Long-term effects of COVID-19 on mental health: A systematic review

Persistent neurocognitive deficits in long COVID: Evidence of structural changes and network abnormalities following mild infection

This study aimed to investigate the neurocognitive deficits, structural brain alterations, and network abnormalities in individuals who had a mild SARS-CoV-2 infection, with and without brain fog, as a symptom of long COVID. A cross-sectional study was conducted involving 75 participants, categorized into three groups: 24 healthy controls (HCs), 26 COVID-19 survivors without brain fog (woFOG), and 25 with brain fog (wFOG). Neuropsychological assessments included the Free and Cued Selective Reminding Test (FCSRT) and Addenbrooke's Cognitive Examination-Revised (ACE-R). Structural and functional brain alterations were examined using voxel-based morphometry (VBM) and resting-state functional MRI (rs-fMRI). The wFOG group exhibited significant cognitive impairments, particularly in delayed free recall, attention, memory, and visuospatial skills, compared to both the woFOG and HC groups. Structural MRI analyses revealed reduced gray matter concentrations (GMC) in the left inferior temporal gyrus, left fusiform gyrus, and right orbital gyri in both COVID-19 groups relative to HCs. Additionally, the wFOG group exhibited further GMC reductions in the bilateral caudate nuclei, right putamen/pallidum, and amygdala compared to the woFOG group. rs-fMRI analyses demonstrated altered connectivity patterns in COVID-19 survivors, characterized by increased connectivity in the default mode network and visual networks, alongside decreased connectivity in the dorsal attention network. These findings indicate that even mild COVID-19 can result in persistent neurocognitive deficits, structural brain alterations, and functional network abnormalities, both in individuals with and without brain fog. The observed changes highlight the importance of long-term monitoring and targeted interventions to address potential cognitive and neurological consequences of long COVID.

Mapping the Burden of Conduct Disorder in the Middle East and North Africa: Global Burden of Disease Study 2021

This study aims to investigate the prevalence, incidence, and Years Lived with a Disability (YLDs) caused by conduct disorder in 21 countries of the Middle East and North Africa (MENA). Sex and age differences in conduct disorder were investigated as well as the trend of conduct disorder from 1990 to 2021. Data from the MENA were used for this study. This super region includes 21 countries. All-age count estimates and age-standardized rate (Per 100,000) were calculated for prevalence, incidence, and YLDs. Each of the disease burden indicators was examined in the period of 1990-2021, stratified by sex, age, and location, and the % change between 1990 and 2021 was reported. The 95% uncertainty interval was reported for each of the reported estimates. In 2021, there were 41 million cases of conduct disorder, globally. In 2021, there were 3.5 million cases of conduct disorder in MENA; the conduct disorder count had a significant growth from 1990. At the national level, the highest conduct disorder was in Iran. The lowest age-standardized prevalence rate (ASPR) per 100,000 conduct disorder was in Syria. Of the total cases of conduct disorder in the MENA, 2.350 million were males and 1.100 million were females. The findings of this study showed an increase in the burden of conduct disorder over the past three decades in the MENA. Considering the demographic changes and population increase compared to three decades ago, as well as social, health, and economic developments, it is necessary to pay more attention to the health of children and adolescents in health-related policies.

Exploring the role of mitochondrial dysfunction and aging in COVID-19-Related neurological complications

The COVID-19 pandemic, caused by SARS-CoV-2, posed a tremendous challenge to healthcare systems globally. Severe COVID-19 infection was reported to be associated with altered immunometabolism and cytokine storms, contributing to poor clinical outcomes and in many cases resulting in mortality. Despite promising preclinical results, many drugs have failed to show efficacy in clinical trials, highlighting the need for novel approaches to combat the virus and its severe manifestations. Mitochondria, crucial for aerobic respiration, play a pivotal role in modulating immunometabolism and neuronal function, making their compromised capability as central pathological mechanism contributing to the development of neurological complications in COVID-19. Dysregulated mitochondrial dynamics can lead to uncontrolled immune responses, underscoring the importance of mitochondrial regulation in shaping clinical outcomes. Aging further accelerates mitochondrial dysfunction, compounding immune dysregulation and neurodegeneration, making older adults particularly vulnerable to severe COVID-19 and its neurological sequelae. COVID-19 infection impairs mitochondrial oxidative phosphorylation, contributing to the long-term neurological complications associated with the disease. Additionally, recent reports also suggest that up to 30% of COVID-19 patients experience lingering neurological issues, thereby highlighting the critical need for further research into mitochondrial pathways to mitigate long-tern neurological consequences of Covid-19. This review examines the role of mitochondrial dysfunction in COVID-19-induced neurological complications, its connection to aging, and potential biomarkers for clinical diagnostics. It also discusses therapeutic strategies aimed at maintaining mitochondrial integrity to improve COVID-19 outcomes.

Cognitive-affective maps extended logic: Proposing tools to collect and analyze attitudes and belief systems

Cognitive-affective maps extended logic is a software package that includes three tools designed for the collection and analysis of cognitive-affective maps (CAMs). CAMs are an innovative research method used to identify, visually represent, and analyze belief systems or any semantic knowledge. By instructing participants on how to draw a CAM, they can create a visual depiction of a belief system that illustrates their attitudes, thoughts, and emotional associations regarding a specific topic. CAMs can be considered as networks enabling participants to freely draw concepts and illustrate the affective (emotional) evaluations and connections between them. To simplify the creation of CAM studies, we first developed an administrative panel for researchers which enables them to set up CAM studies without any coding. Second, to draw CAMs, a tool was developed to give participants the opportunity to create a visual depiction of their own belief system regarding a specific topic. Third, the resulting data can be analyzed using the respective data analysis app, which tracks each analysis step to make the analysis process fully transparent. As a time-efficient approach, CAMs can be used to inform exploratory research questions, like the conceptualization of surveys, or be valuable as an independent method. The tools are available under a free and open-source license. Further information, code, and comprehensive documentation are available at https://drawyourminds.de .

Anxiety, depression, and poor sleep quality in two-year survivors of mild to severe SARS-CoV-2 infection and matched comparison groups

OBJECTIVE

This study explores differences in the co-distribution of anxiety and depression symptoms and sleep quality scores between survivors of COVID-19 and comparison groups, nearly two years after COVID-19 diagnosis.

METHODS

Individuals enrolled at primary healthcare centers of Matosinhos were selected and grouped according to hospitalization and SARS-CoV-2 infection between March 2020 and February 2021: group#1, hospitalized due to COVID-19 (n = 96); group#2, hospitalized, uninfected (n = 81); group#3, infected, non-hospitalized (n = 205); group#4, uninfected, non-hospitalized (n = 236). Groups #2 and #4 were matched to groups #1 and #3, respectively, in a ratio of 1:1, by age, sex and level of care. They were evaluated between July 2022 and October 2023 with the Hospital Anxiety and Depression Scale (subscales HADS-A, anxiety, and HADS-D, depression) and the Pittsburgh Sleep Quality Index (PSQI). Partition clustering centered on the median of HADS-A, HADS-D, and PSQI scores was used to identify two clusters. Logistic regression was used to compute adjusted Odds Ratios (aOR) and 95 % confidence intervals (CI) of the associations between the study group and the two clusters.

RESULTS

The cluster of worse mental health (n = 338) presented scores mostly above five, while the best mental health cluster (n = 280) presented scores up to five. Participants infected with SARS-CoV-2 during the first year of the pandemic were more likely to have worse mental health (aOR, 95%CI: 1.46, 1.03-2.05).

CONCLUSIONS

Survivors of COVID-19 of the first year of the pandemic may require a special clinical attention to ensure that care is provided to improve mental health and prevent a worsening of anxiety and depression symptoms, and sleep problems.

Excess weight is associated with neurological and neuropsychiatric symptoms in post-COVID-19 condition: A systematic review and meta-analysis

BACKGROUND/PURPOSE

Excess weight has been identified as a potential risk factor for post-COVID-19 condition (PCC). This systematic review and meta-analysis aimed to investigate whether excess weight is associated with the development or experience of neurological and neuropsychiatric symptoms in PCC.

METHODS

We conducted a comprehensive search of eight databases (PubMed, Embase, Scopus, Web of Science, VHL, Google Scholar, ProQuest, and medRxiv) for studies published up to July 2023. Studies were included if they assessed PCC symptoms in relation to nutritional status, specifically the development of neurological and neuropsychiatric symptoms more than 12 weeks post-infection. The analysis compared exposure and controls groups (excess weight vs. normal weight; obesity vs. non-obesity). Data were synthesized using a random-effects model.

RESULTS

Of the 10,122 abstracts screened, 18 studies (n = 139,091 adults) were included. These studies included 79,050 individuals with excess weight vs 57,926 normal-weight individuals and 30,694 individuals with obesity vs 107,612 non-obese individuals. The presence of excess weight in PCC was significantly associated with persistent depression (RR = 1.21; 95% CI: 1.03-1.42), headache (OR = 1.23; 95% CI: 1.10-1.37), memory issues (RR = 1.43; 95% CI: 1.24-1.65), sleep disturbance (RR = 1.31; 95% CI: 1.16-1.48), and vertigo (RR = 1.21; 95% CI: 1.04-1.41). Obesity was significantly associated with persistent headache (OR = 1.45; 95% CI: 1.37-1.53), numbness (RR = 1.61; 95% CI: 1.46-1.78), smell disorder (OR = 1.16; 95% CI: 1.11-1.22), taste disorder (OR = 1.22; 95% CI: 1.08-1.38), and vertigo (RR = 1.44; 95% CI: 1.35-1.53).

CONCLUSIONS

Excess weight, including overweight and obesity, is associated with experiencing neuro-symptoms related to PCC. Individuals with these conditions urgently need enhanced personalized care management in current post-pandemic context.

Subjective cognitive, psychiatric, and fatigue symptoms two years after COVID-19: A prospective longitudinal cohort study

Introduction

COVID-19 survivors may present with cognitive and psychiatric symptoms long after the acute phase of SARS-CoV-2 infection.

Objectives

To determine subjective cognitive, psychiatric, and fatigue symptoms two years after COVID-19, and their change from six months to two years.

Methods

We assessed three COVID-19 patient groups of different acute disease severity (ICU-treated, ward-treated, home-isolated) concerning subjective cognitive functioning (AB Neuropsychological Assessment Schedule), anxiety (Generalised Anxiety Disorder 7), depression (Patient Health Questionnaire 9), post-traumatic stress (Impact of Event Scale 6), and fatigue (Multidimensional Fatigue Inventory) with a mailed questionnaire approximately two years after acute COVID-19. We compared the results with those obtained six months after the acute disease. We studied whether any change emerged in the scores of symptomatic patients between six- and 24-month follow-ups.

Results

Two years post-COVID-19, 58 ICU-treated, 35 ward-treated, and 28 home-isolated patients responded to the questionnaire. Subjective cognitive symptoms and fatigue emerged as the most common problems occurring in 30.6 and 35.5% of patients, respectively. In patients with clinically significant symptoms at six months, symptom scores for depression, anxiety, and post-traumatic stress decreased at two years.

Conclusions

Two years after COVID-19, particularly self-reported cognitive symptoms and fatigue remained clinically significant, but also some recovery was evident in depression, anxiety, and post-traumatic stress.

Can Personality Traits Affect Sleep Quality in Post-COVID-19 Patients?

Objectives: In the present study, we aimed (i) to describe the personality traits of a cohort of post-COVID-19 condition (PCC) patients compared with a healthy control (HC) group, (ii) to evaluate the relationship between sleep quality and personality traits, and (iii) to investigate whether this relationship differs according to disease severity. Methods: We included 599 participants from the Nautilus Project (ClincalTrials.gov IDs: NCT05307549 and NCT05307575) with an age range from 20 to 65 years old. Of 599 participants, 280 were nonhospitalized (mild PCC), 87 were hospitalized (hospitalized PCC), 98 were in the PCC-ICU, and 134 were in the HC group. We assessed sleep quality with the Pittsburgh Sleep Quality Index (PSQI) and personality traits with the NEO Five-Factor Inventory (NEO FFI). Results: We found that mild-PCC patients had higher scores of neuroticism than HCs (p < 0.001) and ICU-PCC patients did (p = 0.020). The higher the neuroticism score was, the higher the total PSQI score (B 0.162; p < 0.001), the worse the sleep latency (B 0.049; p < 0.001), the greater the degree of sleep disturbance (B 0.060; p < 0.001), the greater the use of sleeping medication (B 0.035; p = 0.033), and the greater the incidence of daytime disturbances (B 0.065; p < 0.001) among the PCC patients. High neuroticism is also an indicator of worse sleep quality in mild-PCC (t = 3.269; p 0.001) and hospitalized-PCC (t = 6.401; p < 0.001) patients and HCs (t = 4.876; p < 0.001) but not in ICU-PCC patients. Conclusions: Although neuroticism affected sleep quality in both the PCC patients and HCs, the clinical implications and magnitude of the relationship were more significant in the PCC group. Specific and multidimensional interventions are needed to treat sleep problems in this population, and the influence of their personality traits should be considered.

The experience and influence of youth in China in coping with stressful life events during the post-COVID-19 pandemic era: a qualitative study

BACKGROUND

The COVID-19 pandemic has had a profound effect on the mental well-being of individuals, particularly among the youth. The experience of stressful life events has been linked to increased poor mental health. While the immediate effects have been documented, there is evidence to suggest that the pandemic's impact on mental health could persist in the long run. Additionally, the pandemic has influenced coping strategies and forms of social support.

METHODS

A phenomenological descriptive study was conducted to elucidate the changes in strategies adopted by youth to cope with stressful life events during the COVID-19 era. Thirty-three Chinese youths aged 15 to 24 years who have experienced regular COVID-19 pandemic prevention and control were invited to complete a semi-structured interview. Colaizzi's method was used to analyze the data. Triangulation was adopted to ensure the validity.

RESULTS

Four key themes were generated, including (1) negative changes in mental health, (2) positive changes in mental health, (3) changes in the adoption of coping strategies, and (4) the utilization of internet-based coping strategies.

CONCLUSIONS

The results could guide the development of interventions to help the youth cope with stressful life events and further promote mental health among this population.

TRIAL REGISTRATION

This study has prospectively been registered on the Chinese Clinical Trial Registry (ID: ChiCTR2200060894) on 14/06/2022.

Food scarcity and decrease in income are associated with depression after COVID-19 pandemic in rural settings

Objective

The current study is a cross-sectional survey that aims to assess an association COVID-19 on mental health in rural areas of Central India.

Methods

Generalized Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire (PHQ-9), and Impact of Events Scale-Revised (IES-R) were used to evaluate the anxiety, depression, and post-traumatic stress disorder (PTSD) among families with at least one member having been affected by COVID-19 during November 2022 to December 2022 in Durg District of Chhattisgarh State.

Results

A total of 431 participants were interviewed from 18 villages of Durg district of Chhattisgarh state. Symptoms of distress, anxiety and depression were observed in 26.2, 14.8 and 11.8% of participants. The death of family members due to COVID-19 and out of pocket expenditure was considerably associated with a higher risk of mental distress. A reduction in income was significantly associated with depression (p-value = 0.025, OR = 2.066, 95% CI = 1.115-3.817). Decline in income was also linked to depression among study participants (p value = 0.025, OR = 2.066, 95% CI = 1.115-3.817). Education, smoking and out of pocket expenditure was found be independently associated with occurrence of symptoms concerned with PTSD.

Conclusion

The study points to the significance of socioeconomic factors like food security, and income stability during COVID-19 in mental health outcomes even after 1 year of pandemic. Increasing access to mental health resources and support for those affected by financial and food insecurities can help individuals cope with stress and maintain mental well-being.

Trajectories of relationship and sexual satisfaction over 2 years in the Covid-19 pandemic: A latent class analysis

OBJECTIVE

Previous research on the impact of the Covid-19 pandemic on romantic relationships has mainly concentrated on short-term effects and average trends of change. This study aimed to explore different trajectories of relationship and sexual satisfaction from April 2020 to March 2022.

METHOD

Including a cross-national sample of 2859 individuals, a latent class approach was applied to identify subgroups of sexual and relationship satisfaction trajectories. Participants' satisfaction levels, attachment style, psychological symptoms, life satisfaction, and living arrangements were taken into account.

RESULTS

Three latent classes were identified for both relationship and sexual satisfaction: (1) a group with high satisfaction levels but a slightly declining trajectory, (2) a group with low satisfaction levels but an ascending trajectory, and (3) a fluctuating group. Living apart, having children, psychological symptoms, low life satisfaction, and avoidant attachment characterized the two groups with low or fluctuating trajectories.

CONCLUSIONS

The findings suggest that there were different trajectories of relationship and sexual satisfaction during the pandemic, which can be predicted by individual dispositions. Even 2 years after the pandemic, its effects had not disappeared.

Mental health of young adults pursuing higher education in Tier-1 cities of India: A cross-sectional study

India, with its vast youth population, grapples with significant mental health issues among young adults in higher education, due to factors such as academic pressure, social isolation, stigma, economic uncertainty, screen time, sedentary lifestyles, and pandemic-related stresses. Though the issue has garnered attention, there's a gap in post-pandemic mental health research for Indian students. This study aims to address this by investigating anxiety, depression, and overall mental well-being among students aged 18-29 in higher educational institutions across eight major Indian cities, categorized by gender, zone, city, and institution type. Using a cross-sectional design and multi-stage sampling, we surveyed 1628 students (47.1 % males, 52.9 % females) using the Mental Health Inventory (MHI-38). Female students reported higher distress levels than males. Students from the Western and Southern zones showed higher positivity and well-being. Kolkata students reported low positivity but superior well-being. Hyderabad students reported low depression levels. Central University students reported more depression, while government arts and science college students reported lower life satisfaction. The majority exhibited moderate to high levels of anxiety (69.9 %), depression (59.9 %), loss of behavioral/emotional control (65.1 %), and distress (70.3 %). These statistics underscore the burden of mental health issues faced by this demographic. Despite the prevalence, a minimal number of young adults accessed mental health services, often due to stigma and cultural biases. This study highlights how the post-pandemic context has exacerbated these barriers, revealing significant mental health issues among participants and underscoring the urgent need for targeted interventions in educational institutions amidst rising suicide rates in this demographic.

The impact of the pandemic on non-COVID-19 causes of death in the United States: a multiple cause of death analysis

Multiple cause of death data allow for a more granular analysis of the pandemic's impact on mortality from non-COVID-19 causes of death compared with analysis of a single underlying cause of each death because they are often a co-morbidity of COVID-19. This study estimates excess mortality in the US of non-COVID-19 causes measured as a multiple cause (reported anywhere on the death certificate). Death registration data were used to conduct Poisson regressions of 24 non-COVID-19 causes to estimate expected age-standardized death rates and excess mortality in 2020-21, including by place of death. The ratio of COVID-19 mortality (as underlying or contributing cause) to excess mortality of each non-COVID-19 cause was calculated. During 2020-21, 21 of 24 non-COVID-19 causes exhibited excess mortality, highest for pneumonia (males 126.5%; 95% confidence interval 116.6-136.9%), other respiratory diseases (males 45.2%; 42.2-48.2%), other kidney diseases (males 45.0%, 37.8-52.0%), diabetes (females 38.3%, 32.8-43.4%) and hypertensive heart disease (females 28.9%, 22.8-33.9%). Suicide and influenza mortality was lower than expected. The ratio of COVID-19 (underlying cause) to excess mortality was 74.2% (69.2-79.7%) for men and 68.7% (63.5-75.0%) for women, was significantly higher for hospital (over 90%) than home (less than 16%) deaths and varied greatly between causes. The pandemic led to excess mortality for almost all non-COVID-19 causes in the US when measured as a multiple cause, being particularly high in several non-communicable diseases that increase the risk of dying from COVID-19. COVID-19 appears underreported for home deaths due to its low ratio to excess mortality in this setting.

Increased post-COVID-19 behavioral, emotional, and social problems in Taiwanese children

BACKGROUND

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has remarkably impacted children's mental health. Investigating whether COVID-19-related behavioral changes persist after recovery from the acute phase of infection warrants investigation. The present study aimed to identify children's behavioral/emotional and social adjustment problems after SARS-CoV-2 infection.

METHODS

84 children aged 6-16 received assessments within 6 months after being tested positive for COVID-19. Their parents reported observations about their children 3 months before SARS-CoV-2 infection (pre-COVID condition) and the most recent 2 weeks (post-COVID condition) on a wide range of psychopathologies and social functional impairments. A control group consisted of 84 age-, sex-, and IQ-matched healthy children, with the same measures as those employed in the COVID group.

RESULTS

Compared with the control group, the COVID group in the post-COVID condition had more severe symptoms of inattention, hyperactivity-impulsivity, opposition, a wide range of emotional and behavioral problems, and poor school functions, school attitude, social interaction, school behavioral problems, and interaction problems with their parents. Compared with the pre-COVID condition, the COVID group had greater severity of inattention, somatic complaints, thought problems, internalizing problems, poor school functions, and interaction problems with their parents in the post-COVID condition.

CONCLUSIONS

The present study identified a significant link between SARS-CoV-2 infection and various post-COVID mental health sequelae in children, including behavioral/emotional and social adjustment challenges. Our results underline the importance of raising awareness about ongoing post-COVID mental health concerns in children.

University Students with Current Suicidal Ideation and Perceived Changes during the COVID-19 Pandemic: A Qualitative Study

INTRODUCTION

Mental health problems seemed to have increased among university students during the COVID-19 pandemic. To deepen our understanding of the pandemic's effects in this population, we conducted qualitative research to investigate any perceived changes in students during the pandemic, differentiating the sample based on the presence or absence of current suicidal ideation (SI).

METHODS

A wide sample of Italian university students (n = 1,214) completed an online questionnaire during the COVID-19 pandemic, March 2020-June 2021. We conducted a computer-assisted content analysis of an open-ended question about the perceived changes that occurred to them during the pandemic.

RESULTS

(1) Four thematic clusters were identified: "The psychological impact of the pandemic," "New ties and new loneliness," "An uncertain forethought" and "Discovering the value of relationships." (2) In subjects characterized by severe SI, the state of confinement at home was related to the most intense emotional states and worries. (3) Students with severe SI were different from the others, in particular using the lemma "panic," which was the only psychological state specifically associated with this group.

CONCLUSIONS

Students with current severe SI experienced higher level of psychological distress and suffering compared to the other groups during the pandemic.

Brain health Begins Before Birth (B4): A "learning" pregnancy and birth cohort study

Mental health disorders affect over 1 billion people worldwide, profoundly impacting individuals, families, and the global economy. Risk for psychopathology begins early in life, with the perinatal period representing a critical window of vulnerability. The Brain health Begins Before Birth (B4) Study at Massachusetts General Hospital (MGH) is a prospective birth cohort designed to identify modifiable risk and resilience factors influencing early brain development and child- and adult-onset psychopathology. This study aims to deeply phenotype prenatal exposures through maternal surveys administered at multiple time points during and after pregnancy; assess early neurodevelopmental outcomes through the first two years of life; and triangulate exposure and outcome data with underlying biological mechanisms. The B4 Study consists of structured, remote surveys covering psychosocial, environmental, and health-related factors throughout pregnancy and the first two years of life, supplemented by medical record review. By integrating risk and resilience factors into a dynamic learning cohort model, the B4 Study aims to advance the field of preventive psychiatry by identifying actionable pathways for early intervention, testing strategies in real-time, and ultimately shaping policies that promote lifelong mental health and wellbeing from the earliest stages of development.

Screening and monitoring patients at high risk for mental health issues in COVID-19: a multicenter pre-post assessment study

PURPOSE

This study aimed to present the methods for screening, monitoring, and intervening with patients at high risk for mental health issues with COVID-19 at residential treatment centers, which are isolation treatment facilities for COVID-19 patients.

METHODS

We evaluated the mental health status of COVID-19 patients in three residential treatment centers. At admission and one day before discharge, patients received via their mobile a questionnaire containing one question each on anxiety, subjective psychological distress, post-traumatic stress symptoms, depression and suicidal ideation to identify those at high risk for mental health issues. High-risk patients and normal-risk participants who requested consultation were referred for psychological counseling. We evaluated the participants' clinical and mental health characteristics and performed a logistic regression analysis to identify factors associated with worsened depression and suicide risk at discharge.

RESULTS

Of 5,163 qualifying patients, 1,941 patients (37.6%) had their mental health assessed both at admission and discharge. In total, 661 persons (34.1%) required mental health support at admission and 648 persons (33.4%) at discharge. The patients at high risk for mental health issues at admission had an odds ratio of 5.31 (95% CI: 4.23-6.66) for depression at discharge, compared to those with normal mental health status at admission. The group that requested professional psychological counseling at admission showed an odds ratio of 2.33 (95% CI: 1.31-4.13) for depression at discharge.

CONCLUSIONS

Repeated mental health monitoring is crucial for COVID-19 patients. Additionally, a flexible intervention strategy should be developed to implement different screening methods for patients at high risk for mental health issues, depending on the status of the COVID-19 epidemic and available resources.

Veterans at High Risk for Post-COVID-19 Suicide Attempts or Other Self-Directed Violence

Importance

US veterans have a higher risk of suicide than the general civilian population. Research suggests that COVID-19 infection is associated with increased risk of suicide attempts or other forms of self-directed violence (SDV) among veterans.

Objective

To identify subgroups of veterans with high risk of post-COVID-19 suicide attempts or SDV.

Design, Setting, and Participants

This is a retrospective cohort study conducted using data from the Veteran Health Administration (VHA). Participants included VHA enrollees with a first case of COVID-19 between May 1, 2021, and April 30, 2022, residing in the 50 states or Washington, DC.

Exposure

COVID-19 infection.

Main Outcomes and Measures

The main outcome was a suicide attempt or SDV 12 months after COVID-19 infection. Latent class analysis was used to identify subgroups. Outcome rates and 95% CIs per 10 000 veterans were calculated. Multinomial regressions were used to model outcome risk and marginal risk ratios with 99.5% CIs to compare outcome risk across latent classes.

Results

The cohort included 285 235 veterans with COVID-19 and was predominantly male (248 118 veterans [87.0%]) and younger than 65 years (171 636 veterans [60.2%]). Chronic pain (152 788 veterans [53.6%]), depression (98 093 veterans [34.4%]), and posttraumatic stress disorder (79 462 veterans [27.9%]) diagnoses were common. The 12-month outcome rate was 73.8 events per 10 000 (95% CI, 70.7-77.0 events per 10 000). Two latent classes with high rates of suicide attempt or SDV were identified. The first high-risk subgroup (46 693 veterans [16.4%]) was older (34 472 veterans [73.8%] aged ≥65 years) and had a high prevalence of physical conditions (43 329 veterans [92.8%] had hypertension, and 36 824 veterans [78.9%] had chronic pain); the 12-month outcome rate was 103.7 events per 10 000 (95% CI, 94.7-113.3 events per 10 000). The second high-risk subgroup (82 309 veterans [28.9%]) was generally younger (68 822 veterans [83.6%] aged <65 years) with a lower prevalence of physical conditions but high prevalence of mental health conditions (61 367 veterans [74.6%] had depression, and 50 073 veterans [60.8%] had posttraumatic stress disorder); the 12-month outcome rate was 162.9 events per 10 000 (95% CI, 154.5-171.8 events per 10 000), and compared with the lowest risk subgroup, the 12-month risk of suicide attempts or SDV was 14 times higher in this subgroup (risk ratio, 14.23; 99.5% CI, 10.22-19.80).

Conclusions and Relevance

In this cohort study of veterans with COVID-19, 2 veteran subgroups with distinct health profiles had high rates of suicide attempts and SDV, suggesting that different groups may require different approaches to suicide prevention after COVID-19.

Global prevalence of post-COVID-19 condition: a systematic review and meta-analysis of prospective evidence

INTRODUCTION

We investigated the prevalence of new or persistent manifestations experienced by COVID-19 survivors at 3 or more months after their initial infection, collectively known as post-COVID-19 condition (PCC).

METHODS

We searched four electronic databases and major grey literature resources for prospective studies, systematic reviews, authoritative reports and population surveys. A random-effects meta-analysis pooled the prevalence data of 22 symptoms and outcomes. The GRADE approach was used to assess the certainty of evidence. PROSPERO CRD42021231476.

RESULTS

Of 20 731 identified references, 194 met our inclusion criteria. These studies followed 483 531 individuals with confirmed COVID-19 diagnosis over periods of up to 2 years. Most focused on adults, nearly two-thirds were conducted in Europe and 63% were of high or moderate quality. The supplementary search identified 17 systematic reviews, five authoritative reports and four population surveys that reported on PCC prevalence. Our analysis revealed that more than half of COVID-19 survivors experienced one or more symptoms more than a year after their initial infection. The most common symptoms were fatiguedyspneamemory, sleep or concentration disturbances; depressionand pain. Limitation in returning to work was the most common outcome. Prevalence tended to be higher among females, individuals hospitalized during their initial infection and those who experienced severe COVID-19 illness.

CONCLUSION

PCC presents a significant health burden, affecting some groups more than others. This information will help inform health care system policies and services for people living with PCC and those caring for them.

Impact of the COVID-19 pandemic on women in the workplace in the Middle East and North Africa: A scoping review protocol

INTRODUCTION

The COVID-19 pandemic has disrupted the livelihoods of working men and women worldwide. The pandemic exacerbated already existing inequities, especially in sectors where women predominate, such as the healthcare, education, and hospitality sectors. Women in the Middle East and North Africa (MENA) region, a world outlier for low female labor force participation despite high female education levels, may have been disproportionately impacted by the pandemic. Understanding the impact of COVID-19 on women's livelihoods and health is critical to support and retain women in the labor force during external health shocks. However, until now there has been relatively little research on this topic in MENA. Therefore, this scoping review aims to determine the impact of the COVID-19 pandemic on the health and wellbeing of women workers in low-and-middle-income countries in the MENA region.

METHODS

The outcome of interest is COVID-19 related occupational health (COVID-19 infection related to workplace exposures and pandemic-related occupational stressors) and the impact on mental and physical health among women workers in LMIC in MENA. Academic databases, including APA PsycINFO, Arab World Research Source: Al-Masdar, Global Health, MEDLINE, Scopus and Web of Science Core Collection will be searched. The study selection process will involve two independent reviewers and data extraction will involve summarizing key information from the included studies using a predefined charting table. The evidence will be analyzed descriptively, providing a comprehensive overview of the identified themes and patterns.

DISCUSSION

It is anticipated that this review will facilitate a deeper understanding of the impact of the COVID-19 pandemic on working women in the MENA region. The findings may inform data-driven policies and targeted interventions that not only attract and retain women in the workforce but also enhance their health and well-being.

Leveraging Large Language Models for Infectious Disease Surveillance-Using a Web Service for Monitoring COVID-19 Patterns From Self-Reporting Tweets: Content Analysis

BACKGROUND

The emergence of new SARS-CoV-2 variants, the resulting reinfections, and post-COVID-19 condition continue to impact many people's lives. Tracking websites like the one at Johns Hopkins University no longer report the daily confirmed cases, posing challenges to accurately determine the true extent of infections. Many COVID-19 cases with mild symptoms are self-assessed at home and reported on social media, which provides an opportunity to monitor and understand the progression and evolving trends of the disease.

OBJECTIVE

We aim to build a publicly available database of COVID-19-related tweets and extracted information about symptoms and recovery cycles from self-reported tweets. We have presented the results of our analysis of infection, reinfection, recovery, and long-term effects of COVID-19 on a visualization website that refreshes data on a weekly basis.

METHODS

We used Twitter (subsequently rebranded as X) to collect COVID-19-related data, from which 9 native English-speaking annotators annotated a training dataset of COVID-19-positive self-reporters. We then used large language models to identify positive self-reporters from other unannotated tweets. We used the Hibert transform to calculate the lead of the prediction curve ahead of the reported curve. Finally, we presented our findings on symptoms, recovery, reinfections, and long-term effects of COVID-19 on the Covlab website.

RESULTS

We collected 7.3 million tweets related to COVID-19 between January 1, 2020, and April 1, 2024, including 262,278 self-reported cases. The predicted number of infection cases by our model is 7.63 days ahead of the official report. In addition to common symptoms, we identified some symptoms that were not included in the list from the US Centers for Disease Control and Prevention, such as lethargy and hallucinations. Repeat infections were commonly occurring, with rates of second and third infections at 7.49% (19,644/262,278) and 1.37% (3593/262,278), respectively, whereas 0.45% (1180/262,278) also reported that they had been infected >5 times. We identified 723 individuals who shared detailed recovery experiences through tweets, indicating a substantially reduction in recovery time over the years. Specifically, the average recovery period decreased from around 30 days in 2020 to approximately 12 days in 2023. In addition, geographic information collected from confirmed individuals indicates that the temporal patterns of confirmed cases in states such as California and Texas closely mirror the overall trajectory observed across the United States.

CONCLUSIONS

Although with some biases and limitations, self-reported tweet data serves as a valuable complement to clinical data, especially in the postpandemic era dominated by mild cases. Our web-based analytic platform can play a significant role in continuously tracking COVID-19, finding new uncommon symptoms, detecting and monitoring the manifestation of long-term effects, and providing necessary insights to the public and decision-makers.

Cognition and objective sleep quality in post-COVID-19 patients

In the current study, we aimed (i) to evaluate sleep quality via wrist actigraphy monitoring of nonhospitalized and hospitalized post-COVID-19 condition (PCC) participants; (ii) to correlate actigraphy measures with subjective measures of sleep quality, such as the Pittsburgh Sleep Quality Index (PSQI); and (iii) to investigate whether total sleep time or sleep efficiency could affect PCC cognitive performance. We included 49 individuals with PCC from the NAUTILUS Project (NCT05307549 and NCT05307575) who were monitored for 1 week via actigraphy and who were also assessed with a comprehensive neuropsychological battery and the PSQI. We found that there were significant differences between nonhospitalized PCCs and hospitalized PCCs in the number of awakenings. We also found a correlation between the total sleep time of both measures (actigraphy and PSQI), but we did not observe correlations between objective and subjective parameters of latency and sleep efficiency. Regarding cognition and actigraphy measures, there was a trend of statistical significance in the performance of immediate visual memory, attention span and social cognition according to sleep efficiency. In conclusion, results indicate that although the PSQI provides clinically relevant indicators of sleep, there are divergent results between self-reported and objective sleep measures (actigraphy). Furthermore, we found a tendency toward statistical significance in cognitive performance in PCC participants according to their sleep efficiency which could indicate that is more important for cognitive function of post-COVID-19 patients than total sleep time.

Insular-striatal activation during COVID-19 predicts stress reactivity in high-trait anxiety

The COVID-19 pandemic, unlike natural disasters that cause short-term stress, has led to prolonged psychological strain, increasing attentional biases toward health threats and worsening mental health. Prolonged exposure to pandemic-related stressors has exacerbated these issues, with individual differences, such as anxiety levels, influencing vulnerability and resulting in varied outcomes. Understanding how neurocognitive processes modulate attentional biases, such as prolonged attention (overresponding) to threats or avoidance, is crucial for explaining their effects on mental health during the pandemic. Real-world examination of these biases is needed to confirm their manifestation and better target interventions. This longitudinal study explored the neural network of attentional biases in anxious individuals, focusing on whether initial activation at baseline (T1) could predict changes in perceived stress. High and low trait anxious (HTA, LTA) adults completed an emotional Stroop task during two fMRI visits, one year apart. Results showed insular-fronto-striatal hypoactivation in the HTA group over time, indicating increased avoidance in HTA participants. Initial insular-striatal activation at T1 predicted perceived stress changes in the HTA group. Reduced activation in these regions suggests avoidance and impaired stress coping, highlighting increased stress vulnerability in HTA individuals during the pandemic and underscoring the importance of interventions to enhance resilience.

Emotional distress and affective knowledge representation one year after the COVID-19 outbreak

This study examines whether the detrimental effects of the COVID-19 pandemic on the affectivity of the population extend one year after the outbreak. In an online-mobile session, participants completed surveys (i.e., demographic characteristics, positive-negative affectivity, interoceptive awareness) and a similarity judgment task of triplets of emotional concepts, from which we derived 2D maps of their affective knowledge representation. Compared with pre-pandemic data derived from a comparable population, we report three main findings. First, we observed enhanced negative affectivity during the pandemic, but no changes in positive affectivity levels. Second, increased self-reported interoceptive awareness compared to pre-pandemic data, with greater attention to bodily sensations and adaptive aspects of interoceptive sensitivity. Furthermore, female participants reported higher scores than males on the questionnaire subscales of Emotional Awareness and Attention Regulation. Third, the effect of pandemic-related conditions is also apparent in the mental organization of emotional concepts, especially for female participants (i.e., reduced coherence in the organization of the concepts along the arousal dimension and more misclassification of concepts based on arousal) and participants who did not perform physical activity (a collapse of the arousal dimension). Some of the effects of the pandemic, thus, persist about a year after the outbreak. These results advise providing programs of psychological and emotional assistance throughout the pandemic beyond the outbreak, and that age-dependent gender differences should be accounted for to define tailored interventions. Physical activity might relieve pandemic-related stressors, so it should be promoted during particularly stressful periods for the population.

The Moderating Role of Social Capital Between Parenting Stress and Mental Health and Well-Being Among Working Mothers in China

Rapid economic growth has transformed social and family structure globally, including in China, over the past few decades. With women's engagement in the workforce, the dual demand of paid and domestic work has become a major source of stress, particularly among mothers. Working mothers face unique challenges of family obligations blended with contemporary values of women's career aspirations.

METHODS

This study recruited 189 participants. This study employed quantitative methods to investigate the relationship between parenting stress and mental health, and the moderating role of social capital, among working mothers in Zhaoqing, Guangdong province of China.

RESULTS

The findings suggested a high level of parenting stress among Chinese working mothers. Their stress is associated with depressive symptoms. What should be noted is that social capital acts as a moderator between their stress and depressive symptoms.

DISCUSSION

This study reveals the buffering effect of social capital against parenting stress and depression in Chinese working mothers, with an emphasis on the importance of workplace flexibility and social support systems in addressing work-family conflicts. The study enriches the study of the buffer effect of social capital on mental health. This knowledge can inform the development of targeted interventions and support systems to improve working mothers' overall well-being.

Influencing factors and changing trends of depressive symptoms among middle and junior high school students in Eastern China from 2019 to 2023: a cross-sectional study

BACKGROUND

The emergence of the COVID-19 pandemic led to increased levels of depression among adolescents in 2019. However, the situation regarding adolescent depression in the later stages of the pandemic remains unclear. This study investigated depressive symptoms status and changing trends among middle and junior high school students from 2019 to 2023.

METHODS

Data were collected from 9,920 middle and junior high school students between 2019 and 2023 via multistage stratified cluster sampling. Students were administered an online survey, completed the Chinese version of the Center for Epidemiologic Studies Depression Scale, and answered questions regarding basic information, such as birth date. Univariate and multivariate analyses were performed to examine the factors that influenced depressive symptoms. Furthermore, Trend X2 Test and Logistic regression was employed to analyze the changing trends of depressive symptoms among the participants.

RESULTS

Of the students, 14.5% and 5.8% could have and had definitely experienced depressive symptoms, respectively. Junior high school students (AOR = 1.409, 95%CI = 1.164-1.706) had a higher risk of definite depressive symptoms. Males (possible depressive symptoms: AOR = 0.803, 95%CI = 0.716-0.902; definite depressive symptoms: AOR = 0.829, 95%CI = 0.695-0.988) were less likely to experience depressive symptoms. Families with parental absence (single-parent families, reconstituted families, and families where both parents are absent), less than one hour of outdoor activity and less than eight hours of sleep, increased the risk of both possible and definite depressive symptoms. Detection rate of depressive symptoms among middle school students followed an inverted U-shape trend; it rose in 2020 and 2021 and declined in 2022 and 2023. Detection rates of depressive symptoms among junior high school students in 2020, 2022, and 2023 decreased compared with 2019 (p < 0.05).

CONCLUSION

Educational stage, sex, family type, and duration of outdoor activities and sleep were factors that influenced depressive symptoms among middle and junior high school students. A proportion of middle school students with depressive symptoms exhibited an increasing and decreasing trend from 2019 to 2023. Students exposed to risk factors require additional attention, with timely early intervention to mitigate the impact of environmental stress and prevent the further development of depressive symptoms into a more severe and less manageable state.

Cognitive deficits and cortical volume loss in COVID-19-related hyposmia

BACKGROUND AND PURPOSE

Studies have found that up to 73% of COVID-19 patients experience hyposmia. It is unclear if the loss of smell in COVID-19 is due to damage to the peripheral or central mechanisms. This study aimed to explore the impacts of COVID-19-induced hyposmia on brain structure and cognitive functions.

METHODS

The study included 36 hyposmic (h-COV) and 21 normosmic (n-COV) participants who had recovered from mild COVID-19 infection, as well as 25 healthy controls (HCs). All participants underwent neurological examination, neuropsychiatric assessment and Sniffin' Sticks tests. High-resolution anatomical images were collected; olfactory bulb (OB) volume and cortical thickness were measured.

RESULTS

Addenbrooke's Cognitive Examination-Revised total and language sub-scores were slightly but significantly lower in the h-COV group compared to the HC group (p = 0.04 and p = 0.037). The h-COV group exhibited poorer performance in the Sniffin' Sticks test terms of discrimination score, identification score and the composite score compared to the n-COV and HC groups (p < 0.001, p = 0.001 and p = 0.002 respectively). A decrease in left and right OB volumes was observed in the h-COV group compared to the n-COV and HC groups (p = 0.003 and p = 0.006 respectively). The cortical thickness analysis revealed atrophy in the left lateral orbitofrontal cortex in the h-COV group compared to HCs. A significant low positive correlation of varying degrees was detected between discrimination and identification scores and both OB and left orbital sulci.

CONCLUSION

Temporary or permanent hyposmia after COVID-19 infection leads to atrophy in the OB and olfactory-related cortical structures and subtle cognitive problems in the long term.

The short-term impacts of COVID-2019 on depressive symptoms and cognitive decline: A community-based cohort study

Background

Neurological and psychological sequelae may persist after the infection of coronavirus disease 2019 (COVID-19). Depression and cognitive decline could increase the risk of Alzheimer's disease.

Objective

To estimate the impacts of COVID-19 on depressive symptoms and cognitive decline.

Methods

The data was from Beijing Research on Ageing and Vessel (BRAVE), which included all residents in the Xishan community. The first wave survey was performed from October to November 2019 (baseline) before the COVID-19 pandemic. The second wave survey was interrupted into two periods due to the introduction of the Ten New Measures, from October to November 2022 (no participants were infected) and from March to April 2023 (most participants were infected), providing an excellent opportunity to investigate the short-term impacts of COVID-19 on depressive symptoms and cognitive function with linear mixed models.

Results

Among a total of 1012 participants, the median (interquartile range, IQR) age at baseline was 60.00 (56.00, 65.00) years, with 374 (36.96%) men and 479 participants COVID-19 infected. Compared with uninfected participants, the infected did not suffer pronounced depressive symptoms (β = -0.047; 95% CI -0.204 to 0.110) and accelerated declines in global cognition (β = 0.116; 95% CI -0.001 to 0.234) from wave 1 to wave 2. Sensitive analyses shared generally consistent findings.

Conclusions

The impacts of COVID-19 infection on depressive symptoms and cognitive decline were not significant among participants in the BRAVE cohort. Further research is needed to investigate the long-term impacts on neurological and psychiatric symptoms.

Analyzing Mental Health Shifts Among Migrant Workers in Korea: A Comparative Study During and Post the COVID-19 Era

In the midst of a pandemic like COVID-19, migrant workers are highly vulnerable to the risk of mental health challenges and disorders. This study aimed to examine the variations in mental health and associated factors among migrant workers in Korea during and after the COVID-19 pandemic. A total of 830 migrant workers were included in this quantitative population-based study across two distinct COVID-19 periods: 415 from August 15, 2020 to January 20, 2021 (termed "during COVID-19" post-WHO pandemic declaration) and 415 from June 10 to September 18, 2023 (termed "after COVID-19" post-WHO and Korean Government announcement of the end COVID-19 as a global health emergency). The mental health of migrants was assessed using Patient Health Questionnaire-9 for depression and Generalized Anxiety Disorder-7 for anxiety, and compared between the two defined COVID-19 periods. Migrant workers exhibited higher means of depression (15.99 ± 5.16 vs. 8.78 ± 5.77) and anxiety (11.02 ± 4.45 vs. 6.97 ± 4.42) during the COVID-19 compared to after the COVID-19. The prevalence of severe depression (30.4% vs. 8.2%, p = .038) and severe anxiety (24.1% vs. 5.3%, p = .047) was significantly higher during the COVID-19 than after the pandemic. Changes in the mean depression scores among migrants were significantly influenced by living status (0.12 ± 11.10, p = .030) and employment status (0.44 ± 10.33, p = .043), while changes in mean anxiety scores were influenced by social relief funds (2.88 ± 8.61, p = .046) and employment status (1.13 ± 8.39, p = .012). This study highlights the increased susceptibility of migrant workers to depression and anxiety during COVID-19 compared to after the pandemic. Thus, it is imperative to prioritize the expansion of social support funds, ensure employment stability, and implement regular health check-up services to reduce mental health disorders among migrants.

Psychosocial Determinants of Oral Health Related to COVID-19 Infection in Myanmar Older Adults

This study aimed to investigate and compare the psychosocial and oral health factors among Myanmar older adults with and without a history of COVID-19 infection and assessed the association between psychological factors and oral health outcomes among those with a history of COVID-19 infection. A cross-sectional study was conducted among 203 participants in Yangon from 2023 to 2024 using face-to-face interviews and clinical oral examinations. Participants with a history of COVID-19 infection experienced greater psychological distress and poorer oral health outcomes than those without such a history. In those who contracted COVID-19, depression positively associated with decayed teeth; decayed, missing, and filled permanent teeth (DMFT); and oral health impact profile-14 (OHIP-14), whereas negatively associated with present teeth. Anxiety positively related to decayed teeth, DMFT, and periodontal pockets. Stress negatively associated with decayed teeth, but positively with OHIP-14. Implementing oral health promotion programs and providing mental support for this vulnerable population are essential to improve their oral health and well-being.

Persistent post COVID-19: Implications for women's health research and policy from members of the Women's Health Expert Panel of the American Academy of Nursing

BACKGROUND

Despite that globally the percent of women and men who tested positive for COVID-19 appears equal and that men with COVID-19 were 60% more likely than women to be severely ill and to die from complications (Rozenberg et al., 2020), studies of sex differences show that women compared with men are more likely to manifest persistent post-COVID-19 syndrome (PPCS).

PURPOSE

In this paper, we address some of the extant evidence for impact of the PPCS on women's health and well-being to underpin our suggestions for research and policy considerations.

METHODS

We assessed key papers in the extant literature to formulate views on needed health-related research and policies.

DISCUSSION

We discuss how key PPCS manifestations vary by sex, resemble sequelae uncovered for other chronically fatiguing or serious postinfectious trauma conditions, influence women's reproductive health (e.g., menstrual cycle, fertility, pregnancy, and menopause transition), impair women's social function and economic productivity, and challenge what is required for influential treatment and prevention.

CONCLUSION

To inform effective diagnosis, management and prevention of the significantly prevalent and debilitating PPCS, high on research and policy agendas should be uncovering multidimensional evidence of the impact on women, especially on their overall and reproductive health, well-being, social function and economic productivity.

From Pandemic to COVID-19 Endemic: Mental Health Impact, Psychological and Social Well-Being Among Social Work Students-Implications for the Healthcare System

Background/Objectives: Our research paper aims to analyse the relationship between the perceived impact on mental health due to the COVID-19 pandemic, social well-being, and psychological well-being among social work students. As we transition from the pandemic phase to an endemic phase of COVID-19, it is necessary to examine these aspects, recognizing the interdependence and complementarity of social and medical care within the healthcare system. Methods: The research was conducted nearly three years after the lockdown measures imposed by the spread of COVID-19, during a period when onsite academic activities had resumed, as they were prior to the pandemic. The sample consisted of 235 social work students from both bachelor's and master's programmes studying at a large university in Romania. Data was collected between December 2022 and January 2023, during a time when onsite educational activities were once again taking place. Results: Our results show that, despite the significant amount of time that had passed since the pandemic began, its negative effects were still strongly felt on a psychosocial level. Conclusions: This finding leads us to conclude that there is a long-term COVID-19 impact on mental health. Most study participants reported experiencing high (42.10%) or moderate (23%) levels of being mentally affected, which also affected their psychological and social well-being, key factors in preparing future social-medical care professionals to provide adequate integrated healthcare services.

The impact of the COVID-19 pandemic on access to mental health services and socioeconomic inequalities in Italy

Objective

Comprehensive evidence on the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on the use of mental health services is scarce. The aim of this study was to evaluate the impact of the COVID-19 pandemic on the access to mental health services in Italy and to assess the socioeconomic and citizenship inequalities for the same outcome.

Methods

A population-based longitudinal open cohort of residents aged ≥ 10 years was established in three large centers covering about 6 million beneficiaries (nearly 10% of the entire population) of the Italian National Health Service (NHS) from 01 January 2018 to 31 December 2021. The primary outcome of interest was the first access to one of the following mental health care services (FAMHS): outpatient facilities, hospital discharges, psychiatric drug prescriptions, emergency room admissions, residential and day care facilities, co-pay exemptions. To evaluate the effect of the COVID-19 pandemic on FAMHS, the temporal trend of FAMHS rates was investigated through an interrupted time series (ITS) analysis of their monthly rates. Crude incidence rates per 100,000 person days with 95%CI were calculated comparing the two time periods (pre- and post-COVID-19) by sex, age group, deprivation index (as a proxy of socioeconomic status), and citizenship. Finally, adjusted rates and rates ratios with 95%CI were estimated via ITS analysis using a step-change model.

Results

ITS analysis for the trend of FAMHS rates showed a significant drop at the outbreak of the pandemic in crude rates and after adjusting for age, sex, deprivation level, and citizenship (RR=0.83 p<0.001). After the outbreak of COVID-19, the trend increased, with rates returning to pre-pandemic levels. Adjusted incidence rate ratios (IRRs) showed a higher probability of having a FAMHS for females, Italians, and for residents in the most deprived areas. A gradient of higher rates with the increase in age was observed. Greater COVID-19 impact was found on the most deprived areas of residence, with a reduction in IRRs from pre- to post-COVID-19 significantly stronger.

Conclusions

The COVID-19 pandemic increased socioeconomic inequalities in mental health in Italy. Population-based cohorts are the most powerful instrument to monitor inequalities in access to mental health services and to provide timely information to drive policy.

Mental health symptoms and burdens after a SARS-CoV-2 infection

BACKGROUND

Previous studies have found adverse effects on mental health following infection with SARS-CoV-2. This study investigates whether mental health is also impaired in unknowingly infected individuals. In addition, the relevance of the severity of the infection and the time since the onset of infection were analyzed.

METHODS

Data from the population-representative Gutenberg COVID-19 Study (GCS) were used (N = 2,267). SARS-CoV-2 infection was determined multimodally by self-report, throat swabs (acute infections) and antibody measurements (previous infections). Participants completed self-report questionnaires on mental health.

RESULTS

Neither unknowing nor knowing SARS-CoV-2 infection had an impact on mental health. However, symptom severity and previous depression or anxiety predicted higher levels of depressiveness, anxiety and somatic complaints. Our results confirm findings suggesting that the severity of the initial infection and previous mental illness, but not knowledge of the infection, are the most important predictors of negative mental health outcomes following SARS-CoV-2 infection.

CONCLUSION

The results suggest that mental health care should focus on individuals who suffer from a severe acute COVID-19 infection or have a history of mental illness.

Fear and Impact of COVID-19 Among Post-Infected Adults: Types and Associations with Quality of Life and Post-Traumatic Stress Symptoms

Survivors of COVID-19 are susceptible to diminished health-related quality of life (HRQoL) and adverse psychological health, which may be exacerbated by their experiences of fear and the impact of the pandemic itself. This study aims to identify distinct fear and impact patterns related to the COVID-19 pandemic among survivors through latent profile analysis (LPA) and examine the associations of fear and impact patterns with post-traumatic stress symptoms (PTSS) and HRQoL. A total of 5,890 Vietnamese COVID-19 survivors completed the COVID-19 Impact Battery- Disability Scale (CIB-D), the Fear of COVID-19 Scale (FCoV-19 S), the Impact of Event Scale-Revised for PTSS, and the 36-Item Short Form Survey (SF-36) for HRQoL. Four distinct groups of fear and impact were identified: "Fearful and highly impacted" (26.8%), "moderately impacted yet not fearful" (22.9%), "less impacted and less fearful" (18.6%), and "mildly impacted and neutral" (31.7%). Survivors who were "less impacted and less fearful" exhibited significantly higher HRQoL scores (regression coefficient, B: 10.9; 95% confidence interval (CI): 10.0 - 11.7), both in terms of physical (B: 12.0; 95%CI: 11.1 - 12.9) and mental health (B: 19.4; 95%CI: 9.6 - 11.1), and lower PTSS levels (B: -24.5; 95%CI: -25.8 - -23.3) compared to those who were "highly impacted and fearful". It is imperative to acknowledge the intricate association between fear, impact, and mental health to comprehensively address the diverse needs of this distinct population post-COVID-19. These findings provide insights for designing interventions and support mechanisms for COVID-19 survivors.

COVID-19 Infection Experience and Depressive Symptoms Among Chinese Medical Staff: The Mediating Role of Professional Burnout

OBJECTIVES

This study aimed to assess the relationship between COVID-19 infection-related conditions and depressive symptoms among medical staff after easing the zero-COVID policy in China, and to further examine the mediating role of professional burnout.

METHODS

A total of 1716 medical staff from all levels of health care institutions in 16 administrative districts of Beijing, China, were recruited to participate at the end of 2022 in this cross-sectional study. Several multiple linear regressions and mediating effects tests were performed to analyze the data.

RESULTS

At the beginning of the end of the zero-COVID policy in China, 91.84% of respondents reported infection with COVID-19. After adjusting for potential confounding variables, the severity of infection symptoms was significantly positively associated with high levels of depressive symptoms (β = 0.06, P < 0.001), and this association was partially mediated by professional burnout. Specifically, emotional exhaustion (95% CI, 0.131, 0.251) and depersonalization (95% CI, 0.009, 0.043) significantly mediated the association between the severity of infection symptoms and depressive symptoms.

CONCLUSIONS

The mental health of medical staff with more severe symptoms of COVID-19 infection should be closely monitored. Also, interventions aimed at reducing emotional exhaustion and depersonalization may effectively reduce their risk of developing depressive symptoms.

Impact of the COVID-19 pandemic on communal religious worshippers' mental health and the benefits of positive religious coping

Background

In the United Kingdom, onsite religious services were halted during COVID-19 lockdowns, which were followed by various levels of restrictions on communal worship including social distancing, mandatory wearing of face masks, adequate ventilation and a ban on congregational singing and chanting. The aim of our study was to evaluate the impact of closures and changes within places of worship in response to the first lockdown in 2020, to assess the effect of the pandemic on religious practice and worshippers' wellbeing and religious coping.

Methods

Participants were regular worshippers in the UK, recruited through an online survey using convenience sampling. Respondents were asked about their attitudes to changes to places of worship in the UK and their wellbeing and mental health, including assessment of their risk of depression and anxiety using the Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder Assessment (GAD-7) measures. Questionnaires were completed August to November 2020.

Findings

939 participants were included in the analysis. Median age was 52.7 years and 66.1 % were female. 80.7 % identified as Christian. 165 (19.3 %) had mild, 45 (5.3 %) moderate, 25 (2.9 %) moderately severe and 10 (1.2 %) severe depression, and 192 (22.5 %) had mild, 55 (6.4 %) moderate and 27 (3.2 %) severe anxiety, according to PHQ-9 and GAD-7 scores, respectively. Nearly half (46.4 %) reported that their mood and anxiety levels had worsened and 16.6 % reported that they felt the things they were doing in their lives were not worthwhile. The vast majority of respondents (92.7 %) reported that prayer had helped them cope with the way they had felt during lockdown: 29.2 % and 47.0 % reported that it helped moderately and a great deal, respectively. This 76.2 % had significantly lower levels of moderate/severe depression and anxiety (adjusted odds ratio: depression 0.37 (95%CI 0.22-0.63), anxiety 0.52 (95%CI 0.31-0.88).

Interpretation

Our study demonstrates the significant impact of COVID-19 on communal worshippers' mental health and reinforces the benefits of positive religious coping during the first UK lockdown. Barriers to communal worship participation during lockdowns, including access to appropriate technology, need to be recognised and facilitators identified.

COVID-19 and Mental Illnesses in Vaccinated and Unvaccinated People

Importance

Associations have been found between COVID-19 and subsequent mental illness in both hospital- and population-based studies. However, evidence regarding which mental illnesses are associated with COVID-19 by vaccination status in these populations is limited.

Objective

To determine which mental illnesses are associated with diagnosed COVID-19 by vaccination status in both hospitalized patients and the general population.

Design, Setting, and Participants

This study was conducted in 3 cohorts, 1 before vaccine availability followed during the wild-type/Alpha variant eras (January 2020-June 2021) and 2 (vaccinated and unvaccinated) during the Delta variant era (June-December 2021). With National Health Service England approval, OpenSAFELY-TPP was used to access linked data from 24 million people registered with general practices in England using TPP SystmOne. People registered with a GP in England for at least 6 months and alive with known age between 18 and 110 years, sex, deprivation index information, and region at baseline were included. People were excluded if they had COVID-19 before baseline. Data were analyzed from July 2022 to June 2024.

Exposure

Confirmed COVID-19 diagnosis recorded in primary care secondary care, testing data, or the death registry.

Main Outcomes and Measures

Adjusted hazard ratios (aHRs) comparing the incidence of mental illnesses after diagnosis of COVID-19 with the incidence before or without COVID-19 for depression, serious mental illness, general anxiety, posttraumatic stress disorder, eating disorders, addiction, self-harm, and suicide.

Results

The largest cohort, the pre-vaccine availability cohort, included 18 648 606 people (9 363 710 [50.2%] female and 9 284 896 [49.8%] male) with a median (IQR) age of 49 (34-64) years. The vaccinated cohort included 14 035 286 individuals (7 308 556 [52.1%] female and 6 726 730 [47.9%] male) with a median (IQR) age of 53 (38-67) years. The unvaccinated cohort included 3 242 215 individuals (1 363 401 [42.1%] female and 1 878 814 [57.9%] male) with a median (IQR) age of 35 (27-46) years. Incidence of most outcomes was elevated during weeks 1 through 4 after COVID-19 diagnosis, compared with before or without COVID-19, in each cohort. Incidence of mental illnesses was lower in the vaccinated cohort compared with the pre-vaccine availability and unvaccinated cohorts: aHRs for depression and serious mental illness during weeks 1 through 4 after COVID-19 were 1.93 (95% CI, 1.88-1.98) and 1.49 (95% CI, 1.41-1.57) in the pre-vaccine availability cohort and 1.79 (95% CI, 1.68-1.90) and 1.45 (95% CI, 1.27-1.65) in the unvaccinated cohort compared with 1.16 (95% CI, 1.12-1.20) and 0.91 (95% CI, 0.85-0.98) in the vaccinated cohort. Elevation in incidence was higher and persisted longer after hospitalization for COVID-19.

Conclusions and Relevance

In this study, incidence of mental illnesses was elevated for up to a year following severe COVID-19 in unvaccinated people. These findings suggest that vaccination may mitigate the adverse effects of COVID-19 on mental health.

Socio-demographic and clinical predictors of post-acute, mid-and long-term psychological sequelae of COVID-19: a two-year cross-sectional investigation on 1317 patients at the University Hospital of Verona

BACKGROUND

The present paper focuses on socio-demographics, clinical variables, and the distance from the infection in predicting the long-term psycho-social consequences of COVID-19.

METHODS

Patients were screened with a cross-sectional design at the Psychological Service of the University Hospital of Verona (Italy) at 3, 6, 12, and 18 months after their SARS-CoV-2 infection. The assessment was part of the Horizon 2020-funded ORCHESTRA Project and included the Hospital Anxiety and Depression Scale (HADS), the Short Form Health Survey 36 (SF-36), the Impact of Event Scale-Revised (IES-R), and ad-hoc questions measuring pre-post COVID-19 changes on psycho-social dimensions (sleep quality, nutrition, level of autonomy, work, social relationships, emotional wellbeing).

RESULTS

Between June 2021 and June 2023, we evaluated 1317 patients (mean age 56.6 ± 14.8 years; 48% male): 35% at three months, 40% at 6, 20% at 12, and 5% at 18 months after the infection. Thirty-five percent were hospitalized due to COVID-19. Overall, 16% reported some form of clinically significant mental distress following the infection (HADS-TOT), with 13% and 6%, respectively, experiencing anxiety (HADS-Anxiety) and depressive symptoms (HADS-Depression). Four percent testified post-traumatic symptoms. The SF-36 scale revealed that 16% and 17% of subjects had physical or psychological deterioration in quality of life, respectively. The regression analyses showed that females experienced higher levels of anxiety and depression compared to males, along with worse mental and physical quality of life and pre-post infection changes in nearly all the investigated psycho-social dimensions. Younger people felt more anxiety and had a reduced mental quality of life than their older counterparts, who, in turn, had poorer scores in terms of autonomy and physical functioning. Hospitalized patients had lower levels of self-sufficiency, social relationships, and work than non-hospitalized people. The latter were more anxious and reported a lower physical quality of life. Finally, patients evaluated for the first time at 12- and 18 months showed a more significant impairment in mental and physical quality of life than those assessed at three months.

CONCLUSIONS

Our data show that COVID-19 psychological sequelae tend to persist over time, still needing clinical attention and intervention planning, especially for females.

Mapping the landscape of mental health and long COVID: a protocol for scoping review

INTRODUCTION

Mental health concerns are prevalent among adult patients with long COVID (LC), but the current state of knowledge regarding mental health in the context of LC is not fully understood. The objective of this scoping review is to map and summarise the existing research on mental health conditions among LC patients and highlight the knowledge gaps. This review aims to provide a comprehensive overview of the evolving landscape of research in the area.

METHODS AND ANALYSIS

The concept of interest is mental health in adult LC patients. This scoping review will be guided by the Joanna Briggs Institute Manual for Evidence Synthesis and reported according to the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review guidelines. Using predefined search parameters, a comprehensive search of two electronic databases (Medline and APA PsycINFO) and grey literature sources identified 3104 potentially eligible articles published from 1 January 2020 to 4 April 2024. Following the removal of duplicates, 2767 articles were imported for screening in Covidence. The study selection process involves screening titles, abstracts and full text of potentially relevant articles, which will then be analysed using thematic analysis. Data will be extracted using a predefined extraction form.

ETHICS AND DISSEMINATION

Ethical approval is not required because this study does not involve human participants or primary data collection. The findings from this review will be disseminated through a peer-reviewed publication, conference presentations and professional networks. In addition, a summary of the results will be shared with patient partners and other relevant stakeholders.

PUBLIC HEALTH IMPLICATIONS

The findings from this scoping review will contribute to a better understanding of mental health issues arising in LC patients and inform future research directions and public health interventions in this area.

Parallel Mediating Effects of Sleep Quality, Psychological Distress, and Self-Stigma in the Associations Between Long COVID Symptoms and Quality of Life Among Taiwanese Individuals With Mental Health Illness

BACKGROUND

Long COVID symptoms (i.e., experiencing symptoms of COVID-19 for 3 months post-COVID-19) affect individuals' health and their quality of life (QoL). However, the pathways through which it does so are not fully known.

AIM

The present study examined the mediating roles of sleep quality, psychological distress, and self-stigma in the associations between long COVID symptoms and QoL among individuals with mental illness.

METHOD

Individuals with mental illness (n = 333) were recruited from a psychiatric center in southern Taiwan to participate in the study. Data were collected regarding sleep quality, psychological distress, self-stigma, and QoL. Independent t-tests, Pearson correlations, and regression with Hayes' Process Macro were used to compare groups, examine relationships, and parallel mediation models, respectively.

RESULTS

Participants with long COVID symptoms had significantly worse sleep quality, psychological distress, physical QoL, and psychological QoL compared to those without symptoms. There were significant relationships between sleep quality, psychological distress, self-stigma, and QoL. Sleep quality significantly mediated the associations between long COVID symptoms and physical and social QoL. Psychological distress significantly mediated the associations between long COVID symptoms and all domains of QoL, but not self-stigma.

CONCLUSION

There are alternative pathways (e.g., sleep quality and psychological distress) through which long COVID symptoms may affect the QoL of individuals with mental illness. The findings suggest that individuals with long COVID symptoms have a higher chance of having poor QoL. Therefore, there may be the need for counseling and possible therapy for those who contract COVID-19, especially among individuals who already have mental illness.

Impact of COVID-19 on psychological distress in subsequent stages of the pandemic: The role of received social support

This longitudinal study examined a sample of adult Poles (N = 1245), who were interviewed three times from July 2021 to August 2022, during the later stages of the COVID-19 pandemic. The study had two primary objectives. The first was to assess the impact of the pandemic on psychological distress, measured through symptoms of depression and anxiety. The pandemic's effects were evaluated using three predictors: direct exposure to COVID-19, COVID-19 related stressors, and perceived threats from COVID-19. The second objective was to investigate the role of received social support in coping with the pandemic's hardships. Receipt of social support was measured by both the quantity of help received and the perceived quality of that support. A Latent Growth Curve Model (LGCM) was employed to analyze psychological distress across three waves, controlling for sociodemographic variables, non-COVID life events, coping self-efficacy, and perceived social support. Findings indicated that COVID-19 stressors and COVID-19 threats were strongly and consistently associated with greater psychological distress throughout the study period. The impact of direct COVID-19 exposure was limited. The quantity of received support predicted higher distress, whereas higher quality of received support was linked to better mental health. Crucially, the relationship between the quantity of support and distress was moderated by the quality of support. Effective social support was associated with the lowest distress levels, regardless of the amount of help received. Conversely, receiving large amounts of low-quality support was detrimental to psychological health. In summary, the ongoing psychosocial challenges of COVID-19 significantly eroded mental health, highlighting the importance of support quality over quantity in coping with significant life adversities.

Post-traumatic Reactions and Social-Emotional Competence Among Chinese High School Students Experiencing COVID-19 Lockdown: A Network Analysis

In the post-pandemic era, psychological traumas have emerged as major mental health issues. However, the post-traumatic reactions and their connections with social-emotional competence among high school students experiencing COVID-19 lockdown have not been adequately explored. This study aimed to reveal the characteristics of their positive and negative post-traumatic reactions, and their connections with social-emotional competence. Network analysis was used on data from 1096 Chinese high school students who experienced COVID-19 lockdown. Measures included the DSECS-S, the PTGI and the PC-PTSD-5. The results revealed that "Valuing life" and "Recalling unwillingly" were identified as core factors of post-traumatic reactions, while "Having close friendships", "Getting along well with others" and "Respecting others' emotions" played a bridging role in connecting the communities of social-emotional competence and post-traumatic reactions. This study enriches research on post-traumatic reactions, emphasizing the importance of implementing social-emotional competence programs to tackle mental health crises.

Mental wellness and health-related quality of life of young adult survivors of childhood cancer in Singapore

Introduction

Childhood cancer survivors (CCS) are at risk of experiencing psychological distress years after completing cancer treatments. We aimed to assess the prevalence and associated risk factors affecting psychological distress and health-related quality of life (HRQOL) among CCS in Singapore, and compare with their siblings without a history of or existing cancer as control.

Method

We recruited 143 young adult CCS aged ≥18 years attending survivorship clinics at KK Women's and Children's Hospital in Singapore who were in remission for ≥5 years and treatment-free for ≥2 years, and 57 siblings. CCS and siblings were matched at a 1:1 ratio based on sociodemographic factors yielding 46 pairs for comparison. Among CCS participants, 79 (55.2%) were male, 86 (60.1%) had leukaemia, 29 (20.3%) had solid tumours, 15 (10.5%) had lymphoma and 13 (9.1%) had brain tumours. All participants completed the Brief Symptom Inventory-18 (BSI-18) and Medical Outcomes Short Form-36 (MOS SF-36) questionnaires from August 2021 to July 2022.

Results

There were 35 (24.5%) CCS who reported psychological distress in the BSI-18 Global Severity Index. Five (3.5%) and 31 (21.7%) CCS reported low HRQOL in the physical and mental composite scores, respectively. Mean scores between CCS and their siblings were not statistically significant across all domains of the BSI-18 and MOS SF-36. Associated risk factors for psychological distress and low HRQOL among CCS were history of psychiatric illness after cancer diagnosis and mood affected by the COVID-19 pandemic.

Conclusion

CCS reported significant psychological distress and low HRQOL although they were not statistically different from their siblings. A holistic and risk factor-centric follow-up programme can aid early detection and mitigation of psychological late effects for CCS and their families.

Disparities in spatiotemporal clustering of maternal mental health conditions before and during the COVID-19 pandemic

Mounting evidence indicates the worsening of maternal mental health conditions during the COVID-19 pandemic. Mental health conditions are the leading cause of preventable death during the perinatal and postpartum periods. Our study sought to detect space-time patterns in the distribution of maternal mental health conditions in pregnant women before (2016-2019) and during (2020-2021) the COVID-19 pandemic in North Carolina, USA. Using the space-time Poisson model in SaTScan, we performed univariate and multivariate cluster analysis of emergency department (ED) visits for perinatal mood and anxiety disorders (PMAD), severe mental illness (SMI), maternal mental disorders of pregnancy (MDP), suicidal thoughts, and suicide attempts during the pre-pandemic and pandemic periods. Clusters were adjusted for age, race, and insurance type. Significant multivariate and univariate PMAD, SMI, and MDP clustering persisted across both periods in North Carolina, while univariate clustering for both suicide outcomes decreased during the pandemic. Local relative risk (RR) for all conditions increased drastically in select locations. The number of zip code tabulation areas (ZCTAs) included in clusters decreased, while the proportion of urban locations included in clusters increased for non-suicide outcomes. Average yearly case counts for all maternal mental health outcomes increased during the pandemic. Results provide contextual and spatial information concerning at-risk maternal populations with a high burden of perinatal mental health disorders before and during the pandemic and emphasize the necessity of urgent and targeted expansion of mental health resources in select communities.

Social determinants of health and COVID-19 recovery after inpatient rehabilitation

BACKGROUND

Neighborhoods with more social determinants of health (SDOH) risk factors have higher rates of infectivity, morbidity, and mortality from COVID-19. Patients with severe COVID-19 infection can have long-term functional deficits leading to lower quality of life (QoL) and independence measures. Research shows that these patients benefit greatly from inpatient rehabilitation facilities (IRF) admission, but there remains a lack of studies investigating long-term benefits of rehabilitation once patients are returned to their home environment.

OBJECTIVE

To determine SDOH factors related to long-term independence and QoL of COVID-19 patients after IRF stay.

DESIGN

Multisite cross-sectional survey.

SETTING

Two urban IRFs.

MAIN OUTCOME MEASURES

Primary outcome measures were Post-COVID Functional Status Scale (PCFS) and Short Form-36 (SF-36) scores. Secondary outcomes were quality indicator (QI) scores while at IRF and a health care access questionnaire. Results were analyzed using analysis of variance and multivariate logistic regression analyses.

RESULTS

Participants (n = 48) who were greater than 1 year post-IRF stay for severe COVID-19 were enrolled in the study. Higher SF-36 scores were associated with male gender (p = .002), higher income (≥$70,000, p = .004), and living in the city (p = .046). Similarly, patients who were of the male gender (p = .004) and had higher income (≥$70,000, p = .04) had a greater odds of a 0 or 1 on the PCFS. Age was not associated with differences. Women were more likely to seek follow-up care (p = .014). Those who sought follow-up care reported lower SF-36 overall and emotional wellness scores, p = .041 and p = .007, respectively. Commonly reported barriers to health care access were financial and time constraints.

CONCLUSIONS

Patients with SDOH risk factors need to be supported in the outpatient setting to maintain functional gains made during IRF stays. Female gender, income, and urban setting are potential predictors for long-term QoL and independence deficits after rehabilitation for COVID-19 infection. Low emotional wellness is an indicator for patients to seek out care as far out as 1 year from their rehabilitation stay.

The Impact of SARS-CoV-2 Infection on Sleep, Daytime Sleepiness, and Depression-Longitudinal Cohort Study

Background and Objectives: COVID-19 disease, caused by the SARS-CoV-2 virus, has presented significant challenges to global health, with acute and chronic implications for various aspects of well-being, including sleep and quality of life. This study aimed to investigate the impact of SARS-CoV-2 infection on sleep quality, daytime sleepiness, and quality of life in hospitalised and home-treated patients after three and six months. Materials and Methods: A longitudinal cohort study was conducted, enrolling hospitalised patients from a single clinical university hospital and home-treated participants through a survey spread through social networks. Individuals who had tested positive for the SARS-CoV-2 virus in the past three months and had a symptomatic course of the disease were included in the study. Participants with previously diagnosed sleep disorders were excluded from the study. Participants were evaluated using internationally validated self-evaluation scales, including the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9) and Fatigue Severity Scale (FSS). Data were collected three and six months after laboratory-confirmed SARS-CoV-2 infection, with informed consent obtained from all participants. Statistical analysis was performed using the Wilcoxon signed rank test, Fisher-Freeman-Halton exact, Pearson Chi tests and Spearman correlation. Results were considered statistically significant with p value < 0.05. Results: In total, 66 participants with a mean age of 44.05 ± 21.61 years were enrolled in the study. Most patients (n = 36) were treated at home and 30 at hospital. Six months after SARS-CoV-2 infection, home-treated patients reported a higher prevalence of poor sleep quality (52.8%, n = 19, p = 0.015, PSQI) and hospitalised patients showed a lower prevalence of depressive symptoms (p < 0.001, PHQ-9) as 90% (n = 27) had minimal or no symptoms compared to 30.6% (n = 11) in a home-treated group. Conclusions: These findings mark the importance of the COVID-19 patients' management settings as people treated at home had worse sleep quality and more depressive symptoms six months after infection indicating worse life quality.

The study of mental health status of people with epilepsy during the COVID-19 pandemic: A systematic review and meta-analysis study

INTRODUCTION

The COVID-19 pandemic has affected the lives of people with epilepsy (PWE) in various ways. This systematic review and meta-analysis aims to assess the mental health status and prevalence of mental disorders including depression, anxiety, stress, and psychological distress among PWE. Furthermore, this study evaluates changes in sleep patterns and presence of sleep disturbances among them. The findings of this systematic review can help health organizations, policymakers, and health workers to better prepare and respond to future health crises for PWE and other chronic disease patients.

METHOD

This systematic review was prepared using PRISMA reporting guidelines. We systematically searched PubMed, Web of Science, Scopus and Cochrane Library databases for studies that reported data on mental health parameters including depression, anxiety, stress, psychological distress, quality of life, and sleep quality, during the pandemic until May 2023. The analytical procedures were executed through the utilization of Comprehensive Meta-Analysis (CMA) software.

RESULTS

In our study, a total of 61 carefully selected studies were analyzed, yielding valuable insights into the prevalence and impact of various mental health indicators among PWE. The findings revealed that a significant proportion of PWE experienced distressing psychological symptoms, with depression being reported by 34% of participants. Additionally, anxiety was prevalent among 43% of individuals, while stress symptoms were reported by 49% of respondents. Moreover, a substantial portion of PWE, approximately 38%, reported experiencing poor sleep quality, further underscoring the multifaceted nature of the challenges faced by this population. These findings highlight the need for targeted interventions and comprehensive support systems to address the mental health concerns and sleep disturbances faced by individuals living with epilepsy.

CONCLUSION

The findings revealed that a substantial number of PWE experience symptoms of depression, anxiety, stress, and poor sleep quality. These results emphasize the importance of considering mental health and sleep assessments as integral components of care for individuals with epilepsy. The study underscores the need for further research and targeted interventions to address the mental health burden faced by this population. By prioritizing and addressing these challenges, healthcare providers can enhance the overall well-being and quality of life for individuals living with epilepsy.

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.

Cohort profile: the Johns Hopkins COVID Long Study (JHCLS)-a US nationwide prospective cohort study

PURPOSE

COVID-19 continues to affect millions of individuals worldwide, both in the short and long term. The post-acute complications of SARS-CoV-2 infection, referred to as long COVID, result in diverse symptoms affecting multiple organ systems. Little is known regarding how the symptoms associated with long COVID progress and resolve over time. The Johns Hopkins COVID Long Study aims to prospectively examine the short-term and long-term consequences of COVID-19 in individuals both with and without a history of SARS-CoV-2 infection using self-reported data collected in an online survey.

PARTICIPANTS

16 764 adults with a history of SARS-CoV-2 infection and 799 adults without a history of SARS-CoV-2 infection who completed an online baseline survey.

FINDINGS TO DATE

This cohort profile describes the baseline characteristics of the Johns Hopkins COVID Long Study. Among 16 764 participants with a history of SARS-CoV-2 infection and defined long COVID status, 75% reported a very good or excellent health status prior to infection, 99% reported experiencing at least one COVID-19 symptom during the acute phase of infection, 9.9% reported hospitalisation and 63% were defined as having long COVID using the WHO definition.

FUTURE PLANS

Analysis of longitudinal data will be used to investigate the progression and resolution of long COVID symptoms over time.