Longitudinal changes of anxiety and depressive symptoms during the COVID-19 pandemic in Germany: The role of pre-existing anxiety, depressive, and other mental disorders

Prevalence and correlates of generalized anxiety disorder and subthreshold anxiety symptoms in south China: A network perspective

AIMS

To investigate the prevalence of generalized anxiety disorder (GAD) and subthreshold anxiety symptoms (SAS) in Guangdong province of China, and to identify the central anxiety symptoms, while further exploring their associations with sociodemographic characteristics, lifestyle factors, and somatic diseases.

METHODS

This survey was conducted in 21 administrative regions of Guangdong province with multistage-stratified cluster random sampling method. Multivariate logistic regression analyses were performed to estimate the adjusted odds ratios (ORs) and their 95 % confidence intervals (CIs). Network analyses were conducted to explore the centrality of anxiety symptoms.

RESULTS

A total of 16,377 individuals were included in this study. The weight 12-month prevalence rates for GAD and SAS were 3.5 % and 10.0 %, respectively. Multivariable logistic regression analysis identified several factors significantly associated with increased risks of GAD and SAS, including younger age, female, no spouse, current alcohol consumption, never exercising, comorbidities, sleep duration of less than 7 h. Notably, the factors related to GAD and SAS largely overlapped, with urban residency and napping correlating specifically with SAS, and mental health literacy correlating specifically with GAD. Network analysis identified "Trouble relaxing" (GAD4) as the most central symptom of anxiety.

CONCLUSIONS

GAD and SAS were prevalent among residents in south China. More attention and assistance should be prioritized to individuals with younger age, female, no spouse, current alcohol consumption, sleep less than 7 h, and comorbid with somatic diseases. Taking regular exercise and improving mental health literacy may be beneficial in preventing and controlling anxiety.

Long-term efficacy of cognitive behavioural therapy for generalized anxiety disorder: A 2-8-year follow-up of two randomized controlled trials

Anxiety disorders are the most prevalent mental disorders globally, with generalized anxiety disorder (GAD) being one of the most common among them. While GAD can be effectively treated with bona fide cognitive behavioural therapy (CBT), research on its long-term efficacy is scarce. This study examined the long-term efficacy of CBT for GAD in terms of statistical symptom reduction and clinically significant change. A follow-up of 93 GAD patients, 2-8 years post-treatment from two randomized controlled implementation trials, was conducted. Outcome measures included two disorder-specific outcomes and three general mental health outcomes. Statistical symptom reduction was assessed using piecewise linear growth models, and clinically significant change was evaluated based on Jacobson and Truax's (1991) criteria. Results indicated that treatment gains were maintained from six-months post-treatment to long-term follow-up for all outcome measures except depressive symptoms, which increased during this period. Clinically significant change analysis showed that 57 %-77 % of participants were categorised as recovered 2-8 years post-CBT. This study provides insights into treatment durability 2-8 years post-treatment. Treatment success was largely maintained, with more than half to three-quarters of patients categorised as recovered, supporting the sustained efficacy of CBT for GAD.

Viral Transmission? A Longitudinal Study of Media Use and Its Relation to Mental Strain During the First 2 Years of the COVID-19 Pandemic

BACKGROUND

In light of the dynamic COVID-19 pandemic, the exposure to pandemic-related media coverage may change over time and may be particularly relevant due to associations with psychopathological symptoms. The aims of the present study were to examine changes in media consumption over time and to analyze its prospective associations with psychological strain.

METHOD

The study uses a longitudinal observational design with ten periods of online data collection from March 2020 to April 2022 in an adult convenience sample (N = 8337) of the general population in Germany.

RESULTS

Our data revealed that the frequency and duration of pandemic-related media exposure as well as their subjective critical evaluation showed the highest levels at the beginning of the pandemic and peaked again in autumn 2020 and spring 2021. The primarily used media formats changed only slightly over time. The amount of media exposure at baseline was associated with more impairing pandemic-related anxiety 1 month, 1 year, and 2 years later.

CONCLUSION

Our results hint to potentially problematical and long-lasting associations of pandemic-related media consumption with mental strain. Our findings could serve as an orientation for recommendations, further research, and adequate interventions for a responsible dealing with media coverage.

TRIAL REGISTRATION

The authors have pre-registered this research at clinicaltrials.gov without an analysis plan; retrievable at: https://clinicaltrials.gov/ct2/show/NCT04331106 .

Mental Health in the Time of the COVID-19 Pandemic: A Scoping Review of Collateral Effects on Common Mental Disorders (CMDs)

It is unclear whether the COVID-19 pandemic has had consequences for common mental disorders (CMDs). This scoping review aims to examine direct infection-related (e.g., severe COVID-19 illness), psychosocial (e.g., social isolation), and indirect outcomes (e.g., changes in incidence) that have been particularly discussed so far. A literature search for clinically diagnosed adult CMDs was conducted using Pubmed, Web of Science, and PsycInfo (n = 5325). After completion of the screening process, 26 included studies remained for extraction. None of the included studies reported post-pandemic data. The effects appeared to be particularly pronounced for anxiety and obsessive-compulsive disorders in the first year of the pandemic. This was followed by a period of adjustment, during which rates of mental disease and its symptoms largely returned to pre-pandemic levels. Fluctuating rates of CMDs may have had COVID-related causes. Preventive temporary inpatient care could be a protective approach for those at risk or vulnerable, as well as establishing pandemic consultation and building resilience. A gap in the research is the lack of comparisons of CMD data before, during, and after the pandemic to distinguish transient disease rates from chronic disease requiring treatment.

How Does the Normalization Process After the COVID-19 Pandemic Affect Patients With Obsessive-Compulsive Disorder? A Longitudinal Study

ABSTRACT

This study aims to investigate the effect of the normalization process after the pandemic on obsessive-compulsive disorder (OCD) patients. During the pandemic period, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Padua Inventory-Washington State University Revision, the Fear of COVID-19 Scale (FCV-19S), and an interview form inquiring sociodemographic characteristics were applied to the participant patients with OCD. During the normalization process, the patients were reevaluated after about 1 year. A significant decrease was found in the patients' FCV-19S and PE-WSUR total scores along with all subscale scores as well as the Y-BOCS scores. The FCV-19S was associated with OCD symptoms both during the pandemic and the normalization period. The final FCV-19S scores of patients with a Y-BOCS score of 12 and under were found to be statistically significantly lower than the others. This study shows that OCD symptom severity and fear of COVID-19 decreased with the normalization process. A decrease in pandemic-related stress and fear of COVID-19 with the normalization process may have positively affected OCD patients.

Symptoms of anxiety and depression among health and social science students: A multicenter study

Background

The mental health of university students is a global concern, with high rates of depression and anxiety that need to be addressed.

Aim

We aimed to compare the mental health of Portuguese, Swedish and German university students in the health and social sciences following the Covid-19 pandemic and to analyze the factors associated with depressive and anxious symptoms in each country.

Methods

A cross-sectional study with a sample of students from Portugal, Germany and Sweden was conducted. Data from online questionnaires, including a sociodemographic and clinical questionnaire, the Patient Health Questionnaire (PHQ-9), the General Anxiety Disorder (GAD-7) and the MHI-5 (Mental Health Inventory) was collected from October to December 2022.

Results

The sample was composed of 1670 university students. The prevalence of mild to severe depressive symptoms was 72.7 % in Germany, 62.9 % in Sweden, and 60.3 % in Portugal and the prevalence of mild to severe anxiety symptoms was 78.6 % in Portugal, 73.7 % in Germany, and 66.9 % in Sweden. Being a female student, having a previous mental health disorder diagnosis, and poor academic performance were associated with higher severity of depression and anxiety symptoms in all three countries. Country-specific factors associated with more depressive and/or anxiety symptoms were younger age, smoking, low socioeconomic level and living away from home. Swedish students who do not consume alcohol had more anxiety symptoms and German students who do not consume alcohol had more depressive symptoms.

Conclusion

The high prevalence of depressive and anxiety symptoms among students in the three countries highlights the need to address modifiable factors that contribute to this mental health burden. Our results, which are in line with international trends, underline the need for policy reforms that target the main determinants of mental health, in particular by improving socio-economic conditions. Addressing these factors could play a crucial role in improving mental health outcomes in this population.

The influence of hope and optimism on trajectories of COVID-19 stress, health anxiety, and wellbeing during the COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic posed a threat to public health and psychological functioning, with early studies documenting higher rates of psychopathology within the United States and globally. Hope and optimism promote adjustment and are associated with positive physical and mental health outcomes. Thus, individual differences in hope and optimism may also foster resilience during a global health crisis.

AIMS

The current study examined how hope and optimism influenced longitudinal health-focused distress and wellbeing during the pandemic.

METHODS

Data were collected from 788 American adults across three periods during Spring-Summer 2020 using MTurk. Latent growth curve modeling examined whether hope and optimism predicted COVID stress, health anxiety, and wellbeing trajectories.

RESULTS

COVID stress and health anxiety decreased after the onset of the pandemic, whereas wellbeing was stable. Individually, hope and optimism predicted lower initial COVID stress and health anxiety, along with greater initial wellbeing. When examining the combined influence of hope and optimism, optimism was more strongly related to health-focused distress, though both were strong predictors of wellbeing.

CONCLUSIONS

These findings indicate that Americans were resilient and positive expectancies, particularly optimism, predicted better initial adjustment to the early phases of the pandemic. Thus, positive expectancies appear to be protective during a global health crisis.

Evaluation of the mental health of COVID-19 patients discharged from the intensive care unit

In this editorial, I address the mental health status of patients who have been discharged from intensive care units (ICUs) after battling coronavirus disease 2019 (COVID-19). An ICU admission is generally a stressful experience, and for severe COVID-19 survivors prolonged treatment in the ICU can lead to significant psychological consequences. These individuals may experience psychiatric distress, including symptoms such as insomnia, anxiety, depression, and even post-traumatic psychological issues. Research indicates that during the first 6 months to 1 year following an ICU stay, nearly one-third of survivors exhibit symptoms similar to those of depression and post-traumatic stress disorder. Several factors may have contributed to the development of depressive and anxious symptoms during the COVID-19 pandemic, particularly for those who underwent an ICU stay. The ICU environment itself is inherently stressful, filled with the constant noise of various medical devices. Studies have provided strong evidence that the prolonged need for ventilation support and the loss of freedom of movement are key factors in the development of psychological problems among COVID-19 patients who had been treated in the ICU.

The trajectory of anxiety and depressive symptoms and the impact of self-injury: A longitudinal 12-month cohort study of individuals with psychiatric symptoms

BACKGROUND

Individuals reporting self-injury are at greater risk of several adverse outcomes, including suicide. There is reason to be concerned how these individuals cope when stressful life events increase. This study aimed to investigate the trajectories of anxiety and depressive symptoms and the predictive value of self-injury history in individuals with psychiatric symptoms during the unique and stressful conditions of the COVID-19 pandemic.

METHODS

In a longitudinal population cohort study (N = 1810) ranging from 2020 to 2022, anxiety (measured by Generalized Anxiety Disorder, GAD-7) and depressive symptoms (measured by Patient Health Questionnaire, PHQ-9) were self-reported monthly during 12 months. Latent growth curve models with and without self-reported self-injury history as predictors were conducted.

RESULTS

Overall, anxiety and depressive symptoms decreased from baseline, but remained at moderate severity at follow-up. Individuals reporting suicidal or nonsuicidal self-injury reported significantly higher symptom severity at baseline. In addition, individuals reporting suicidal self-injury demonstrated a slower rate of decline in the symptom load over the course of 12 months.

CONCLUSIONS

Over the course of 12 months, anxiety and depressive symptoms decreased in individuals with psychiatric symptoms, but still indicate a psychiatric burden. Individuals with a history of self-injury could be more vulnerable in face of stressful conditions such as those experienced during the COVID-19 pandemic.

The impact of the COVID-19 pandemic on individuals with pre-existing diabetes mellitus

OBJECTIVES

To examine the psychosocial impact of the COVID-19 pandemic on patients with a diagnosis of diabetes mellitus (DM).

METHODS

Semi-structured interviews were conducted with 31 individuals with DM attending a diabetes clinic to determine the impact of the COVID-19 restrictions on anxiety and depressive symptoms, social and occupational functioning and quality of life. Anxiety symptoms were correlated with functioning, quality of life and diabetes self-management.

RESULTS

Likert data demonstrated that social functioning (mean = 5.5, SD = 3.7) and quality of life (mean = 4.1, SD = 3.1) were most impacted by the COVID-19 pandemic. Anxiety symptoms were prevalent with 13 individuals (41.9%) scoring above cut-off scores for the presence of anxiety symptoms based on the Beck Anxiety Inventory. Diabetes self-management was significantly correlated with functioning (r = 0.51, p = 0.006) and inversely correlated with anxiety symptoms (r = -0.51, p = 0.007). A prior history of a depressive or anxiety disorder was associated with significantly increased anxiety symptoms, as well as impaired global functioning (p < 0.01), poorer self-care of diabetes (p = 0.014) and satisfaction with diabetes treatment (p = 0.03).

CONCLUSIONS

The psychological and social impact of COVID-19 restrictions on individuals with DM was significant, with poorer management of diabetes correlated with anxiety symptom severity.

Depression and Anxiety among Migrant Older Adults during the COVID-19 Pandemic in China: Network Analysis of Continuous Cross-Sectional Data

Many Chinese migrant older adults are more prone to mental health problems due to their "migrant" status. During the COVID-19 pandemic, restrictions on their mobility exacerbated these conditions. Mental health is a crucial dimension of healthy aging. Network analysis offers a novel method for exploring interactions between mental health problems at the symptom level. This study employs network analysis to examine the interactions between comorbid depressive and anxiety symptoms across different stages of the COVID-19 pandemic. Surveys were conducted from September 2019 to January 2020 (T1), September 2020 to January 2021 (T2), and September 2021 onwards (T3). Depression and anxiety symptoms were measured by the Patient Health Questionnaire-9 (PHQ-9) and the Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Expected Influence (EI) and Bridge Expected Influence (Bridge EI) were used to identify central and bridge symptoms in the network. Network stability and accuracy tests were performed. Among the Chinese migrant older adults, the anxiety prevalence was 18.50% at T1, 21.11% at T2, and 9.38% at T3. The prevalence of depression was 26.95% at T1, 55.44% at T2, and 60.24% at T3. The primary central symptoms included 'Afraid something will happen' (A2), 'Irritability' (A6), 'Panic' (A7), 'Feeling of worthlessness' (D6), 'Anhedonia' (D1), and 'Feeling of fear' (A5). The major bridge symptoms included 'Feeling of fear' (A5), 'Panic' (A7), 'Irritability' (A6), 'Fatigue' (D4), 'Anhedonia' (D1), and 'Depressed or sad mood' (D2). Differences in network structure were observed across the periods. The network analysis further revealed the evolving relationships between central and bridge symptoms over time, highlighting the importance of targeted intervention strategies for central and bridge symptoms of comorbid depression and anxiety at different periods.

Coping with a global crisis-Changes in worries about the Russo-Ukrainian War

Global crises, such as the Russo-Ukrainian War, can lead to worrying, which in turn can result in health problems when not positively coped with. This study investigates how the worries of Germans are related to general coping strategies. Three consecutive online surveys were distributed from the beginning of March until the beginning of May 2022. The surveys assessed participants' worries about the Russo-Ukrainian War and their use of four coping domains for the two preceding weeks. A total of 175 (54.3% female; Mage = 33.3, SD = 13.6, 18-66 years) participants completed all three questionnaires. Worries and coping (meaning-focused, problem-focused, social, and avoidance coping) declined over time. Cross-sectionally all coping domains, except meaning-focused coping, correlated positively with initial worries, indicating a higher use of coping strategies when worries were present. In line with this, the use of both social and avoidance coping declined over the course of the study when worries were reduced. Furthermore, a higher initial use of avoidance coping was associated with a stronger decline in worries. Worries and coping strategies both declined following the Russian invasion of Ukraine which suggests that worries and coping strategies adapt to one another over time.

Patterns and correlates of mental healthcare utilization during the COVID-19 pandemic among individuals with pre-existing mental disorder

How did mental healthcare utilization change during the COVID-19 pandemic period among individuals with pre-existing mental disorder? Understanding utilization patterns of these at-risk individuals and identifying those most likely to exhibit increased utilization could improve patient stratification and efficient delivery of mental health services. This study leveraged large-scale electronic health record (EHR) data to describe mental healthcare utilization patterns among individuals with pre-existing mental disorder before and during the COVID-19 pandemic and identify correlates of high mental healthcare utilization. Using EHR data from a large healthcare system in Massachusetts, we identified three "pre-existing mental disorder" groups (PMD) based on having a documented mental disorder diagnosis within the 6 months prior to the March 2020 lockdown, related to: (1) stress-related disorders (e.g., depression, anxiety) (N = 115,849), (2) serious mental illness (e.g., schizophrenia, bipolar disorders) (N = 11,530), or (3) compulsive behavior disorders (e.g., eating disorder, OCD) (N = 5,893). We also identified a "historical comparison" group (HC) for each PMD (N = 113,604, 11,758, and 5,387, respectively) from the previous year (2019). We assessed the monthly number of mental healthcare visits from March 13 to December 31 for PMDs in 2020 and HCs in 2019. Phenome-wide association analyses (PheWAS) were used to identify clinical correlates of high mental healthcare utilization. We found the overall number of mental healthcare visits per patient during the pandemic period in 2020 was 10-12% higher than in 2019. The majority of increased visits was driven by a subset of high mental healthcare utilizers (top decile). PheWAS results indicated that correlates of high utilization (prior mental disorders, chronic pain, insomnia, viral hepatitis C, etc.) were largely similar before and during the pandemic, though several conditions (e.g., back pain) were associated with high utilization only during the pandemic. Limitations included that we were not able to examine other risk factors previously shown to influence mental health during the pandemic (e.g., social support, discrimination) due to lack of social determinants of health information in EHR data. Mental healthcare utilization among patients with pre-existing mental disorder increased overall during the pandemic, likely due to expanded access to telemedicine. Given that clinical correlates of high mental healthcare utilization in a major hospital system were largely similar before and during the COVID-19 pandemic, resource stratification based on known risk factor profiles may aid hospitals in responding to heightened mental healthcare needs during a pandemic.

Changes in mental distress among employees during the three years of the COVID-19 pandemic in Germany

OBJECTIVES

The COVID-19 pandemic changed the future of work sustainably and led to a general increase in mental stress. A study conducted during the second and third pandemic wave with a retrospective survey of the first wave among 1,545 non-healthcare workers confirmed an increase in anxiety and depression symptoms and showed a correlation with the occupational SARS-CoV-2 infection risk. This online follow-up survey aims to examine changes in mental distress as the pandemic progressed in Germany and to identify factors influencing potential changes.

METHODS

Longitudinal data from 260 subjects were available for this analysis. Mental distress related to anxiety and depression symptoms, assessed by the Patient Health Questionnaire-4 (PHQ-4), and occupational risk factors were solicited at the end of 2022 and retrospectively at the fifth wave. Categorized PHQ-4 scores were modelled with mixed ordinal regression models and presented with odds ratios (OR) and 95% confidence intervals (95% CI).

RESULTS

A previous diagnosis of a depressive or anxiety disorder was a strong risk factor for severe symptoms (OR 3.49, 95% CI 1.71-7.11). The impact of occupational SARS-CoV-2 infection risk on mental distress was increased, albeit failing to reach the formal level of statistical significance (high risk OR 1.83, 95% CI 0.59-5.63; probable risk OR 1.72, 95% CI 0.93-3.15). Mental distress was more pronounced in those with a previous diagnosis of anxiety and depression. Confirmed occupational risk factors were protective measures against occupational SARS-CoV-2 infection perceived as inadequate, chronic work-related stress, overcommitment, reduced interactions with fellow-workers, and work-privacy conflicts.

CONCLUSIONS

The pandemic had a negative impact on anxiety and depression symptoms among the studied non-healthcare workers, particularly early in the pandemic, although this effect does not appear to be permanent. There are modifiable risk factors that can protect workers' mental health, including strengthening social interactions among employees and reducing work-privacy conflicts.

What set some young adults apart during the COVID-19 pandemic? Mental health trajectories, risk and protective factors in an Australian longitudinal study

OBJECTIVE

Evidence suggests that young adults (aged 18-34) were disproportionately impacted by the COVID-19 pandemic, but little is known about their longer-term mental health changes beyond the early pandemic period. This article investigates heterogeneous trajectories of mental health among Australian young adults across 2 years of the pandemic and identifies a broad range of associated risk and protective factors.

METHOD

Young adults (N = 653, Mage = 27.8 years) from the longitudinal Alone Together Study were surveyed biannually between July 2020 and June 2022. Measures assessed anxiety (7-item Generalised Anxiety Disorder scale) and depression (9-item Patient Health Questionnaire) symptoms at Waves 1-4, as well as demographic, psychological, adversity and COVID-19 factors at baseline.

RESULTS

Four and three distinct trajectories of anxiety and depressive symptoms, respectively, were identified through growth mixture modelling. The proportion of participants in each anxiety trajectory were Asymptomatic (45.9%), Mild Stable (17.9%), Moderate-Severe Stable (31.1%) and Initially Severe/Recovering (5.1%). For depression, Mild Stable (58.3%), Moderate-Severe Stable (30.5%) and Reactive/Recovering (11.2%). Baseline factors associated with severe symptom trajectories included a lifetime mental health disorder, pre-pandemic stressful events, identifying as LGBTQIA+ and/or female, and experiencing one or more infection-control measures. Higher household income was protective.

CONCLUSION

Most young adults demonstrated stable trajectories of low or high symptoms during the pandemic, with smaller groups showing initially severe or reactive symptoms followed by marked improvements over time. Vulnerable subgroups (gender- or sexuality-diverse, those with prior adversity or pre-existing mental ill-health) may face ongoing impacts and require targeted psychosocial supports to assist their mental health recovery post-COVID-19 and in the event of future crises.

Changes in the Clinical Practice of Mental Health Service Providers Throughout the COVID-19 Pandemic: Longitudinal Questionnaire Study

BACKGROUND

The COVID-19 pandemic impacted the practices of most mental health providers and resulted in a rapid transition to providing telemental health services, changes that were likely related to stay-at-home policies as well as increased need for services.

OBJECTIVE

The aim of this study was to examine whether these changes to practice have been sustained over time throughout the course of the COVID-19 pandemic and whether there are differences among mental health provider type and setting. We hypothesized that there would be an increase in the number of patients seen in person after the initial surge of the pandemic in spring 2020 and subsequent discontinuation of stay-at-home policies, though with continued implementation of telemental health services across settings.

METHODS

This study surveyed 235 of the 903 mental health providers who responded to a survey in spring 2020 (Time point 1) and at a 1-year follow-up in spring 2021 (Time point 2). Differences in practice adjustments, factors related to telemental health, and number of patients seen were examined across provider type (social worker, psychologist, neuropsychologist) and setting (academic medical center [AMC], community mental health, private practice, and Veterans Affairs hospital).

RESULTS

From Time point 1 to Time point 2, there was a small but significant increase in the overall number of providers who were implementing telehealth (191/235, 81% to 204/235, 87%, P=.01) and there was a significant decline in canceled or rescheduled appointments (25%-50% in 2020 to 3%-7% in 2021, P<.001). Psychologists and providers working at AMCs reported decreased difficulty with telehealth implementation (P<.001), and providers working at AMCs and in private practice settings indicated they were more likely to continue telehealth services beyond spring 2021 (P<.001). The percent of time working remotely decreased overall (78% to 59%, P<.001), which was most notable among neuropsychologists and providers working at an AMC. There was an overall increase in the average number of patients seen in person per week compared with earlier in the pandemic (mean 4.3 to 8.7, P<.001), with no change in the number of patients seen via telehealth (mean 9.7 to 9.9, P=.66).

CONCLUSIONS

These results show that the rapid transition to telemental health at the onset of the COVID-19 pandemic in spring 2020 was sustained over the next year, despite an overall increase in the number of patients seen in person. Although more providers reported returning to working on-site, over 50% of providers continued to use a hybrid model, and many providers reported they would be more likely to continue telemental health beyond spring 2021. This suggests the continued importance and reliance on telemental health services beyond the acute pandemic phase and has implications for future policies regulating the availability of telemental health services to patients.

[Anxiety, Depression, Psychological Strain and Physical Complaints before and after the Covid-19 Pandemic in a German Longitudinal Study with Adults from Saxony]

OBJECTIVE

The objective of the study was to investigate whether psychological distress increased in a German community sample from Saxony during the course of the Corona pandemic.

METHODS

In 2017/2018 and 2022, N=289 participants (54.7% female) of the Saxon Longitudinal Study were interviewed about their psychological well-being using questionnaires (PHQ-4, SSS-8).

RESULTS

There is a significant increase in complaints (anxiety, depression, psychological distress, physical complaints) compared to 2017/2018 to 2022 with effect sizes in the small and medium range (Cohens d=0.26-0.62).

CONCLUSION

Data collection was not due to the pandemic but was routine as part of an ongoing long-term study. The Covid-19 pandemic led to an increase in psychological distress and physical complaints in a Saxonian, age-homogeneous population sample.

COVID-19, new challenges to human safety: a global review

In the context of sustainable human development, human safety has gradually shifted from traditional state and political conflict to social conflict and horizontal inequality, and the pandemic has exacerbated this variation risk. This narrative review includes literature from 40 countries on five continents since 2020, explored and tidy up the impacts of pandemics on human safety based on three perspectives: personal safety, family safety and social safety, refined the macroscopic concept of human safety. The comprehensibility of the global review conclusions is enhanced by combining it with Maslow's hierarchy of needs. Finally, some novel and comparative results are included to broaden the understanding of the impact of the pandemic, and help policymaker better understand human safety changes from a new perspective.

Intolerance of Uncertainty and Worry Prospectively Predict COVID-19 Anxiety and Distress: A 4-Year Longitudinal Study

The COVID-19 pandemic precipitated an uptick in poor mental health outcomes, including coronavirus-related anxiety and distress. Preliminary research has shown that intolerance of uncertainty (IU) and worry proneness, two transdiagnostic risk factors for anxiety and related disorders, are associated cross-sectionally with pandemic-related fear and distress. However, the extent to which IU and worry proneness prospectively predict coronavirus-related anxiety and distress is unclear. Whether IU and worry may also interact in prospectively predicting coronavirus-related anxiety and distress is also unknown. To address this knowledge gap, the present study examined IU and trait worry as prospective predictors of the level and trajectory of coronavirus anxiety and COVID stress syndrome over time, as well as the extent to which worry moderated the relation between IU and pandemic-related outcomes. Participants (n = 310) who completed self-report measures of IU and trait worry in 2016 were contacted following the onset of COVID-19 in 2020 and completed biweekly measures of coronavirus anxiety and COVID stress syndrome for 30 weeks. Multilevel models revealed that IU assessed in 2016 significantly predicted the severity of both coronavirus anxiety and COVID stress syndrome throughout the study period in 2020. Worry also moderated the link between IU and coronavirus anxiety, such that individuals with high levels of trait worry and high IU in 2016 experienced the most coronavirus anxiety in 2020. Results suggest that IU and worry functioned as independent and interactive vulnerability factors for subsequent adverse psychological reactions to COVID-19. Clinical implications and future directions are discussed.

Depression and anxiety symptom network structure among patients with coronary heart disease and association with quality of life: protocol for a multicentre cross-sectional and prospective longitudinal study

BACKGROUND

Anxiety and depression are critical mental health problems among persons with coronary heart disease (CHD). The range of symptoms is an important stressor for adverse cardiovascular events, and these symptoms can be involved in various ways during the course of CHD. However, the characteristics and mechanisms of comorbidity between the two mental states from the viewpoint of symptom interactions in patients with CHD remain unclear. Therefore, we aim to apply a symptom-oriented approach to identify core and bridge symptoms between anxiety and depression in a population with CHD and to identify differences in network structure over time and symptomatic link profiles.

METHODS AND ANALYSIS

We designed a multicentre, cross-sectional, longitudinal study of anxiety and depression symptoms among patients with CHD. We will evaluate degrees of symptoms using the Generalized Anxiety Disorder Scale, the Patient Health Questionnaire and the WHO Quality of Life-Brief version. Patients will be followed up for 1, 3 and 6 months after baseline measurements. We will analyse and interpret network structures using R software and its packages. The primary outcomes of interest will include centrality, bridge connections, estimates, differences in network structures and profiles of changes over time. The secondary outcome measures will be the stability and accuracy of the network. By combining cross-sectional and longitudinal analyses, this study should elucidate the central and potential causative pathways among anxiety and depression symptom networks as well as their temporal stability in patients with CHD.

ETHICS AND DISSEMINATION

The project conforms to the ethical principles enshrined in the Declaration of Helsinki (2013 amendment) and all local ethical guidelines. The ethics committee at the University of South China approved the study (Approval ID: 2023-USC-HL-414). The findings will be published and presented at conferences for widespread dissemination.

TRIAL REGISTRATION NUMBER

ChiCTR2300075813.

Trajectories of mental health outcomes following COVID-19 infection: a prospective longitudinal study

BACKGROUND

The COVID-19 pandemic has triggered a global mental health crisis. Yet, we know little about the lasting effects of COVID-19 infection on mental health. This prospective longitudinal study aimed to investigate the trajectories of mental health changes in individuals infected with COVID-19 and to identify potential predictors that may influence these changes.

METHODS

A web-survey that targeted individuals that had been infected with COVID-19 was used at three time-points: T0 (baseline), T1 (six months), and T2 (twelve months). The survey included demographics, questions related to COVID-19 status, previous psychiatric diagnosis, post-COVID impairments, fatigue, and standardized measures of depression, anxiety, insomnia. Linear mixed models were used to examine changes in depression, anxiety, and insomnia over time and identify factors that impacted trajectories of mental health outcomes.

RESULTS

A total of 236 individuals completed assessments and was included in the longitudinal sample. The participants' age ranged between 19 and 81 years old (M = 48.71, SD = 10.74). The results revealed notable changes in mental health outcomes over time. The trajectory of depression showed significant improvement over time while the trends in anxiety and insomnia did not exhibit significant changes over time. Younger participants and individuals who experienced severe COVID-19 infection in the acute phase were identified as high-risk groups with worst mental ill-health. The main predictors of the changes in the mental health outcomes were fatigue and post-COVID impairments.

CONCLUSIONS

The findings of our study suggest that mental health outcomes following COVID-19 infection exhibit a dynamic pattern over time. The study provides valuable insights into the mental health trajectory following COVID-19 infection, emphasizing the need for ongoing assessment, support, and interventions tailored to the evolving mental health needs of this population.

The crisis is over, long live the crisis: mental health in emerging adulthood during the course of the COVID-19 pandemic

Introduction

As a multidimensional stressor, the COVID-19 pandemic posed a significant threat to mental health, with studies showing younger age groups to be particularly vulnerable. Thus, this study aimed to monitor mental health, potential risk/protective factors, and pandemic-related variables among young university students during the pandemic.

Methods

Students of the University of Greifswald (M age = 23.0 years, 73.9% female) participated in five cross-sectional online surveys in December 2020 (N = 1,127), March 2021 (N = 760), June/July 2021 (N = 531), December 2021 (N = 1,226), and December 2022 (N = 814). Sociodemographic data, depression and anxiety severity, loneliness, quality of life, coping strategies, resilience, self-esteem, and emotion regulation were measured. First, results from December 2020 were compared to pre-pandemic normative data. Second, the time course during the pandemic was analyzed. Third, linear models were calculated to examine the influence of risk and protective factures on depression and anxiety severity.

Results

Higher levels of depression, anxiety, and loneliness, as well as lower levels of self-esteem, physical and mental health, social relationships and well-being were found in December 2020 compared to pre-pandemic. Levels of depression and anxiety severity peaked in December 2022. Female sex, loneliness, and previous mental treatment showed associations with higher depression and anxiety severity, while higher self-esteem, resilience and use of reappraisal strategies appeared to act as protective factors.

Discussion

The study indicates the pandemic's detrimental impact on students' mental health and quality of life. Identified risk and protective factors provide guidance for tailored prevention and treatment, as well as the design of measures for future pandemics and other crisis.

A Cross-Sectional Survey on Psychological Health and Influencing Factors Among 2628 Asymptomatic and Mild COVID-19 Patients in Fangcang Shelter Hospital

Purpose

The Coronavirus disease 2019 (COVID-19) remains a global public health concern. Many people have been forced to change their lifestyles, which has led to psychological and sleep problem. This study aims to investigate the psychological health problems and factors among patients in the Fangcang Shelter Hospital (FSH) during the COVID-19 pandemic.

Patients and Methods

A Cross-Sectional survey was conducted to investigate the sleep, anxiety, depression and stress disorders of 2628 asymptomatic and mild patients treated in FSH of Zhengzhou, Henan Province, from 30 October to 6 December 2022, by scanning a WeChat two-dimensional code. Sociodemographic data and influencing factors in FSH were collected, Insomnia Severity Index (ISI), 9-item Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Impact of Event Scale-Revised (IES-R) were administered. Descriptive statistics, t-tests or analysis of variance, Spearman or Pearson correlation analysis, and multivariate regression analysis were used to explore the relationships between different variables and their impact on psychological health indicators.

Results

The proportions of patients with insomnia, depressive disorder, anxiety, and stress disorders were 33.49%, 35.80%, 31.74%, and 43.57%, respectively. Spearman correlation analysis demonstrated that factors such as gender, higher education level, positive nucleic acid test results, longer illness duration, underlying diseases, and extended electronic device use were associated with elevated psychological distress scores. Notably, within FSH, extended exposure to light, a noisy environment, and sleep schedule management significantly impacted the prevalence of insomnia, depression, anxiety, and stress disorders (p<0.01). Multivariable binary logistic regression analysis identified higher education level, light exposure, noisy environment, sleep management, and electronic device usage as the primary risk factors for psychological distress.

Conclusion

Patients in FSH face psychological distress influenced by sociodemographic factors, environment, and lifestyle, highlighting the need for integrated psychological support in healthcare, particularly in temporary medical facilities during crises.

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

BACKGROUND

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

AIMS

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Illness anxiety predicts higher mental strain and vaccine willingness-A nine-wave longitudinal study during the first 1.5 years of the COVID-19 pandemic in Germany

Illness anxiety may amplify vulnerability to psychopathological symptoms during the COVID-19-pandemic-perhaps especially at the beginning of the pandemic and during high infection waves, but empirical evidence on this is lacking. In addition, considering a potentially functional facet of it, illness anxiety might be associated with higher vaccine willingness. We analyzed data of a nine-wave longitudinal online-survey (March 2020-October 2021) with 8148 non-probability sampled adults of the general population in Germany (clinicaltrials.gov: NCT04331106). Using multilevel analysis, we investigated longitudinal associations of dimensionally assessed illness anxiety (worry about illness, bodily preoccupation) with mental strain and vaccine willingness and considered the dynamic of the pandemic (i.e., duration and infection rates). Higher worry about illness and bodily preoccupation were associated with higher COVID-19-related fears, unspecific anxiety, depressive symptoms, and vaccine willingness. Vaccine willingness increased over time and in parallel to higher infection rates. Symptoms of mental strain decreased with continuing duration of the pandemic but increased when infection rates inclined. This decrease and increase, respectively, was steeper in individuals with higher illness anxiety. Our findings suggest that individuals with higher illness anxiety are more vulnerable to experience psychopathological symptoms during the ongoing pandemic, particularly at its beginning and during times of high infection rates. Thus, illness anxiety and associated symptoms should be targeted by adaptive measures. The fluctuation of symptoms parallel to the pandemic situation implies that support should be particularly issued at the beginning of extraordinary situations as well as during phases of high infection rates.

Total cortisol output during an acute stressor predicts youths' internalizing symptoms during the COVID-19 pandemic

Individual differences in cortisol output may influence adolescents' adjustment to the COVID-19 pandemic; however, boys and girls may differ in terms of associations between cortisol output and internalizing symptoms in the context of COVID-19-related stress. We examined whether pre-pandemic cortisol output during an acute stressor, assessed approximately three years prior to the pandemic, predicted change in adolescents' internalizing symptoms early during the COVID-19 pandemic. Consistent with previous work on other life stressors, girls' cortisol output was positively associated with anxious and somatic symptoms early in the pandemic. Conversely, cortisol output and depressive symptoms were negatively associated for boys; boys with higher cortisol had depressive symptoms which significantly decreased over time. Findings suggest that hypothalamic-pituitary-adrenal axis stress functioning plays a role in shaping differences between adolescent boys' and girls' adjustment during the experience of a ubiquitous chronic stressor.

Associations Between Anxiety and Home Learning Difficulties in Children and Adolescents with ADHD During the COVID-19 Pandemic

The COVID-19 pandemic has markedly impacted functioning for children and adolescents including those with attention-deficit/hyperactivity disorder (ADHD). We explored home learning difficulties (HLD) during COVID-19 restrictions in Australian children (aged 5-17) with ADHD, aiming to: (1) describe home learning experiences, and (2) examine associations between child anxiety (i.e., concurrent anxiety symptoms and pre-existing anxiety disorder status) and HLD. Baseline data from the longitudinal ADHD COVID-19 Survey were used (n = 122). Parents reported on school factors and HLD; pre-existing anxiety and co-occurring difficulties; anxiety, ADHD, and oppositional symptoms; demographics; and medications. Parents retrospectively reported more children often looked forward to school pre-pandemic, than during the pandemic. Anxiety symptoms, but not pre-existing anxiety disorder status, were associated with HLD after accounting for covariates. ADHD inattention symptoms were also associated with HLD. Results support recommendations to continue pre-pandemic supports to assist with ADHD symptoms during home learning, and strategies/supports for families are discussed.

[Pre-existing Mental Disorders and Depressiveness in the Second Wave of the SARS-CoV-2-Pandemic - The Role of Pandemic-Associated Stressors]

The second wave of the SARS-CoV-2 pandemic was characterized by drastic restrictions. From previous pandemics as well as from the first wave, it is known that especially individuals with a history of mental disorders may be highly vulnerable to develop poor mental health. Therefore, this paper examines the association of prior mental disorders (PMD) and depressiveness in the 2nd pandemic wave, considering general stress, perceived isolation, perception of political measures to curb the pandemic, fears regarding consequences of the pandemic and changes in the employment and income situation. A cross-sectional analysis was conducted with data of 812 participants of the health related beliefs and health care experiences in Germany study (HeReCa). The association between PMD and depressiveness was studied by means of weighted (for education and age) logistic regression, adjusted for the named variables as well as sociodemographic characteristics. Individuals with PMD displayed substantially more often higher depressiveness than individuals without PMD (OR: 25.1; 95% CI: 11.0-57.3). This association decreased partially by accounting for higher general stress and stress from isolation. Lack of partnership, low income, and male sex were associated with higher depressiveness, but only marginally changed the association of PMD and depressiveness. Overall, during the pandemic, persons with PMD were more likely to develop higher depressiveness than persons without. It is strongly advised to provide care for mental illness in pandemic times, which can be completed by E-Mental-Health or professional support for coping with stress.

Stress and Depressive and Anxiety Symptoms in the General Population and in SARS-CoV-2-Infected Patients-Findings from a Population-Based Three-Wave Study

Objective: Understanding factors that impaired mental health during the COVID-19 pandemic is extremely relevant in order to mitigate long-term consequences of the pandemic and to promote resilience in future crises. Method: Data were collected in southern Germany in a population-based survey study (CoKoS) with three times of measurement in May 2020, November 2020 and July 2021. Predictors of depressive and anxiety symptoms were measured with a short version of the Patient Health Questionnaire (PHQ-4) in the general population (N = 758) and individuals who were infected with SARS-CoV-2 in the beginning of the pandemic (N = 412). We investigated differences between both samples and how stress components (worry, tension, demands and joy) measured with the Perceived Stress Questionnaire (PSQ) varied with depressive and anxiety symptoms over time. Three linear mixed models (GLMMs) were fitted to predict the PHQ-4 stepwise, including sociodemographic variables and stress (PSQ). Results: Depressive and anxiety symptoms increased from May 2020 to November 2020 and remained stable until July 2021. There were no differences between people with SARS-CoV-2 infection and the general population. Those with a pre-existing disease and lower education reported higher levels of depressive and anxiety symptoms. Stress explained a substantial fraction of variance in depressive and anxiety symptoms. The stress component worry emerged as the strongest predictor of depressive and anxiety symptoms, whereas joy seemed to buffer these symptoms. Conclusions: The results suggest that mitigating people's worry and increasing joy may promote resilience in future crises. Future studies should assess mental health interventions targeted at vulnerable groups, such as those with lower socioeconomic status and poorer health.

Social distancing policy and mental health during COVID-19 pandemic: an 18-month longitudinal cohort study in South Korea

Background

Despite the effectiveness of social distancing policies in preventing the spread of Coronavirus Disease 2019 (COVID-19), their impact on mental health remains a concern. Longitudinal studies investigating the psychological effects of social distancing are limited.

Methods

Longitudinal data on psychological variables were collected eight times between May 2020 and November 2021 through online surveys in South Korea.

Results

The participants in the study reported a worsening of depressive and anxiety symptoms, suicide risk, and psychological distress with increasing levels of social distancing. Specifically, during the third wave, when social distancing levels peaked, the highest levels of depression, anxiety, and psychological distress were observed, and the second-lowest levels of vitality were reported. Furthermore, psychological risk factors, such as depressive symptoms, anxiety symptoms, and suicidal risk, were closely associated with vitality levels in daily life.

Discussions

During the pandemic, although social distancing helped prevent the spread of COVID-19, it also led to increased depression, anxiety, suicide risk, psychological distress, and decreased vitality. Engagement at a personal level in fundamental daily activities is important to cope with psychological distress. Our results indicate that commitment to fundamental daily activities and following routines is an important protective factor against psychological distress, notwithstanding COVID-19.

A 2-year longitudinal evaluation of the impact of the COVID-19 pandemic on individuals with pre-existing anxiety disorders

OBJECTIVES

To examine if the COVID-19 pandemic is associated with a differential effect over a 2-year time period in relation to its psychological and social impact on patients with established anxiety disorders.

METHODS

Semi-structured interviews were conducted with 21 individuals attending the Galway-Roscommon Mental Health Services in Ireland with an ICD-10 diagnosis of an anxiety disorder. Interviews occurred at three time-points over a 2-year period to determine the impact of the COVID-19 pandemic and associated restrictions on anxiety and depressive symptoms, social and occupational functioning, and quality of life.

RESULTS

No statistical difference in symptomatology was noted between the three time-points in relation to anxiety symptoms as measured utilising psychometric rating scales (Beck Anxiety Inventory (BAI), Hamilton Anxiety Rating Scale (HARS) or Likert Scale measures). The greatest impact of COVID-19 at all time-points related to social functioning and quality of life. Significant variability was noted for individual participants. Qualitative analysis noted a tentative optimism for the future in the setting of vaccination and societal re-opening. Fear of re-emerging anxiety symptoms with the removal of societal restrictions was noted.

CONCLUSIONS

No significant overall change in symptomatology or functioning over time was noted for individuals with pre-existing anxiety disorders, however variability was demonstrated, with some individuals describing ongoing anxiety, social isolation and concern for their future. A strong theme of hope for the future and less concern regarding the COVID-19 pandemic was evident; however tailored supports including the utilisation of tele-psychiatry is suggested, particularly for those experiencing increased anxiety with the removal of societal restrictions.

A longitudinal evaluation of the impact of the COVID-19 pandemic on a cohort of patients treated with clozapine

OBJECTIVES

We previously demonstrated that three months into the COVID-19 pandemic, the impact on individuals with treatment-resistant psychotic disorders was modest. Here, we examined and compared the psychological and social impact of the COVID-19 pandemic on the same patient cohort 12 months after their initial study engagement.

METHODS

Semi-structured interviews were conducted with 54 individuals (85.7% response rate) between June 12 and July 29, 2021, 12 months after their initial interviews. Participants' subjective experience of the impact of the COVID-19 pandemic on anxiety symptoms, social and vocational functioning was measured utilising the same Likert scales at both time points. Anxiety symptoms were additionally measured using subjective (Beck Anxiety Inventory) and objective (Hamilton Anxiety Rating Scale (HARS)) psychometric instruments. Paired t-tests or Wilcoxon ranked tests compared parametric or non-parametric data over time. Free-text responses pertaining to participants' perspectives on the impact of COVID-19 were grouped into themes.

RESULTS

A minor increase in anxiety symptoms was demonstrated utilising the HARS (1.9 points, z = 3.017, p = 0.003), with a minimal increase in depressive symptoms noted using Likert ratings (0.8 points, z = 2.119, p = 0.034). Five themes were identified with the most prevalent being (i) positivity regarding vaccination, (ii) social isolation from family members and (iii) looking forward to post-COVID-19 'normality'. However, negative views pertaining to the psychosocial impact of COVID-19 and vaccination were additionally reported.

CONCLUSIONS

No significant overall clinical change in symptomatology or functioning over time was noted.The study demonstrated that positive views regarding vaccination and optimism for the future were evident for some participants.

Changes in mental health among U.S. military veterans during the COVID-19 pandemic: A network analysis

Increases of symptoms of posttraumatic stress disorder (PTSD), anxiety and depression have been observed among individuals exposed to potentially traumatic events in the first months of the COVID-19 pandemic. Similarly, associations among different aspects of mental health, such as symptoms of PTSD and suicidal ideation, have also been documented. However, studies including an assessment prior to the onset and during the height of the pandemic are lacking. We investigated changes in symptoms of PTSD, depression, anxiety, suicidal ideation, and posttraumatic growth in a population-based sample of 1232 U.S. military veterans who experienced a potentially traumatic event during the first year of the pandemic. Symptoms were assessed prior to (fall/winter 2019) and one year into the pandemic (fall/winter 2020). We compared changes in symptom interrelations using network analysis, and assessed their associations with pandemic-related PTSD and posttraumatic growth symptoms. A subtle increase in psychopathological symptoms and a decrease in posttraumatic growth was observed one year into the pandemic. The peripandemic network was more densely connected, and pandemic-related PTSD symptoms were positively associated with age, anxiety, worst-event PTSD symptoms, and pandemic-related posttraumatic growth. Our findings highlight the resilience of veterans exposed to a potentially traumatic event during the first year of a pandemic. Similarly, the networks did not fundamentally change from prepandemic to one year into the pandemic. Despite this relative stability on a group level, individual reactions to potentially traumatic events could have varied substantially. Clinicians should individualize their assessments but be aware of the general resilience of most veterans.

Posttraumatic stress symptoms in healthcare workers during the COVID-19 pandemic: A four-wave longitudinal study

BACKGROUND

Posttraumatic stress symptoms of healthcare workers have become a significant public concern in the healthcare system that have long COVID-19. It is less known how the pandemic impacts the HCWs' PTSS longitudinally and long-term risk factors for it.

METHODS

Four consecutive surveys were conducted among healthcare workers in China from 2019 to 2023 COVID-19 outbreaks. Multilevel mixed-effect models were used to examine longitudinal changes and risk factors. Network analysis was utilized to explore network centrality changes in PTSS symptoms.

RESULTS

HCWs' PTSS symptoms were increased over time during the COVID-19 pandemic. Being female, being nurse, working in the emergency department, working longer hours, less frequently going back home and having COVID-19 infection are risk factors of PTSS for HCWs; unmarried is the protective factor. Significant interaction between symptom changes and profession exists. PTSS networks showed that Avoidance of thoughts, Emotional-cue activity, Exaggerated startle response and Hypervigilance were the central symptoms during four waves. The global strength of the PTSS network grows over time, and nodal strength of Avoidance of thoughts, Loss of interest and Negative beliefs increased by COVID-19.

CONCLUSION

The pandemic's impacts on healthcare workers vary by professions. PTSS symptoms exacerbate, reinforce each other, and persists with recurring waves.

Mental health in Europe during the COVID-19 pandemic: a systematic review

The COVID-19 pandemic caused immediate and far-reaching disruption to society, the economy, and health-care services. We synthesised evidence on the effect of the pandemic on mental health and mental health care in high-income European countries. We included 177 longitudinal and repeated cross-sectional studies comparing prevalence or incidence of mental health problems, mental health symptom severity in people with pre-existing mental health conditions, or mental health service use before versus during the pandemic, or between different timepoints of the pandemic. We found that epidemiological studies reported higher prevalence of some mental health problems during the pandemic compared with before it, but that in most cases this increase reduced over time. Conversely, studies of health records showed reduced incidence of new diagnoses at the start of the pandemic, which further declined during 2020. Mental health service use also declined at the onset of the pandemic but increased later in 2020 and through 2021, although rates of use did not return to pre-pandemic levels for some services. We found mixed patterns of effects of the pandemic on mental health and social outcome for adults already living with mental health conditions.

Were we happy and we didn't know it? A subjective dynamic and financial assessment pre-, during and post-COVID-19

The COVID-19 pandemic has brought many changes into people's lives. Fear, job insecurity, changes in their financial stability, concerns about their future lives have changed the entire lives of people and have affected the cognitive well-being of individuals. The purpose of the present analysis is to measure how the COVID-19 pandemic, along with financial factors, has affected the perceived level of well-being of individuals. We are also interested whether there are differences between life before COVID-19, life now with COVID-19, and life after the COVID-19 pandemic, in terms of future expectations. To address this objective, we performed an ANOVA approach and a GLM estimate on repeated measures for a large sample (1572 respondents) from 43 worldwide countries, during the period May 2020 and July 2021. Our results show that financial factors reflected by both the size of income and changes in personal or family income affect the levels of happiness. Robustness checks using stress as an alternative estimator for happiness have consolidated our results. Additionally, we find that well-being during COVID-19 compared to the previous period decreased, while in future, people expect to be happier, but not more than in the past when they did not know about the existence of this virus. This is one of the first studies to investigate the relationship between happiness and income before, during, and after COVID-19. These findings are important for policymakers to improve the conditions of living in the areas of health and financial stability.

Patient-reported distress at a cancer center during the COVID-19 pandemic

Assessments of health-related quality of life (HRQOL) are conducted by health systems to improve patient-centered care. Studies have shown that the COVID-19 pandemic poses unique stressors for patients with cancer. This study investigates change in self-reported global health scores in patients with cancer before and during the COVID-19 pandemic. In this single-institution retrospective cohort study, patients who completed the Patient-Reported Outcomes Measurement Information System (PROMIS) at a comprehensive cancer center before and during the COVID-19 pandemic were identified. Surveys were analyzed to assess change in the global mental health (GMH) and global physical health (GPH) scores at different time periods (pre-COVID: 3/1/5/2019-3/15/2020, surge1: 6/17/2020-9/7/2020, valley1: 9/8/2020-11/16/2020, surge2: 11/17/2020-3/2/2021, and valley2: 3/3/2021-6/15/2021). A total of 25,192 surveys among 7209 patients were included in the study. Mean GMH score for patients before the COVID-19 pandemic (50.57) was similar to those during various periods during the pandemic: surge1 (48.82), valley1 (48.93), surge2 (48.68), valley2 (49.19). Mean GPH score was significantly higher pre-COVID (42.46) than during surge1 (36.88), valley1 (36.90), surge2 (37.33) and valley2 (37.14). During the pandemic, mean GMH (49.00) and GPH (37.37) scores obtained through in-person were similar to mean GMH (48.53) and GPH (36.94) scores obtained through telehealth. At this comprehensive cancer center, patients with cancer reported stable mental health and deteriorating physical health during the COVID-19 pandemic as indicated by the PROMIS survey. Modality of the survey (in-person versus telehealth) did not affect scores.

Health-Promoting Factors and Their Relationships with the Severity of Symptoms in Patients with Anxiety Disorders during the COVID-19 Pandemic

BACKGROUND

Anxiety disorders are one of the most common mental disorders in the modern world. The COVID-19 pandemic has led to the onset of many mental disorders in people who did not have them before. It can be suspected that in people who already had anxiety disorders before the pandemic, their quality of life has significantly deteriorated.

AIM

The aim of the study was to assess the relationships between life satisfaction, acceptance of illness, the severity of anxiety and depression symptoms and health behaviors in a group of patients diagnosed with anxiety disorders during the COVID-19 pandemic.

MATERIAL AND METHODS

The study was conducted in the period from March 2020 to March 2022. There were 70 people among the respondents, including 44 women aged 44.06 ± 14.89 years and 26 men aged 40.84 ± 16.72 years. All persons were diagnosed with generalized anxiety disorder. Patients with other co-occurring disorders were excluded, i.e., depression and signs of organic damage to the central nervous system, as were those with cognitive disorders that prevented the completion of the questionnaires. The following scales were used in the study: the Satisfaction with Life Scale (SWLS), Acceptance of Illness Scale (AIS), Health Behavior Inventory (HBI) and Hospital Anxiety and Depression Scale (HADS). Spearman's rank correlation coefficient and the Mann-Whitney U test were used for statistical analyses.

RESULTS

In the Satisfaction in Life questionnaire, the respondents obtained an average score of 17.59 ± 5.74 points. In the AIS scale, the mean score obtained by the patients was 27.10 ± 9.65 points. In the overall Health Behavior Inventory (HBI), the average score was 79.52 ± 15.24 points. In the HADS questionnaire, probants obtained an average of 8.17 ± 4.37 points in the depression subscale and 11.55 ± 4.46 points in the anxiety subscale. In addition, there were significant negative correlations between life satisfaction (SWLS) and the severity of anxiety and depression (HADS). The lower the perceived quality of life, the significantly higher the anxiety and depressive disorders. The result obtained in the Health Behavior Inventory (HBI) as well as in the subscale of Prohealth Activities (PHA) was negatively associated with the severity of anxiety symptoms. Prohealth activities should therefore be developed to prevent anxiety disorders, as well as to promote positive mental attitudes. In the study, the average result obtained in the subscale of positive mental attitudes correlated negatively with both anxiety and depressive symptoms.

CONCLUSIONS

Life during the pandemic was assessed by patients as unsatisfactory. Health-promoting behaviors, and especially positive mental attitudes, may play a protective role in relation to anxiety and depressive symptoms in a situation of increased stress related to the COVID-19 pandemic in a group of patients with anxiety disorders.

Effect of the COVID-19 Pandemic on the Psychological Health of Patients Who Underwent Liver Transplantation Due to Hepatocellular Carcinoma

BACKGROUND

The primary aim of this study was to compare liver transplant (LT) recipients with and without hepatocellular carcinoma (HCC) in terms of COVID-19-related depression, anxiety, and stress.

METHOD

A total of 504 LT recipients with (HCC group; n = 252) and without HCC (non-HCC group; n = 252) were included in the present case-control study. Depression Anxiety Stress Scales (DASS-21) and Coronavirus Anxiety Scale (CAS) were used to evaluate the depression, stress, and anxiety levels of LT patients. DASS-21 total and CAS-SF scores were determined as the primary outcomes of the study. Poisson regression and negative binomial regression models were used to predict the DASS and CAS scores. The incidence rate ratio (IRR) was used as a coefficient. Both groups were also compared in terms of awareness of the COVID-19 vaccine.

RESULTS

Poisson regression and negative binomial regression analyses for DASS-21 total and CAS-SF scales showed that the negative binomial regression method was the appropriate model for both scales. According to this model, it was determined that the following independent variables increased the DASS-21 total score: non-HCC (IRR: 1.26; p = 0.031), female gender (IRR: 1.29; p = 0.036), presence of chronic disease (IRR: 1.65; p < 0.001), exposure to COVID-19 (IRR: 1.63; p < 0.001), and nonvaccination (IRR: 1.50; p = 0.002). On the other hand, it was determined that the following independent variables increased the CAS score: female gender (IRR:1.75; p = 0.014) and exposure to COVID-19 (IRR: 1.51; p = 0.048). Significant differences were found between the HCC and non-HCC groups in terms of median DASS-21 total (p < 0.001) and CAS-SF (p = 0.002) scores. Cronbach's alpha internal consistency coefficients of DASS-21 total and CAS-SF scales were calculated to be 0.823 and 0.783, respectively.

CONCLUSION

This study showed that the variables including patients without HCC, female gender, having a chronic disease, being exposed to COVID-19, and not being vaccinated against COVID-19 increased anxiety, depression, and stress. High internal consistency coefficients obtained from both scales indicate that these results are reliable.

Impacts of the COVID-19 pandemic on the social sphere and lessons for crisis management: a literature review

The COVID-19 pandemic is the most difficult challenge that has affected humanity in recent decades. It has disrupted many features of development with domino effects in the social sphere. This study reviews the literature on the social effects of the COVID-19 pandemic and identifies the affected social areas that have undergone dramatic changes during the pandemic. We use inductive content analysis and thematic analysis to review the literature. The results show that there are seven major areas that have been negatively affected by the COVID-19 pandemic: health, social vulnerability, education, social capital, social relationships, social mobility, and social welfare. The literature has reported dramatic psychological and emotional effects, exacerbation of segregation and poverty, disruption in educational systems and formation of an information gap, as well as a declining trends of social capital among communities. We highlight some lessons that can be learned from the pandemic to enhance social resilience in future. Among others, to effectively respond to the pandemic and other potential future adverse events, governments should adopt fair policies, identify the required changes in the socially affected contexts and take necessary responsive actions, and adopt collaboratively designed approaches to increase social resilience.

Risk for depression tripled during the COVID-19 pandemic in emerging adults followed for the last 8 years

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has significantly increased depression rates, particularly in emerging adults. The aim of this study was to examine longitudinal changes in depression risk before and during COVID-19 in a cohort of emerging adults in the U.S. and to determine whether prior drinking or sleep habits could predict the severity of depressive symptoms during the pandemic.

METHODS

Participants were 525 emerging adults from the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA), a five-site community sample including moderate-to-heavy drinkers. Poisson mixed-effect models evaluated changes in the Center for Epidemiological Studies Depression Scale (CES-D-10) from before to during COVID-19, also testing for sex and age interactions. Additional analyses examined whether alcohol use frequency or sleep duration measured in the last pre-COVID assessment predicted pandemic-related increase in depressive symptoms.

RESULTS

The prevalence of risk for clinical depression tripled due to a substantial and sustained increase in depressive symptoms during COVID-19 relative to pre-COVID years. Effects were strongest for younger women. Frequent alcohol use and short sleep duration during the closest pre-COVID visit predicted a greater increase in COVID-19 depressive symptoms.

CONCLUSIONS

The sharp increase in depression risk among emerging adults heralds a public health crisis with alarming implications for their social and emotional functioning as this generation matures. In addition to the heightened risk for younger women, the role of alcohol use and sleep behavior should be tracked through preventive care aiming to mitigate this looming mental health crisis.

Depression trajectories during the COVID-19 pandemic in the high-quality health care setting of Switzerland: the COVCO-Basel cohort

OBJECTIVES

During the pandemic, Switzerland avoided stringent lockdowns and provided funds to stabilize the economy. To assess whether and in what subgroups the pandemic impacted on depressive symptoms in this specific Swiss context, we derived depression trajectories over an extended pandemic period in a Swiss cohort and related them to individuals' sociodemographic characteristics.

STUDY DESIGN

This was a population-based cohort study.

METHODS

The population-based COVCO-Basel cohort in North-Western Switzerland invited 112,848 adult residents of whom 12,724 participated at baseline. Between July 2020 and December 2021, 6396 participants answered to additional 18 monthly online questionnaires. Depression symptoms were repeatedly measured by the DASS-21 scale. Group-based Trajectory Models methods were applied to identify clusters of similar depression trajectories. Trajectory clusters were characterized descriptively and with a Multinomial response model.

RESULTS

Three distinct trajectories were identified. The 'Highly affected' trajectory (13%) had a larger presence of younger and female participants with lower average income, higher levels of past depression, and living alone. A majority of individuals in the 'Unaffected' trajectory (52%) were of medium or high average income, older average age, without previous depression symptoms, and not living alone. The 'Moderately affected' trajectory (35%) had a composition intermediate between the two opposite 'extreme' trajectories.

CONCLUSIONS

This study is among few studies investigating depression trajectories up to the time when COVID-19 vaccination was readily available to the entire population. During these 18 months of the pandemic, depressive symptoms increased in a substantial percentage of participants. Economic support, high-quality health care system, and moderate containment measures did not sufficiently protect all population subgroups from adverse, potentially long-term psychological pandemic impacts.

Suicide in Hungary during the first year of the COVID-19 pandemic: Subgroup investigations

BACKGROUND

COVID-19 may unfavourably affect the mental health of individuals in various ways. Accordingly, the concern has been raised that national suicide rates will increase in the wake of the outbreak of the pandemic.

METHODS

In the current study, we tested this conjecture in three age groups (<25; 25-64; ≥65) of the Hungarian total population and the male and female populations. In addition, we assessed whether the pandemic had different effects on counts of suicides committed by violent or non-violent methods. Finally, by comparing the monthly suicide rates in 2020 and the corresponding monthly rates in 2019, we also investigated the "pulling together" hypothesis that postulates that a temporary decrease in suicides may occur after large-scale catastrophic events.

RESULTS

With regard to the total population only the suicide counts of individuals aged 25-64 rose significantly (p < 0.05) during the COVID months of 2020. Similar patterns, but at lower levels of significance (0.05 < p < 0.1), were found in those members of the total population aged 65 or older and among males aged between 25 and 64. Furthermore, we found that the number of violent suicides increased significantly (p < 0.05) during the COVID months. Finally, our results have not confirmed the existence of a "pulling together" phenomenon in association with the COVID-19 pandemic in Hungary.

LIMITATIONS

We used non-individual level data and were therefore unable to control suicide risk factors at the level of individuals.

DISCUSSION

The number of suicides rose significantly in some subgroups of the Hungarian population during the COVID months of 2020.

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

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

Psychological impact of COVID-19 containment on CADASIL patients

INTRODUCTION

COVID-19 restrictive containment was responsible for major psychological distress and alteration of quality of life (QoL) in the general population. Their impact in a group of patients having cerebral small vessel disease (SVD) and at high risk of stroke and disability was unknown.

OBJECTIVE

We aimed to determine the potential psychological impact of strict containment during the COVID-19 pandemic in a sample of CADASIL patients, a rare SVD caused by NOTCH3 gene mutations.

METHODS

Interviews of 135 CADASIL patients were obtained just after the end of the strict containment in France. Depression, QoL and negative subjective experience of the containment were analysed, as well as predictors of posttraumatic and stressor-related manifestations, defined as an Impact Event Scale-Revised score ≥ 24, using multivariable logistic analysis.

RESULTS

Only 9% of patients showed a depressive episode. A similar proportion had significant posttraumatic and stressor-related disorder manifestations independently associated only with socio-environment factors, rather than clinical ones: living alone outside a couple (OR 7.86 (1.87-38.32), unemployment (OR 4.73 (1.17-18.70)) and the presence of 2 or more children at home (OR 6.34 (1.35-38.34).

CONCLUSION

Psychological impact of the containment was limited in CADASIL patients and did not appear related to the disease status. About 9% of patients presented with significant posttraumatic and stressor-related disorder manifestations which were predicted by living alone, unemployment, or exhaustion related to parental burden.

Managing the unexpected: Bicultural identity integration during the COVID-19 emergency

Unexpected and sudden emergency situations such as COVID-19 may render ethnic minorities particularly vulnerable to experiencing negative outcomes. Yet, we put forward that Bicultural Identity Integration (BII) - the degree to which bicultural individuals perceive their cultural identities as compatible and overlapping - may represent a resource in times of emergencies, since it may positively influence, through enhancement of psychological well-being, how bicultural individuals respond in terms of distress and coping strategies. Based on this assumption, the present study aimed at examining the relationship between BII and responses to COVID-19. N = 370 bicultural individuals (mean age = 26.83, SD = 8.74) from different cultural backgrounds were recruited online and completed measures of BII, psychological well-being, COVID-19 distress and coping strategies (positive attitudes, avoidance, social support seeking) during the second wave of the COVID-19 pandemic in Italy. We tested a model in which BII was the predictor, psychological well-being was the mediator and reactions to the COVID-19 emergency (distress, use of coping) were the outcomes. This model was tested against two alternative models. The proposed model showed a better fit to the data compared to the alternative models. In this model, psychological well-being mediated the relationship between BII (harmony) and coping strategies, except social support seeking. These findings highlight the important role played by BII in emergency situations, as it may indirectly, through enhancement of psychological well-being, contribute to enhance biculturals' adaptive reactions in terms of distress as well as affect coping strategies during highly stressful events.

Mental health concerns and network structures of psychological helpline help-seekers during the COVID-19 pandemic in China: Pandemic stage differences

BACKGROUND

The present study aimed to investigate the pandemic stage differences of mental health helpline help-seekers emotional responses, psychiatric symptoms, and related network structures during the COVID-19 pandemic in China.

METHODS

The data was collected by a large-scale psychological helpline in response to the COVID-19 pandemic in mainland China. Counselor-reported information about the help-seekers pandemic-related emotional responses and psychiatric symptoms were recorded. A total of 26,870 callers' data from February 28, 2020, to April 23, 2021, were collected in the present study. A linear probability model and network analysis were conducted to determine the differences in help-seekers mental health concerns and network structures between the pandemic (stage I, from February 28, 2020, to April 28, 2020, N = 9821) and the regular prevention and control period (stage II, from April 29, 2020, to April 23, 2021, N = 17,049).

RESULTS

Results revealed that anger, sadness, and obsession symptoms increased in stage II while symptoms of anxiety, somatization, and feelings of fear and stress were relieved. The network analysis results demonstrated both stage I and II networks centered on anxiety firmly. In stage II, the connection between anxiety and hypochondria and fear's strength centrality descended significantly.

LIMITATIONS

The mental health outcomes of callers only included the counselor-reported data.

CONCLUSIONS

The mental health concerns of helpline callers showed pandemic-related stage differences.

The Influence of the COVID-19 Pandemic on Social Anxiety: A Systematic Review

The COVID-19 pandemic has resulted in negative mental health outcomes throughout the world, and its impact on social interactions and relationships is likely to be evident in problematic social anxiety. This systematic review qualitatively synthesized data from studies that have reported on the effects of the pandemic on social anxiety. A systematic search of Web of Science Core Collection, Embase, PsychINFO, Scopus, EBSCOhost, Cochrane Central Register of Controlled Trials, and Proquest Central-Dissertations and Theses was conducted, with thirty-three studies meeting the inclusion criteria. The results suggest that social anxiety has been heightened in the general population due to the pandemic, with women and low-income earners being especially vulnerable. Other contributing factors include impaired coping strategies, lower socio-emotional well-being, limited support networks, and contraction of the SARS-CoV-2 virus. Individuals with a Social Anxiety Disorder diagnosis may be at risk of a deterioration of mental health in general. Limitations of the literature reviewed include the predominance of cross-sectional study designs, which limit causal inferences are limited. Additionally, associations may be inflated as many studies have not accounted for mediating variables. Taken together, the research suggests that social anxiety, either pre-pandemic or arising due to the pandemic environment, has contributed to a variety of negative mental health outcomes related to social anxiety.

A longitudinal study on changes in food parenting practices during COVID-19 and the role of parental well-being

The COVID-19 pandemic may negatively influence food parenting practices, also among parents of adolescents. Parental well-being (stress and depressive symptoms) may explain these COVID-19 related changes in food parenting practices (snack structure, healthy structure, modeling, autonomy support, and coercive control). However, most previous studies performed before or during the COVID-19 pandemic have been limited by cross-sectional designs. The aim of the current study among parents of adolescent children was twofold. First, we aimed to examine prospective differences in food parenting practices comparing the situation before and during COVID-19. Second, we aimed to examine both cross-sectional and longitudinal associations between parental well-being and the dimensions of food parenting, while additionally examining whether these prospective associations were more pronounced in parents who had experienced more COVID-19 stressful life events. Parents (N = 290; 74.9% female; at baseline: M_age = 46.9; SD_age = 4.3) of adolescent children (at baseline: M_age = 14.3; SD_age = 0.6) completed online surveys about parental well-being and food parenting twice: One year before the COVID-19 pandemic (spring 2019) and during the COVID-19 pandemic, 1.5 years after the first measurement (autumn 2020). In general, we found consistent evidence for an average decrease in food autonomy support and an increase in coercive control during COVID-19. However, parental well-being did not seem to explain (changes in) food parenting practices during COVID-19, also not in combination with stressful life events. Our findings suggest that, regardless of parental well-being, the general COVID-19 situation had some small negative influences on autonomy support and coercive control among parents of adolescents. These findings might be explained by parents being more often confronted with unhealthy eating occasions in the COVID-19 home context, triggering these negative parental responses.