 in China. The keywords on suicide, COVID-19, unemployment, and depression were collected in 2019 and 2020 using the Baidu Search Index (BSI). A time-series analysis examined the dynamic correlations between BSI-COVID-19 and BSI-suicide. A generalized estimating equation model was used to calculate the coefficients of variables associated with the BSI-suicide. The BSI-suicide showed a significant increase (15.6%, p = 0.006) from the 5th to 9th week, which was also the point of the first wave of the COVID-19 outbreak. A time-series analysis between BSI-suicide and BSI-COVID-19 showed that the strongest correlation occurred at lag 1+ and lag 2+ week. In the pre-COVID-19 model, only BSI-depression was highly associated with BSI-suicide (β = 1.38, p = 0.008). During the COVID-19 model, BSI-depression (β = 1.77, p = 0.040) and BSI-COVID-19 (β = 0.03, p < 0.001) were significantly associated with BSI-suicide. In the post-COVID-19 model, BSI depression (β = 1.55, p = 0.010) was still highly associated with BSI-suicide. Meanwhile, BSI-unemployment (β = 1.67, p = 0.007) appeared to be linked to BSI-suicide for the first time. There was a surge in suicide-related online searching during the early stage of the first wave of the COVID-19 outbreak. Online suicide search volume peaked 1-2 weeks after the COVID-19 peak. The BSI of factors associated with suicide varied at different stages of the COVID-19 pandemic. The findings in this study are preliminary and further research is needed to arrive at evidence of causality.

Suicidal Behavior in the First Wave of the COVID-19 Pandemic

PURPOSE OF REVIEW

Since the declaration of the COVID-19 pandemic, there have been numerous social changes to try to ​​contain the spread of the disease. These sudden changes in daily life have also changed the way we relate to others, in addition to creating a climate of uncertainty and fear. Therefore, the objective of this review is to compile published data of the consequences of suicidal behavior in the first months from the onset of the pandemic.

RECENT FINDINGS

The analysis reflects a concern about issues related to suicide since the beginning of the pandemic. A large number of online surveys have been released and have provided data on relatively large populations. The percentage of the population with suicidal ideation in that period seems to be approximately 5-15%. Many studies associate suicidal ideation with being young, female, and presence of sleep problems. Surveys of healthcare workers do not seem to indicate a higher prevalence of suicidal ideation compared to the general population. The incidence of suicide attempts seen in emergency departments did not seem to change, while the number of visits for other issues, unrelated to suicide, did decrease. The few studies on completed suicide do not indicate an increase in incidence in these first 6 months since March 2020, when the WHO declared the start of the pandemic. It does not seem that there have been major changes in the figures related to suicidal behavior in the studies from the first wave of the COVID-19 pandemic, although it is still too early to know the consequences it will have long term. The social and economic damages resulting from the pandemic will certainly take a long time to recover.

Stronger functional network connectivity and social support buffer against negative affect during the COVID-19 outbreak and after the pandemic peak

Health and financial uncertainties, as well as enforced social distancing, during the COVID-19 pandemic have adversely affected the mental health of people. These impacts are expected to continue even after the pandemic, particularly for those who lack support from family and friends. The salience network (SN), default mode network (DMN), and frontoparietal network (FPN) function in an interconnected manner to support information processing and emotional regulation processes in stressful contexts. In this study, we examined whether functional connectivity of the SN, DMN, and FPN, measured using resting-state functional magnetic resonance imaging before the pandemic, is a neurobiological marker of negative affect (NA) during the COVID-19 pandemic and after its peak in a large sample (N = 496, 360 females); the moderating role of social support in the brain-NA association was also investigated. We found that participants reported an increase in NA during the pandemic compared to before the pandemic, and the NA did not decrease, even after the peak period. People with higher connectivity within the SN and between the SN and the other two networks reported less NA during and after the COVID-19 outbreak peak, and the buffer effect was stronger if their social support was greater. These findings suggest that the functional networks that are responsible for affective processing and executive functioning, as well as the social support from family and friends, play an important role in protecting against NA under stressful and uncontrollable situations.

A qualitative study on the impact of COVID-19 on the behavior and attitudes of smokers and non-smokers in South Korea

BACKGROUND

The COVID-19 pandemic has affected all aspects of human society, including education, culture, and the economy, and has also introduced changes in people's health behaviors such as drinking alcohol, nutrition intake, and practicing healthy living. This study conducted qualitative research in the Korean context to examine the changes in the smoking behavior of smokers and secondhand smoke exposure of non-smokers during the COVID-19 pandemic.

METHODS

Focus group interviews were conducted with 36 Korean participants (18 men and 18 women). The groups were composed of cigarette smokers, e-cigarette users, heated tobacco product users, and non-smokers.

RESULTS

During the pandemic, it was found that there was an increase in the frequency of use, irrespective of the tobacco product, in users who refrained from social interaction and worked or studied from home. Users who continued to be socially active increased the amount used with each usage. Smokers showed a tendency to avoid smoking rooms and to smoke alone in places unoccupied by people. In addition, non-smokers' exposure to secondhand smoke did not decrease, but since non-smokers used masks, they reported more relief from the risk of exposure to secondhand smoke than before.

CONCLUSIONS

Despite smokers being a high-risk group for COVID-19, the risk did not result in smoking cessation among smokers. Therefore, policies and educational campaigns to raise awareness about the dangers of smoking and to encourage smoking cessation are needed in the future.

Risk and protective factors of depression in the general population during the COVID-19 epidemic in Korea

BACKGROUND

The risk of depression has risen in the general population during the COVID-19 epidemic. This study was conducted to explore risk and protective factors associated with depression among the general population uninfected by COVID-19.

METHODS

A cross-sectional study was conducted with 1,500 representative South Korean citizens aged 19-65 years through an anonymous online survey. Depression was defined as a Patient Health Questionnaire-9 score of 10 or higher. Other questionnaires included one measuring psycho-behavioural and social changes, and stress, due to COVID-19, a six-item version of the Gratitude Questionnaire (GQ-6), and a three-item version of the UCLA loneliness scale.

RESULTS

Of the 1492 participants not infected by COVID-19, 312 (20.9%) exhibited depression. Multiple logistic regression analysis revealed that depression was positively associated with COVID-19-related stress and psycho-behavioural variables such as disturbances in eating and sleeping, younger age, smoking, underlying mental illness, and loneliness scale scores. In contrast, exercise three or more times per week and GQ-6 scale scores were inversely associated with depression.

CONCLUSION

During the COVID-19 pandemic, maintaining daily routines including eating, sleeping, and regular exercise and focusing on gratitude may be important for the prevention of depression. In addition, more attention should be paid to vulnerable populations, including young people, those with mental illnesses, and smokers, who might be more susceptible to depression.

Suicide prevention and COVID-19

INTRODUCTION

Suicide prevention during Covid 19 has become a global priority because the current pandemic has led to societal difficulties threatening the fabric of our lifestyle with increased morbidity and mortality. Modelling studies published since the COVID 19 pandemic was declared in March 2020 estimate that suicide rates will increase by anywhere between 1% to 145% globally in response to the pandemic and action needs to be taken.

METHODS

A narrative literature review on high quality evidence sources limited to human studies and publications written in English language only has been used to examine the relationship of COVID 19 and existing mental illness or history of mental illness, suicide prevention strategies and changes in overall suicide rates.

RESULTS

A total of 39 papers are summarised and grouped using the headings aetiological factors, proposed interventions to increase access and national policies to provide a framework for suicide prevention during pandemics such as COVID 19. This review indicates that 1) investing in active labour market programmes will result in a decreased suicide rate during times of high unemployment 2) People in low paid and casual jobs require specific support because they are most financially vulnerable during a pandemic related crisis 3) Women require specific support during a pandemic because of the type of employment they have and because they often carry a greater proportion of the domestic burden and are at increased risk of domestic violence during lockdown and crisis 4) Mental health and substance misuse services need to be appropriately funded and prioritised during and post pandemic, due to the associated increase in substance misuse during a pandemic causing worsening mental health and increased risk of suicide 5) National Suicide Prevention Strategies should be developed by all countries and should anticipate response to a range of disasters, including a pandemic 6) Suicide prevention is everybody's business and National Suicide Prevention Strategies should adopt a whole-systems approach including mental health services, primary care, social care, NGO's and other community stakeholders 7) Suicide is preventable 8) It is essential to prioritise suicide prevention strategies in the COVID and post-COVID period to ensure that lives are saved.

DISCUSSION

Increase in suicide is not inevitable and suicide prevention during pandemics and post COVID 19 pandemics requires a collaborative whole system approach. We require real time data to inform dynamic action planning.

Long-Term Impact of COVID-19 on Mental Health among the General Public: A Nationwide Longitudinal Study in China

COVID-19 might have long-term mental health impacts. We aim to investigate the longitudinal changes in mental problems from initial COVID-19 peak to its aftermath among general public in China. Depression, anxiety and insomnia were assessed among a large-sample nationwide cohort of 10,492 adults during the initial COVID-19 peak (28 February 2020 to 11 March 2020) and its aftermath (8 July 2020 to 8 August 2020) using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Insomnia Severity Index. We used generalized estimating equations and linear mixed models to explore factors associated with long-term mental health symptoms during COVID-19. During the five months, mental health symptoms remained consistently elevated (baseline 46.4%; follow-up 45.1%). Long-term depression, anxiety and insomnia were associated with several personal and work-related factors including quarantine (adjusted OR for any mental health symptoms 1.31, 95%CI 1.22–1.41, p < 0.001), increases in work burden after resuming work (1.77, 1.65–1.90, p < 0.001), occupational exposure risk to COVID-19 (1.26, 1.14–1.40, p < 0.001) and living in places severely affected by initial COVID-19 peak (1.21, 1.04–1.41, p = 0.01) or by a COVID-19 resurgence (1.38, 1.26–1.50, p < 0.001). Compliance with self-protection measures, such as wearing face masks (0.74, 0.61–0.90, p = 0.003), was associated with lower long-term risk of mental problems. The findings reveal a pronounced and prolonged mental health burden from the initial COVID-19 peak through to its aftermath in China. We should regularly monitor the mental health status of vulnerable populations throughout COVID-19.

Psychosocial Impact of COVID-19 Pandemic in Libya: A Cross-Sectional Study

Background: Since the outbreak of COVID-19 were announced in Wuhan, China, the virus has spread in most countries. After one year of restrictive measures applied by governments, it is unclear how this prolonged social distancing has affected the mental health of individuals in Libya. Therefore, the present study aims to assess the levels of perceived stress, depression, sleep disturbance, and self-efficacy associated with the pandemic in Libya and their association with the demographic factors. Methods: A cross-sectional study was conducted between October 10 and November 10, 2020 in 21 cities in Libya using an online survey. The survey collected socio-demographic variables and other important psychological variables using valid scales: namely, the Perceived Stress scale, the PROMIS Depression scale, the PROMIS Sleep Disturbance scale, and self-efficacy 6-item scale. Additionally, data were collected regarding eating and smoking habits, housing and living situations, and the preparedness of the public to manage the upcoming waves of the pandemic. Results: The questionnaire was accessed 746 times, and a total of 683 completed questionnaires were analyzed (response rate of 91.6%), with ages ranging from 18 to 94 years (Mean ± SD = 27.09 ± 10.57). Among the respondents, 58.4% were females and 77% were from the age group 18-29 years. The perceived stress, depression, and sleep disturbance symptoms were high in overall population. For stress, 52.7 and 17.1% of respondents reported moderate and high stress, and for sleep quality 28.8 and 8.1% reported moderate and high sleep disturbance, respectively. For depression, the overall median score was 20 (out of 40). The perceived stress, depression, and sleep disturbance were more prevalent among females and the younger age groups (18-29 years old). The overall self-efficacy median total score was 6.67 (out of 10), with a significantly higher median total score for males than females (7 vs. 6.33, p = 0.001). About 14.5% of the respondents were regular cigarette smokers, and most of them (79.8%) described their smoking habits during the previous month as more than typical. In addition, the reported eating habits of almost half of the respondents (43%) had changed, with about one-third (29.6%) reporting that their eating habits had become less healthy during the pandemic. Conclusion: The findings of this research suggest increased levels of stress, depression, and sleep disturbances as well as COVID-19-related fear during the pandemic, especially among young females. This alarming finding urgently calls for safe and low-barrier interventions to help mentally burdened individuals. This study makes a significant contribution in providing essential data on the psychological and social impacts on the Libyan population due to the COVID-19 pandemic.

Sense of Coherence and Mental Health in College Students After Returning to School During COVID-19: The Moderating Role of Media Exposure

The COVID-19 pandemic not only threatens people's physical health, but also affects their mental health in the long term. Although people had returned to work and school, they are closely monitoring the development of the epidemic and taking preventive measures. This study attempted to examine the relationship between media exposure, sense of coherence (SOC) and mental health, and the moderating effect of media exposure in college students after returning to school. In the present study, we conducted a cross sectional survey on 424 college students returning to school around May 2020. Self-report questionnaires were used to assess media exposure scale, SOC, depression, anxiety and stress. Correlation and moderation analysis was conducted. The results showed that (1) negative epidemic information exposure, rather than positive epidemic information exposure, was significantly associated with depression, anxiety, and stress. (2) SOC was also associated with depression, anxiety, and stress. (3) The effect of SOC on depression was modified by negative epidemic information exposure. With the increase of negative epidemic information exposure, the predictive effect of SOC on depression is increasing gradually. These findings demonstrated that negative epidemic information exposure was associated with an increased psychological distress in the sample. A high SOC played a certain protective role in the adaptation of college students in the post-epidemic period. It is important to find more ways to increase the colleges' SOC level and avoid negative information exposure.

Impact of the COVID-19 Pandemic on the Mental Health of College Students: A Systematic Review and Meta-Analysis

BACKGROUND

The coronavirus disease (COVID-19) pandemic has been spreading and brought unprecedented psychological pressure on people across the entire globe since December 2019.

OBJECTIVES

To synthesize the existing evidence of the prevalence of mental health status during the epidemic and provide the basis for mental health education.

MATERIALS AND METHODS

The literature search was conducted in nine databases from December 2019 to October 2020. The risk of bias for each study was assessed, and the random-effects meta-analysis was used to estimate the prevalence of specific mental health problems. The review protocol was registered in PROSPERO with the registration number CRD42020208619.

RESULTS

About 27 studies were included in the analysis with a total of 706,415 participants combined, and 14 mental health problems were gathered. Meta-analysis showed that the prevalence of depression was 39% (95% CI: 27-51%) and that of anxiety was 36% (95% CI: 26-46%). Subgroup analysis indicated that the prevalence of depression and anxiety varied among nations and due to the survey date. The prevalence of depression (60%, 95% CI: 46-74%) and anxiety (60%, 95% CI: 46-74%) in non-Chinese college students was higher than those in Chinese college students (26%, 95% CI: 21-30% and 20%, 95% CI: 14-26%). The proportion of depression (54%, 95% CI: 40-67%) and anxiety (37%, 95% CI: 26-48%) was higher after March 1 than before it (21%, 95% CI: 16-25% and 19%, 95% CI: 13-25%).

CONCLUSIONS

The meta-analysis results presented that the prevalence of depression (39%) or anxiety (36%) among college students greatly increased during the COVID-19 pandemic. In addition, the mental health of college students is affected by the nations and the survey date. It was necessary to take measures to reduce mental health risks during the pandemic.

Suicide behaviors during the COVID-19 pandemic: A meta-analysis of 54 studies

COVID-19, and efforts to mitigate its spread, are creating extensive mental health problems. Experts have speculated the mental, economic, behavioral, and psychosocial problems linked to the COVID-19 pandemic may lead to a rise in suicide behavior. However, a quantitative synthesis is needed to reach an overall conclusion regarding the pandemic-suicide link. In the most comprehensive test of the COVID-19-suicidality link to date, we meta-analyzed data from 308,596 participants across 54 studies. Our results suggested increased event rates for suicide ideation (10.81%), suicide attempts (4.68%), and self-harm (9.63%) during the COVID-19 pandemic when considered against event rates from pre-pandemic studies. Moderation analysis indicated younger people, women, and individuals from democratic countries are most susceptible to suicide ideation during the COVID-19 pandemic. Policymakers and helping professionals are advised that suicide behaviors are alarmingly common during the COVID-19 pandemic and vary based upon age, gender, and geopolitics. Strong protections from governments (e.g., implementing best practices in suicide prevention) are urgently needed to reduce suicide behaviors during the COVID-19 pandemic.

Longitudinal Change of Mental Health among Active Social Media Users in China during the COVID-19 Outbreak

During the COVID-19 pandemic, every day, updated case numbers and the lasting time of the pandemic became major concerns of people. We collected the online data (28 January to 7 March 2020 during the COVID-19 outbreak) of 16,453 social media users living in mainland China. Computerized machine learning models were developed to estimate their daily scores of the nine dimensions of the Symptom Checklist-90 (SCL-90). Repeated measures analysis of variance (ANOVA) was used to compare the SCL-90 dimension scores between Wuhan and non-Wuhan residents. Fixed effect models were used to analyze the relation of the estimated SCL-90 scores with the daily reported cumulative case numbers and lasting time of the epidemic among Wuhan and non-Wuhan users. In non-Wuhan users, the estimated scores for all the SCL-90 dimensions significantly increased with the lasting time of the epidemic and the accumulation of cases, except for the interpersonal sensitivity dimension. In Wuhan users, although the estimated scores for all nine SCL-90 dimensions significantly increased with the cumulative case numbers, the magnitude of the changes was generally smaller than that in non-Wuhan users. The mental health of Chinese Weibo users was affected by the daily updated information on case numbers and the lasting time of the COVID-19 outbreak.

Effects of the COVID-19 pandemic and lockdown on alcohol use disorders and complications

PURPOSE OF REVIEW

To understand the effect of COVID-19 pandemic and lockdown on persons with alcohol use disorders.

RECENT FINDINGS

From a total of 455 titles on COVID-19 and alcohol, 227 abstracts were screened, and 95 articles were reviewed (on November 25th, 2020). The immediate effect was an increase in alcohol related emergencies including alcohol withdrawal, related suicides, and methanol toxicity. Although there are mixed findings with respect to changes in the quantity of drinking, there are reports of binge/heavy drinking during the lockdown as well as relapse postlockdown. Psychological, social, biological, economic and policy-related factors appear to influence the changes in drinking. Although preliminary data suggest no change in alcohol use among persons with comorbid mental illness, findings in this population are presently limited. Among patients with alcohol related liver disease, outcomes appear worse and caution is warranted with the use of medications. Alcohol also appears to increases the risk of COVID-19 infection and complicates its course.Although some nations banned alcohol sales completely during lockdown, others declared it as an essential commodity, resulting in different problems across countries. Alcohol use has added to the burden of the problem particularly among vulnerable groups like the adolescents, elderly, patients with cancer, as well as health professionals. Services for patients with alcohol use disorders have been affected.

SUMMARY

The COVID-19 pandemic has had considerable impact on alcohol use, with an increase in alcohol related emergencies, changes in alcohol use patterns, increased risk of contracting COVID-19, effect on alcohol policies and sales, and an effect on vulnerable groups. It is essential to understand and respond to the current situation, intervene early, and prevent further repercussions of the pandemic.Video abstract link: https://drive.google.com/file/d/1IJWtIs6e554PryKWhdma4VB--mjSZq1C/view?usp=sharing.

Sleep problems during COVID-19 pandemic and its' association to psychological distress: A systematic review and meta-analysis

BACKGROUND

The emerging novel coronavirus disease 2019 (COVID-19) has become one of the leading cause of deaths worldwide in 2020. The present systematic review and meta-analysis estimated the magnitude of sleep problems during the COVID-19 pandemic and its relationship with psychological distress.

METHODS

Five academic databases (Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, and Embase) were searched. Observational studies including case-control studies and cross-sectional studies were included if relevant data relationships were reported (i.e., sleep assessed utilizing the Pittsburgh Sleep Quality Index or Insomnia Severity Index). All the studies were English, peer-reviewed papers published between December 2019 and February 2021. PROSPERO registration number: CRD42020181644.

FINDINGS

168 cross-sectional, four case-control, and five longitudinal design papers comprising 345,270 participants from 39 countries were identified. The corrected pooled estimated prevalence of sleep problems were 31% among healthcare professionals, 18% among the general population, and 57% among COVID-19 patients (all p-values < 0.05). Sleep problems were associated with depression among healthcare professionals, the general population, and COVID-19 patients, with Fisher's Z scores of -0.28, -0.30, and -0.36, respectively. Sleep problems were positively (and moderately) associated with anxiety among healthcare professionals, the general population, and COVID-19 patients, with Fisher's z scores of 0.55, 0.48, and 0.49, respectively.

INTERPRETATION

Sleep problems appear to have been common during the ongoing COVID-19 pandemic. Moreover, sleep problems were found to be associated with higher levels of psychological distress. With the use of effective programs treating sleep problems, psychological distress may be reduced. Vice versa, the use of effective programs treating psychological distress, sleep problems may be reduced.

FUNDING

The present study received no funding.

The Prevalence of Psychological Status During the COVID-19 Epidemic in China: A Systemic Review and Meta-Analysis

The COVID-19 is creating panic among people around the world and is causing a huge public mental health crisis. Large numbers of observational studies focused on the prevalence of psychological problems during the COVID-19 pandemic were published. It is essential to conduct a meta-analysis of the prevalence of different psychological statuses to insight the psychological reactions of general population during the COVID-19 epidemic in China. Sixty six observational studies about the psychological statuses of people during the COVID-19 were included, searching up to 1 December 2020. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used to evaluate the quality of the included studies. OpenMeta[Analyst] was used for the data analysis. High prevalence of acute stress and fear symptoms were observed in the early period of the epidemic. Additionally, anxiety and depression symptoms continued at a high prevalence rate during the epidemic. It should alert the lasting mental health problems and the risk of post-traumatic stress disorder and other mental disorders. Systematic Review Registration: PROSPERO CRD 42020171485.

Associations of risk perception of COVID-19 with emotion and mental health during the pandemic

BACKGROUND

Although there are increasing concerns on mental health consequences of the COVID-19 pandemic, no large-scale population-based studies have examined the associations of risk perception of COVID-19 with emotion and subsequent mental health.

METHODS

This study analysed cross-sectional and longitudinal data from the PsyCorona Survey that included 54,845 participants from 112 countries, of which 23,278 participants are representative samples of 24 countries in terms of gender and age. Specification curve analysis (SCA) was used to examine associations of risk perception of COVID-19 with emotion and self-rated mental health. This robust method considers all reasonable model specifications to avoid subjective analytical decisions while accounting for multiple testing.

RESULTS

All 162 multilevel linear regressions in the SCA indicated that higher risk perception of COVID-19 was significantly associated with less positive or more negative emotions (median standardised β=-0.171, median SE=0.004, P<0.001). Specifically, regressions involving economic risk perception and negative emotions revealed stronger associations. Moreover, risk perception at baseline survey was inversely associated with subsequent mental health (standardised β=-0.214, SE=0.029, P<0.001). We further used SCA to explore whether this inverse association was mediated by emotional distress. Among the 54 multilevel linear regressions of mental health on risk perception and emotion, 42 models showed a strong mediation effect, where no significant direct effect of risk perception was found after controlling for emotion (P>0.05).

LIMITATIONS

Reliance on self-reported data.

CONCLUSIONS

Risk perception of COVID-19 was associated with emotion and ultimately mental health. Interventions on reducing excessive risk perception and managing emotional distress could promote mental health.

Psychological Health, Sleep Quality, Behavior, and Internet Use Among People During the COVID-19 Pandemic: A Cross-Sectional Study

Background: The COVID-19 pandemic has led to an increase in the risk of suicide, uncertainty, mental stress, terror, annoyance, weariness, financial issues, and frustration. We aim to determine the prevalence of insomnia, depressive and anxiety symptoms, and their associated factors among Libyan populations during the COVID-19 pandemic and the civil war. Methods: An online cross-sectional survey was conducted among the Libyan population between July 18 and August 23, 2020. The data collected included basic demographic characteristics, level of education, employment status, COVID-19-related questions, and questions about abuse and domestic violence. This study assessed the psychological status of participants who were screened for anxiety symptoms using the seven-item Generalized Anxiety Disorder scale (GAD-7). Depressive symptoms were also screened for using the two-item Patient Health Questionnaire (PHQ-2) and the Insomnia Severity Index (ISI). Binomial logistic regression was used to predict the probability of insomnia, anxiety and depressive symptoms. Results: A total of 10,296 responses were recorded. Among the participants, 4,756 (46.2%) obtained a cut-off score of ≥ 3 which indicated depressive symptoms. For anxiety, 1,952 participants (19%) obtained a cut-off score of ≥ 15, which indicated anxiety symptoms. For the ISI, the mean (SD) was 11.4 (6.1) for the following categories: no clinical insomnia (0-7) 3,132 (30.4%), sub-threshold insomnia (1-7) 3,747 (36.4%), moderate severity clinical insomnia (8-14) 2,929 (28.4%), and severe clinical insomnia (15-21) 488 (4.7%). Logistic regression analysis showed that depressive symptoms were statistically associated with age, marital status, education level, occupational category, financial problems during the COVID-19 pandemic, health status, having a COVID-19 infection, current health status, suicide ideation, abuse or domestic violence, and lockdown compliance (p < 0.05). The regression analysis revealed a statistically significant association between anxiety symptoms and age, education level, occupational status, financial problems during the COVID-19 pandemic, having a COVID-19 infection, health status, suicide ideation, abuse or domestic violence, and lockdown compliance (p < 0.05). The regression analysis revealed a statistically significant association between insomnia and all study variables with the exception of age, educational level, and occupational status (p < 0.05). Conclusion: Confronted with the COVID-19 outbreak, the Libyan population exhibited high levels of psychological stress manifested in the form of depressive and anxiety symptoms, while one-third of the Libyan population suffered from clinical insomnia. Policymakers need to promote effective measures to reduce mental health issues and improve people's quality of life during the civil war and the COVID-19 pandemic.

Burden of Sleep Disturbance During COVID-19 Pandemic: A Systematic Review

Coronavirus disease 2019 (COVID-19) pandemic may exert adverse impacts on sleep among populations, which may raise awareness of the burden of sleep disturbance, and the demand of intervention strategies for different populations. We aimed to summarize the current evidence for the impacts of COVID-19 on sleep in patients with COVID-19, healthcare workers (HWs), and the general population. We searched PubMed and Embase for studies on the prevalence of sleep disturbance. Totally, 86 studies were included in the review, including 16 studies for COVID-19 patients, 34 studies for HWs, and 36 studies for the general population. The prevalence of sleep disturbance was 33.3%-84.7%, and 29.5-40% in hospitalized COVID-19 patients and discharged COVID-19 survivors, respectively. Physiologic and psychological traumatic effects of the infection may interact with environmental factors to increase the risk of sleep disturbance in COVID-19 patients. The prevalence of sleep disturbance was 18.4-84.7% in HWs, and the contributors mainly included high workloads and shift work, occupation-related factors, and psychological factors. The prevalence of sleep disturbance was 17.65-81% in the general population. Physiologic and social-psychological factors contributed to sleep disturbance of the general population during COVID-19 pandemic. In summary, the sleep disturbance was highly prevalent during COVID-19 pandemic. Specific health strategies should be implemented to tackle sleep disturbance.