Impact of isolation precautions on quality of life: a meta-analysis

Comprehensive examination of support needs and mental well-being: a mixed-method study of the Austrian general population in times of crisis

Introduction

In the recent years, the Austrian general population has faced a confluence of multiple crises. This study investigates the support wishes and mental health parameters of the Austrian general population aiming to comprehending the unmet needs and providing guidance for future psychosocial interventions and research endeavors.

Methods

1,031 participants attended the online survey and one third (n = 332) wished for further support to improve mental well-being in April 2022. A total of 280 participants accompanied their support wish with written accounts. Participants' mental health status was evaluated using the PHQ-9 (depression), GAD-7 (anxiety), ISI (insomnia), PSS-10 (perceived stress), CAGE (alcohol abuse), WHO-5 (well-being), and the SCOFF (eating disorder) questionnaires. Data analysis employed a mixed-methods approach.

Results

The preeminent support wish identified was the need for professional mental support (29.3%), followed by communication (21.6%), other professional support except mental and medical support (13.9%). In line with these findings, participants expressing a support wish experienced increased mental health distress across all assessed parameters.

Conclusion

The findings indicate the presence of a vulnerable population within the Austrian general population, which may benefit from targeted support interventions. Consequently, this study contributes to the identification of unmet support needs among the Austrian populace during times of crisis, facilitating the development and enhancement of precisely tailored intervention strategies.

Modeling relaxed policies for discontinuation of methicillin-resistant Staphylococcus aureus contact precautions

OBJECTIVE

To evaluate the economic costs of reducing the University of Virginia Hospital's present "3-negative" policy, which continues methicillin-resistant Staphylococcus aureus (MRSA) contact precautions until patients receive 3 consecutive negative test results, to either 2 or 1 negative.

DESIGN

Cost-effective analysis.

SETTINGS

The University of Virginia Hospital.

PATIENTS

The study included data from 41,216 patients from 2015 to 2019.

METHODS

We developed a model for MRSA transmission in the University of Virginia Hospital, accounting for both environmental contamination and interactions between patients and providers, which were derived from electronic health record (EHR) data. The model was fit to MRSA incidence over the study period under the current 3-negative clearance policy. A counterfactual simulation was used to estimate outcomes and costs for 2- and 1-negative policies compared with the current 3-negative policy.

RESULTS

Our findings suggest that 2-negative and 1-negative policies would have led to 6 (95% CI, -30 to 44; P < .001) and 17 (95% CI, -23 to 59; -10.1% to 25.8%; P < .001) more MRSA cases, respectively, at the hospital over the study period. Overall, the 1-negative policy has statistically significantly lower costs ($628,452; 95% CI, $513,592-$752,148) annually (P < .001) in US dollars, inflation-adjusted for 2023) than the 2-negative policy ($687,946; 95% CI, $562,522-$812,662) and 3-negative ($702,823; 95% CI, $577,277-$846,605).

CONCLUSIONS

A single negative MRSA nares PCR test may provide sufficient evidence to discontinue MRSA contact precautions, and it may be the most cost-effective option.

Associations Among Online Social Reactions to Disclosure of Sexual Victimization, Coping and Social Isolation

Social reactions to the disclosure of sexual victimization are critical to post-assault recovery. The popular social media hashtag "#MeToo" resulted in numerous survivors of sexual victimization disclosing their experience online. Whereas previous research has examined the association between social reactions to in-person disclosure of sexual victimization and factors commonly associated with adjustment among survivors - such as coping and social support - research is needed to examine correlates of social reactions to online disclosure of sexual victimization. Accordingly, the current study investigated the relationship between online social reactions to the disclosure of sexual victimization via #MeToo and engagement in various coping strategies (problem-focused coping, emotion-focused coping) and social isolation among a sample of 195 adults with a history of sexual victimization. Results indicated that the provision of online resources was associated with lower use of problem-focused and emotion-focused coping strategies. Receipt of online emotional and informational support was associated with increased use of emotion-focused coping strategies. Further, receipt of online social reactions that turned against the survivor and receipt of online social reactions that "made fun of you, insulted you, or said something to hurt you" were associated with higher levels of social isolation. Lastly, online unsupportive acknowledgment and "sharing your tweet with other people" were associated with lower levels of social isolation. Results highlight how online social reactions to disclosure of sexual victimization via #MeToo intersect with coping and social support among survivors of sexual victimization and help to give context to the experience of online disclosure of sexual victimization.

The relationship between subjective compliance with isolation precautions and moral sensitivity in novice nurses: cross-sectional study

BACKGROUND

Increasing compliance with isolation precautions is important in reducing hospital-acquired infections and their consequences. It is not possible to achieve and maintain nurse compliance through supervision, control, pressure, or training. Therefore, nurses must personally demand compliance with isolation precautions. This study aimed to determine the relationship between compliance with isolation precautions and the moral sensitivity levels of nurses who have just started working.

METHODS

This study employed a descriptive and cross-sectional research design. The study population consisted of 456 new nurses recruited during the pandemic. All of the new nurses who volunteered to participate in the study and completed the questionnaires completely were included in the study and 398 nurses constituted the sample of the study. Data were collected from 398 out of 456 novice nurses who agreed to participate in the study. The population coverage rate was 87.28%. Participants were selected using convenience sampling method. The data collection tools included an Introductory Information Form, The Isolation Compliance Precautions Scale (TIPCS), and the Moral Sensitivity Questionnaire (MSQ). Descriptive statistics, correlation analyses, and regression models were used to analyze data.

FINDINGS

The mean score of the MSQ was high (mean ± SD = 90.49 ± 25.94; median (P25-P75) = 84 (range, 74-97), and the score for TIPCS was high (mean ± SD = 79.29 ± 7.68; median (P25-P75) = 82 (range, 76-85)). No correlation was found between MSQ and TIPCS (p > 0.05). According to the regression analysis, although the MSQ did not correlate with TIPCS, compliance with isolation measures was found to increase as the conflict subscale of moral sensitivity increased (β= -0.36, CI= -0.55 to -0.16; p < 0.001). Choosing the profession willingly had a positive correlation with compliance with isolation measures (β = 5.3, CI = 2.4 to 8.3; p < 0.001). In addition, starting the profession at an early age had a positive correlation with compliance with isolation measures (β= -0.49, CI= -0.8 to -0.17; p = 0.002).

CONCLUSION

The conflict sub-dimension of moral sensitivity is an important factor in nurses' compliance with isolation measures, and conducting necessary training and other studies to improve nurses' moral sensitivity may increase their compliance with isolation measures.

Gaming in Pandemic Times: An International Survey Assessing the Effects of COVID-19 Lockdowns on Young Video Gamers' Health

The onset of COVID-19 coincided with the peak growth of video game usage, with 2.7 billion gamers in 2020. During the pandemic, gaming and streaming platforms offered an entertaining, social, and safe alternative to recreation during severe lockdowns and social isolations. This study aimed to examine the impact of the COVID-19 pandemic on health-related outcomes in self-proclaimed video gamers based on the type of lockdown experienced and to discuss the potential role of video games during times of preventive lockdown measures. This was a cross-sectional international survey constructed by two academic institutions, NYIT (NY, USA) and McGill University (Montreal, Canada), and Adamas Esports (BC, Canada). The survey consisted of questions including demographics, multiple choice, ratings, and Likert scales relating to the periods prior to and during the COVID-19 lockdowns. There were 897 respondents from North America (72.7%), Europe (10.9%), Asia (4.9%), and other countries (11.5%), with a mean age of 22 years. Significant increases in game time were reported in casual and competitive gamers during the first months of the pandemic. The level of gaming, type of lockdown, and physical activity level prior to the pandemic were examined as potential moderating factors. Significant increases in sedentary behaviors (video game time and sitting time) were observed, while physical activity levels remained unchanged in most participants, regardless of the type of lockdown. Sleep time, but not sleep quality, increased, while mental health exhibited opposing effects, influenced by the type of lockdown and gaming competition levels. Video games, when played moderately, could offer a cost-effective, safe strategy to promote socialization and mental health and improve the overall well-being of the non-gaming and gaming population during pandemic times when strict lockdowns are in place.

Changes in Patient Experiences of Hospital Care During the COVID-19 Pandemic

Importance

It is important to assess how the COVID-19 pandemic was adversely associated with patients' care experiences.

Objective

To describe differences in 2020 to 2021 patient experiences from what would have been expected from prepandemic (2018-2019) trends and assess correlates of changes across hospitals.

Design, Setting, and Participants

This cohort study compared 2020 to 2021 data with 2018 to 2019 data from 3 900 887 HCAHPS respondents discharged from 3381 HCAHPS-participating US hospitals. The data were analyzed from 2022 to 2023.

Main Outcomes and Measures

The primary outcome was an HCAHPS summary score (HCAHPS-SS), which averaged 10 HCAHPS measures. The primary analysis estimated whether HCAHPS scores from patients discharged from 2020 to 2021 differed from scores that would be expected based on quarterly and linear trends from 2018 to 2019 discharges. Secondary analyses stratified hospitals by prepandemic overall star ratings and staffing levels.

Results

Of the 3 900 887 HCAHPS 2020 to 2021 respondents, 59% were age 65 years or older, and 35% (11%) were in the surgical (maternity) service lines. Compared with trends expected based on prepandemic (2018-2019) data, HCAHPS-SS was 1.2 percentage points (pp) lower for quarter (Q) 2/2020 discharges and -1.9 to -2.0 pp for Q3/2020 to Q1/2021, which then declined to -3.6 pp by Q4/2021. The most affected measures (Q4/2021) were staff responsiveness (-5.6 pp) and cleanliness (-4.9 pp); the least affected were discharge information (-1.6 pp) and quietness (-1.8 pp). Overall rating and hospital recommendation measures initially exhibited smaller-than-average decreases, but then fell as much as the more specific experience measures by Q2/2021. Quietness did not decline until Q2/2021. The HCAHPS-SS fell most for hospitals with the lowest prepandemic staffing levels; hospitals with bottom-quartile staffing showed the largest decrements, whereas top-quartile hospitals showed smaller decrements in most quarters. Hospitals with better overall prepandemic quality showed consistently smaller HCAHPS-SS drops, with effects for 5-star hospitals about 25% smaller than for 1-star and 2-star hospitals.

Conclusions and Relevance

The results of this cohort study of HCAHPS-participating hospitals found that patient experience scores declined during 2020 to 2021. By Q4/2021, the HCAHPS-SS was 3.6 pp lower than would have been expected, a medium effect size. The most affected measures (staff responsiveness and cleanliness) showed large effect sizes, possibly reflecting high illness-associated hospital workforce absenteeism. Hospitals that were lower performing and less staffed prepandemic may have been less resilient to reduced staff availability and other pandemic-associated challenges. However, by Q4/2021, even prepandemic high-performing hospitals had similar declines.

Clostridioides difficile Near-Patient Testing Versus Centralized Testing: A Pragmatic Cluster Randomized Crossover Trial

BACKGROUND

Management of suspected Clostridioides difficile infection (CDI) in the hospital setting typically results in patient isolation, laboratory testing, infection control, and presumptive treatment. We investigated whether implementation of rapid near-patient testing (NPT) reduced patient isolation time, hospital length of stay (LOS), antibiotic usage, and cost.

METHODS

A 2-period pragmatic cluster randomized crossover trial was conducted. Thirty-nine wards were randomized into 2 study arms. The primary outcome measure was effect of NPT on patient isolation time using a mixed-effects generalized linear regression model. Secondary outcomes examined were hospital LOS and antibiotic therapy based on a negative binomial regression model. Natural experiment (NE), intention-to-treat (ITT), and per-protocol (PP) analyses were conducted.

RESULTS

During the entire study period, a total of 656 patients received NPT for CDI and 1667 received standard-of-care testing. For the primary outcome, a significant decrease of patient isolation time with NPT was observed (NE, 9.4 hours [P < .01]; ITT, 2.3 hours [P < .05]; PP, 6.7 hours [P < .1]). A significant reduction in hospital LOS was observed with NPT for short stay (NE, 47.4% [P < .01]; ITT, 18.4% [P < .01]; PP, 34.2% [P < .01]). Each additional hour delay for a negative result increased metronidazole use (24 defined daily doses per 1000 patients; P < .05) and non-CDI-treating antibiotics by 70.13 mg (P < .01). NPT was found to save 25.48 US dollars per patient when including test cost to the laboratory and patient isolation in the hospital.

CONCLUSIONS

This pragmatic cluster randomized crossover trial demonstrated that implementation of CDI NPT can contribute to significant reductions in isolation time, hospital LOS, antibiotic usage, and healthcare cost. Clinical Trials Registration. NCT03857464.

Emotional intelligence: Its place in infection prevention and control

Background

The Infection Prevention Societies Competency Framework is a detailed tool that recognises the multi factorial work of Infection Prevention and Control Teams. This work often takes place in complex, chaotic and busy environments where non-compliance with policies, procedures and guidelines is endemic. As reductions in Healthcare Associated Infection became a health service priority the tone of Infection Prevention and Control (IPC) became increasingly uncompromising and punitive. This can create conflict between IPC professionals and clinicians who may take a different view as to the reasons for sub optimum practice. If unresolved, this can create a tension that has a negative impact on working relationships and ultimately patient outcomes.

Concepts and Context

Emotional Intelligence, that ability to recognise, understand and manage our own emotions and recognise, understand and influence the emotions of others, is not something, hitherto, that has been headlined as an attribute for individuals working in IPC. Individuals with higher level of Emotional Intelligence show a greater capacity for learning, deal with pressure more effectively, communicate in interesting and assertive ways and recognise the strengths and weaknesses of others. Overall, the trend is that they are more productive and satisfied in the workplace.

Conclusion

Emotional Intelligence should be a much sought after trait in IPC as this will better equip a post holder to deliver challenging IPC programmes. When appointing to an IPC team, the candidates Emotional Intelligence should be considered and then developed through a process of education and reflection.

Patients with multi-drug-resistant organisms feel inadequately informed about their status: adverse effects of contact isolation

BACKGROUND

Contact isolation of patients with multi-drug-resistant organisms (MDROs) is an essential element of infection prevention strategies in hospitals worldwide. However, this practice may be associated with adverse side effects on patients' health and well-being.

AIM

This study was the first to assess mental health and well-being variables among isolated patients compared with non-isolated control patients in a German cohort.

METHODS

We conducted a matched case-control study among N = 267 patients admitted to a tertiary care teaching hospital in Germany. Their levels of anxiety, depression, loneliness, and dissatisfaction with their hospital experience were assessed using a questionnaire. Additionally, among isolated patients, it was evaluated how well they felt informed about their MDRO status.

FINDINGS

In our cohort, patients under contact isolation were significantly more dissatisfied than non-isolated control patients but did not show higher levels of anxiety, depression, and loneliness. A large proportion of patients felt insufficiently informed about their MDRO status. This lack of information was the strongest predictor of dissatisfaction among isolated patients.

CONCLUSION

These findings underline the importance of adequate patient communication. It is essential for patients' well-being to receive timely, relevant, and understandable information about the background and consequences of their infection or colonisation with MDROs.

The effect of web-based Hatha yoga on psychological distress and sleep quality in older adults: A randomized controlled trial

BACKGROUND

To date, there has been very limited experimental research on the impact of Yoga on older adults' mental health during the COVID-19 crisis. We aimed to explore the effect of a web-based Hatha yoga program on psychological and quality of sleep in older adults who self-isolated at home during the initial stage of the COVID-19 outbreak.

METHODS

Two hundred volunteers of both sexes were split into experimental (Yoga group, YG) and control (Control group, CG) groups, in a web-based randomized controlled study. All participants were administered the Depression, Anxiety and Stress Scales (DASS-21) and the Pittsburgh sleep quality index (PSQI); at baseline and following an eight-week online Hatha yoga intervention.

RESULTS

The YG showed significant reductions in depression (-56.1%; Z = 5.67, p < 0.01, r = 0.70) anxiety (-64.3%; Z = 5.27, p < 0.01, r = 0.65) and stress (-68.2%; Z = 5.86, r = 0.73) scores, while the CG showed a significant increase in depression. In addition, the total PSQI score of the YG was considerably lower during follow-up (3.38 ± 2.02, p < 0.05) than at baseline (4.8 ± 32, p < 0.05), which indicates an improvement of the quality of sleep. The proportion of individuals experiencing good sleep from the YG increased from 63% to 85% after the Hatha yoga intervention.

CONCLUSION

The use of a web-based Hatha Yoga intervention program was associated with a beneficial effect on the mental health and quality of sleep in older adults.

Understanding Experience of Patients With Highly Infectious Diseases During Extended Isolation: A Design Perspective

OBJECTIVES

This study aimed to develop a better understanding of the unique needs of patients with highly infectious diseases and their perceptions of being placed in isolation. We explore the subjective experiences of patients treated for Ebola in a biocontainment unit (BCU) and the healthcare personnel who cared for them.

BACKGROUND

The 2014 Ebola outbreak and the COVID-19 pandemic have brought to focus some major challenges of caring for patients with serious infectious diseases. Previous studies on BCU design have looked at ways to prevent self- and cross-contamination, but very few have examined how the built environment can support an improved patient experience.

METHOD

A qualitative study was conducted with four patients treated for Ebola and two critical care nurses who provided direct care to them at a single BCU in the U.S. Data were collected through in-depth semi-structured interviews to capture the actual patients' perception and experience of isolation. The interviews were analyzed using the thematic analysis approach.

RESULTS

The Ebola patients placed in source isolation perceived the BCU as an artificial environment where they lacked control, agency, autonomy, and independence. The physical separation from other patients, visitor restrictions, and staff wearing PPE contributed to feelings of social and emotional isolation, and loneliness.

CONCLUSIONS

The isolation can take a toll on physiological and psychological well-being. A thoughtful design of isolation units may improve patients' experience by supporting human and social interactions, empowering patients through space flexibility and personalization of space, and supporting a more holistic approach to isolation care.

Explanatory model of symptoms of stress, anxiety and depression in the general population: Cross-sectional study during the COVID-19 pandemic

COVID-19 pandemic has had a great impact worldwide, specially affecting mental health and has undoubtedly taken part in human behaviour modification, increasing global health burden and with stress, anxiety and depression being the main contributors to this load. Because of the importance of this issue, the objective of this study was the creation of an explanatory model for the causal relationship of the main psychological variables: stress, anxiety and depression in the COVID-19 pandemic context. A cross-sectional study was carried out with a sample of 709 volunteers, sociodemographic variables and psychological symptoms were measured through a virtual DASS-21 questionnaire, during the COVID-19 pandemic, dated from November 2 to 6, 2020. A structural equation model using the weighted least squares means and the adjusted variance was employed for the creation and adjustment of the explanatory relational model. The results showed the presence of stress, anxiety and depression symptoms among the general population. The model showed an adequate fit (CFI = 0.94; TLI = 0.94; RMSEA = 0.06; P = 0.000) and was able to explain more than 80% of depressive symptoms (R²  = 0.86) and more than 70% of anxiety symptoms (R²  = 0.72), in addition to showing a unidirectional causal relationship of long-term stress on anxiety, and anxiety on depressive symptoms, showing a linked behaviour of the same, in the adjusted model. It was also outlined that this model was characterized by being expressed mainly in women, with lower quality of sleep and at a younger age.

Isolated and anxious: A qualitative exploration of the impact of the COVID-19 pandemic on individuals living with spinal cord injury in the UK

OBJECTIVE

People living with spinal cord injury (SCI) are often immunocompromised, and at increased risk of respiratory infection. Given the restrictions in response to the COVID-19 pandemic, those with SCI may be at increased risk of health deterioration, though how this is experienced is poorly understood. This study explored the experiences of people living with SCI during the COVID-19 pandemic.

DESIGN

Participants completed an online survey consisting of demographic questions, and open-ended qualitative questions pertaining to their experiences during the pandemic. Thematic analysis was utilized for the analytical approach.

SETTING

Community-based sample in the UK.

PARTICIPANTS

Participants were recruited via social media outlets of UK-based SCI-specific support charities, and snowball sampling (N = 42, F = 34, M = 8).

RESULTS

Key themes included: (1) lost access to health services and support, capturing concerns surrounding barriers to healthcare and rehabilitation, which intensified secondary consequences of SCI such as spasm and pain; (2) health anxiety, which was perpetuated by perceived heightened vulnerabilities to respiratory complications; (3) social isolation, with significantly reduced social contact, even with care providers, compounding health experiences.

CONCLUSION

People living with SCI during the COVID-19 pandemic experienced a variety of personal physical, psychological, and social challenges, each of which could disrupt daily functioning and quality of life. Increased utilization of telehealth is recommended to support continued engagement in rehabilitation, and foster connection and community amongst others with SCI and health professionals.

Psychological Distress among Hospitalized COVID-19 Patients in Denmark during the First 12 Months of the Pandemic

This study aimed to investigate psychological distress among patients hospitalized with a COVID-19 diagnosis in Denmark during the first 12 months of the pandemic and to assess changes in psychological distress in the three months following discharge. A single-center prospective observational survey study among patients hospitalized with a COVID-19 diagnosis between May 2020 and May 2021 was conducted. Participants completed a survey at three time points: at admission, and 1 and 3 months after discharge. Psychological distress was assessed by validated scales measuring symptoms related to depression, anxiety, stress, insomnia, post-traumatic stress disorder (PTSD), and health-related quality of life (HRQoL). In total, 95 patients were included. At admission, the proportion of patients with symptoms of depression was 43%, symptoms of anxiety 32%, moderate/high level of stress 39%, insomnia 52%, and probable/positive PTSD 19%. The burden of symptoms related to depression and anxiety decreased significantly over time, while there was no significant change over time in stress, insomnia, or PTSD. Suboptimal levels of physical and mental HRQoL were detected at admission but improved over time. Patients hospitalized due to COVID-19 during the first year of the pandemic experienced considerable levels of psychological distress at admission, with some improvements within 3 months after discharge.

Living through the psychological consequences of COVID-19 pandemic: a systematic review of effective mitigating interventions

OBJECTIVE

This review assesses interventions and their effectiveness in mitigating psychological consequences from pandemic.

METHOD

Published English literatures were searched from four databases (Medline, PubMed, Embase and PsycINFO) from January 2020 and September 2021. A total of 27 papers with 29 studies (one paper reported three studies) met inclusion criteria. Cochrane risk-of-bias tool is applied to assess the quality of all randomised controlled trials (RCT).

RESULTS

All studies were recently conducted in 2020. Publications were from high-income (13, 44.8%), upper middle-income (12, 41.4%) and lower middle-income countries (3, 10.3%) and global (1, 3.5%). Half of the studies conducted for general population (51.7%). One-third of studies (8, 27.6%) provided interventions to patients with COVID-19 and 20.7% to healthcare workers. Of the 29 studies, 14 (48.3%) were RCT. All RCTs were assessed for risk of biases; five studies (15, 35.7%) had low risk as measured against all six dimensions reflecting high-quality study.Of these 29 studies, 26 diagnostic or screening measures were applied; 8 (30.9%) for anxiety, 7 (26.9%) for depression, 5 (19.2%) for stress, 5 (19.2%) for insomnia and 1 (3.8%) for suicide. Measures used to assess the baseline and outcomes of interventions were standardised and widely applied by other studies with high level of reliability and validity. Of 11 RCT studies, 10 (90.9%) showed that anxiety interventions significantly lowered anxiety in intervention groups. Five of the six RCT studies (83.3%) had significantly reduced the level of depression. Most interventions for anxiety and stress were mindfulness and meditation based.

CONCLUSIONS

Results from RCT studies (11%, 78.6%) were effective in mitigating psychological consequences from COVID-19 pandemic when applied to healthcare workers, patients with COVID-19 and general population. These effective interventions can be applied and scaled up in other country settings through adaptation of modes of delivery suitable to country resources, pandemic and health system context.

The Impact of SARS-CoV-2 (COVID-19) on the Acuity of Mental Health-Related Diagnosis at Admission for Young Adults in New York City and Washington, DC: Observational Study

BACKGROUND

The COVID-19 pandemic has required restrictive measures to mitigate transmission of the virus. Evidence has demonstrated increased generalized anxiety and depression among young adults due to the COVID-19 pandemic. However, minimal research has examined the longitudinal effect of COVID-19 over the course of time and its impact on anxiety and depression. Additionally, age and gender have been found to play a significant role on individuals' mental health, with young adults and women particularly at risk.

OBJECTIVE

The aim of this study was to examine the impact of the COVID-19 pandemic on anxiety and depression upon admissions to treatment.

METHODS

This was an observational study that was completed longitudinally in which the grouping variable split the time interval into five equal groups for assessments over each period of time. A total of 112 young adults (aged 18-25 years) were recruited for the study. Participants completed assessments online through a Qualtrics link.

RESULTS

Psychometric properties of the admission assessments were uniformly highly statistically significant. There was a significant difference in generalized anxiety between the group-1 and group-3 time intervals. No significant difference was found across the time intervals for depression. Differences in predicting the impact of the psychometrics scores were found with respect to gender. Only the ability to participate and the quality-of-life subfactor of the Functional Assessment of Chronic Illness Therapy (FACIT) assessment were significant.

CONCLUSIONS

This study sought to understand the impact that COVID-19 has had on young adults seeking mental health services during the pandemic. Gender emerged as a clear significant factor contributing to increased anxiety in young adults seeking mental health services during the pandemic. These findings have critical importance to ensuring the potential treatment success rate of clients, while providing an overarching understanding of the impact of the pandemic and establishing clinical recommendations for the treatment of individuals who are seeking out treatment.

Measuring perception of mental well-being in patients under isolation precautions: a prospective comparative study

OBJECTIVES

Isolation precautions (IP) are applied to prevent transmission of pathogens in healthcare settings. Potential negative health outcomes experienced by patients have been previously described but results remain conflicting. We aimed at evaluating the psychological impact of IP in adult patients in isolation using a novel psychological assessment tool.

STUDY DESIGN

Prospective matched cohort study.

SETTING

Tertiary care centre in Switzerland.

PARTICIPANTS

Hospitalised patients under IP and non-isolated patients were matched by ward, age and illness severity.

OUTCOME MEASURES

We measured surrogates of mental and social well-being by using the Pictorial Representation of Illness and Self Measure (PRISM) instrument once during hospitalisation. PRISM is a visual psychometric instrument that has been validated as a quantitative measure of suffering. Smaller distance in self-to-illness separation (SIS) signifies higher importance for a patient.

RESULTS

156 patients agreed to participate of which 63 were under IP and 93 were matched controls. Median (IQR) duration of isolation was 5 days (2-10). The median SIS (IQR) for perceived inferior nurses' care was 22.8 (18.5-24.3) and 23.8 (23.3-25.5) for isolated and non-isolated patients, respectively (p<0.001). Similarly, median SIS (IQR) was significantly smaller in isolated than non-isolated patients for avoidance by visitors with 17.5 (7.7-22.0) and 22.2 (21.8-22.6), for loneliness with 7.5 (3.6-16.0) and 18 (10.2-21.6) and for feeling impure with 19 (17.0-21.5) and 21.5 (18.9-22.1), respectively (all p values<0.05).

CONCLUSIONS

IP to prevent transmission of pathogens may negatively impact mental and social well-being. Measures to alleviate adverse effects of IP should be taken routinely.

The COVID-19 pandemic impacts all domains of quality of life in Egyptians with spinal cord injury: a retrospective longitudinal study

Background and objective

During the COVID-19 pandemic, several aspects of life have been affected. These aspects have been impacted especially in persons with spinal cord injury (SCI). The current study explored the overall effect of the COVID-19 pandemic on quality of life (QOL) domains in persons with SCI as well as evaluated their adherence to WHO-COVID 19-preventive measures.

Design

A retrospective longitudinal study was conducted after asking participants to complete an online validated Arabic version of the WHOQOL-BREF questionnaires including their demographics. The WHOQOL-BREF questionnaires were completed targeting two separate occasions to represent their scores prior to and during the pandemic. Participants were asked to rate their adherence to WHO-COVID-19 preventive measures on a 10-point scale.

Setting and participants

115 participants with complete/ incomplete SCI were recruited via social media and contacted by phone to complete the questionnaires.

Results

Persons with SCI had lower QOL scores during the COVID-19 period compared to their QOL during the pre-COVID-19 period; all QOL domains (Physical Health, Psychological, Social Relationships, and Environment) showed a significant decrease (P < 0.001). Regarding COVID-19 preventative measures, participants were most likely to endorse self-isolation as well as staying home measures and least likely to adhere to hand washing and social distancing measures.

Conclusion

The robustly reduced QOL reported by individuals with SCI during the COVID-19 pandemic highlights the need for rehabilitation and mental health services, particularly administered via telehealth, to buffer the effects of the pandemic. Additionally, psychoeducation and support regarding COVID-19 preventative behaviors in this region would be critical.

Intimate Partner Violence and Mental Health during Lockdown of the COVID-19 Pandemic

Background: This study took place in the context of the COVID-19 pandemic. The present research assesses the association between lockdown conditions (such as time spent at home, living environment, proximity to contamination and social contacts), mental health (including intolerance of uncertainty, anxiety and depression) and intimate partner violence within the community. This study evaluates the indirect effect of anxiety and depression on the relationship between intolerance of uncertainty and intimate partner violence (physical assault and psychological aggression). Methods: 1532 adults (80.8% of women, Mage = 35.34) were recruited from the Belgian general population through an online self-report questionnaire completed during the lockdown (from April 17 to 1 May 2020). Results: The results demonstrate that the prevalence of physical assault (including both perpetration and victimization) was significantly higher in men, whereas the prevalence of psychological aggression was significantly higher in women. Men reported significantly more violence during lockdown. Women, on the other hand, were more anxious and more intolerant of uncertainty. No difference between men and women was found for depression. Anxiety and depression significantly mediated the relationship between intolerance of uncertainty and physical assault and psychological aggression. Sex did not moderate the mediation. Conclusion: Clinical implications for public health policy are highlighted.

Mental health status of informal waste workers during the COVID-19 pandemic in Bangladesh

The deadliest coronavirus disease 2019 (COVID-19) is taking thousands of lives worldwide and presents an extraordinary challenge to mental resilience. This study assesses mental health status during the COVID-19 pandemic and its associated factors among informal waste workers in Bangladesh. A cross-sectional survey was conducted in June 2020 among 176 informal waste workers selected from nine municipalities and one city corporation in Bangladesh. General Health Questionnaire (GHQ-12) was used to assess respondents’ mental health. The study found that 80.6% of the individuals were suffering from psychological distress; 67.6% reported anxiety and depression, 92.6% reported social dysfunction, and 19.9% reported loss of confidence. The likelihood of psychological distress (Risk ratio [RR]: 1.23, 95% confidence interval [CI]: 1.02–1.48) was significantly higher for female than male. Multiple COVID-19 symptoms of the family members (RR: 1.20, 95% CI: 1.03–1.41), unawareness about COVID-19 infected neighbor (RR: 1.21, 95% CI: 1.04–1.41), income reduction (RR: 1.60, 95% CI: 1.06–2.41) and daily household meal reduction (RR: 1.34; 95% CI: 1.03–1.73) were also found to be associated with psychological distress. These identified factors should be considered in policy-making and support programs for the informal waste workers to manage the pandemic situation as well as combating COVID-19 related psychological challenges.

Social Inequities in the Impact of COVID-19 Lockdown Measures on the Mental Health of a Large Sample of the Colombian Population (PSY-COVID Study)

The identification of general population groups particularly vulnerable to the impact of COVID-19 lockdown measures on mental health and the development of healthcare policies are priority challenges in the current and future pandemics. This study aimed to identify the personal and social determinants of the impact of COVID-19 lockdown measures on mental health in a large sample of the Colombian population. In this cross-sectional study, an anonymous online survey was answered by 18,061 participants from the general population residing in Colombia during the first wave of the COVID-19 outbreak (from 20 May to 20 June 2020). The risk of depression, anxiety, and somatization disorders were measured using the Patient Health Questionnaire (PHQ-2), Generalized Anxiety Disorder Scale (GAD-2), and Somatic Symptom Questionnaire (SSQ-5), respectively. Overall, 35% of participants showed risk of depression, 29% of anxiety, and 31% of somatization. According to the analysis of social determinants of health, the most affected groups were people with low incomes, students, and young adults (18-29 years). Specifically, low-income young females were the most at-risk population group. These findings show how the lockdown measures affected the general population's mental health in Colombia and highlight some social risk factors in health.

Protocol for the economic evaluation of COVID-19 pandemic response policies

INTRODUCTION

Several treatment options are available for COVID-19 to date. However, the use of a combination of non-pharmaceutical interventions (NPIs) is necessary for jurisdictions to contain its spread. Although the implementation cost of NPIs may be low from the healthcare system perspective, it can be costly when considering the indirect costs from the societal perspective. COVID-19 vaccination campaigns have begun in several countries worldwide. Nonetheless, the quantity of vaccines available remain limited over the next 1 to 2 years. A tool for informing vaccine prioritisation that considers both cost and effectiveness will be highly useful. This study aims to identify the most cost-effective combination of COVID-19 response policies, using Singapore as an example.

METHODS AND ANALYSIS

An age-stratified Susceptible-Exposed-Infectious-Recovered model will be used to generate the number of infections stratified by disease severity under different intervention scenarios. Polices of interest include test-trace-isolate, travel restriction, compulsory face mask and hygiene practices, social distancing, dexamethasone/remdesivir therapy and vaccination. The latest phase 3 trial results and the WHO Target Product Profiles for COVID-19 vaccines will be used to model vaccine characteristics. A cost (expected resource utilisation and productivity losses) and quality-adjusted life years (QALYs) will be attached to these outputs for a cost-utility analysis. The primary outcome measure will be the incremental cost-effectiveness ratio generated from the incremental cost of policy alternatives expressed as a ratio of the incremental benefits (QALYs gained). Efficacy of policy options will be gathered from literature review and from its observed impacts in Singapore. Cost data will be gathered from healthcare institutions, Ministry of Health and published data. Sensitivity analysis such as threshold analysis and scenario analysis will be conducted.

ETHICS AND DISSEMINATION

Ethics approval was not required for this study. The study findings will be disseminated through peer-reviewed journals.

Social distancing as risk reduction strategy during COVID-19 pandemic: A study of Delhi-NCT, India

COVID-19 pandemic impacted countries all over the world calling as urgent need to enhance the capacity of individuals and communities to respond in such disease outbreaks. Public health interventions, such as social distancing could help to protect many vulnerable people and reduce secondary transmissions within the community. This research was undertaken as a longitudinal study to identify and comprehend the preferences given to different preventive measures adopted by individuals to ensure protection against the spread of coronavirus. An online survey was conducted with a representative sample of 176 stakeholders to identify practices and behaviour adopted by the key stakeholders working in the domains of water, health and disaster risk reduction to curb the spread of COVID-19 in Delhi-National Capital Territory of India (Delhi-NCT). Findings of this study shown preferred willingness to adopt sanitisation measures, often by cleaning their hands with soap and water, and restricting any movement inside and outside of the house. Three-fourth of the respondents considered washing their hands after returning from outside an important measure to limit the spread of the disease. Moreover, two-third of the people stopped ordering food from outside as a prevention strategy. Furthermore, only about 36% of the respondents showed interest in stocking up on grocery items as their most preferred choice, reflecting that this was considered to be the least important of all choices. Research outcomes of this study will help policymakers to better understand mitigation options that are used in the early and later stages of the lockdown to improve resilience from such viruses. Further, it will assist decision-makers to understand the range of individual-level practices adopted by stakeholders to mitigate disease transmission at the community level and inform the government's planning efforts in the future.

Health-related quality of life after pulmonary tuberculosis in South Korea: analysis from the Korea National Health and Nutrition Examination Survey between 2010 and 2018

BACKGROUND

Although several studies have reported an association between tuberculosis and health-related quality of life, the change in health-related quality of life after pulmonary tuberculosis has been rarely studied. The purpose of this study was to investigate the effect of past history of pulmonary tuberculosis on health-related quality of life using a nationwide, cross-sectional, observational study in Korea.

METHODS

Among 72,751 people selected using a stratified multi-stage sampling method, 7260 Korean participants were included using propensity score matching. Past history of pulmonary tuberculosis was defined as a previous diagnosis of pulmonary tuberculosis excluding patients with active pulmonary tuberculosis. The primary outcome, health-related quality of life, was assessed by EQ-5D disutility.

RESULTS

Before matching, the mean EQ-5D of individuals with pulmonary tuberculosis history was lower (0.066 vs. 0.056, p: 0.009). However, the difference was nullified after matching (0.066 vs. 0.062, p = 0.354). In multivariable Poisson regression analysis, EQ-5D disutility score was not associated with past pulmonary tuberculosis history. In subgroup analysis, past pulmonary tuberculosis history increased odds of low health-related quality of life in young (odds ratio [OR] 1.57, 95% confidence interval [CI] 1.17-2.11, p = 0.003), unmarried (OR 1.98, 95% CI 1.05-3.73, p = 0.036), or separated patients (OR 1.30, 95% CI 1.02-1.66, p = 0.032). Age and marital status were modulating factors on the effect of past pulmonary tuberculosis history on health-related quality of life.

CONCLUSIONS

There was no difference in health-related quality of life between individuals with and without past pulmonary tuberculosis history. Young and unmarried groups had increased odds for low health-related quality of life after pulmonary tuberculosis due to modulating effects of age and marital status.

Prevalence and Correlates of Likely Major Depressive Disorder among the Adult Population in Ghana during the COVID-19 Pandemic

Background: Emerging research suggests that the novel coronavirus disease (COVID-19) pandemic and associated public health restrictions have caused psychological distress in many contexts. In order for public health authorities and policy makers to effectively address the psychological distress associated with the pandemic, it is important to determine the prevalence and correlates of mental disorders, including depression. Objectives: We aimed to determine the prevalence, and demographic, social, clinical and other COVID-19 related correlates of major depressive disorder symptoms among the general population in Ghana during the COVID-19 pandemic. Method: The study was a cross-sectional survey using online data collection methods. The survey assessed demographic, social and clinical variables as well as COVID-19 related variables. Major depressive disorder symptoms were assessed using the Patient Health Questionnaire-9. The survey link was distributed primarily through WhatsApp-based platforms. Data were analyzed using descriptive and inferential statistics. Results: The overall prevalence of likely MDD symptoms among the sample population was 12.3%. Variables such as employment, loss of jobs during the pandemic and rate of exposure to COVID-related news were independently and significantly associated with the likelihood that respondents had likely MDD. Variables such as gender, relationship, housing status and having a family member or friend who was sick from COVID-19 were not independently significantly associated with the likelihood that respondents had likely MDD, when all other factors in the model were controlled. Conclusion: This study has identified the prevalence and correlates of depression symptoms in Ghana during the COVID-19 pandemic. There is the urgent need for mental health policy makers and the government of Ghana to have policies in place to alleviate the potential threat to the mental health of the population.

Analysis of Facility and Home Isolation Strategies in COVID 19 Pandemic: Evidences from Jodhpur, India

Purpose

Jodhpur administration directed its efforts to control and mitigate COVID 19 infection by implementing and monitoring facility isolation (FI) and home isolation (HI) measures. This study is conducted with a hypothesis that there is no difference in the quality of life and cost-effectiveness of mildly symptomatic or asymptomatic patients in HI and FI.

Patients and Methods

A mixed-method study was conducted in Jodhpur in September 2020. The purposive sampling technique was used and data from 120 individuals admitted in HI and FI were collected. The information about the status and functioning of isolation facilities was collected from various sources. Multi-stakeholder interactions with 15 personnel engaged in managing isolation facilities were done. EQ-5D version (EQ-5D-5L) which consists of the EQ-5D descriptive system and the EQ visual analog scale (EQ-VAS) was used to assess health-related quality of life.

Results

The strength of HI strategy is demonstrated by its ability to provide psychological and social support with minimal logistic requirements but the issue of sufficient household infrastructure, adequate family and societal support for implementing this strategy is of concern. The strength of FI strategy includes its ability to provide support to patients who have issues of sufficient household infrastructure, adequate family and societal support, but this strategy poses a threat of increasing human resource constraints and financial load on the health system. The respondents from HI obtained a mean EQ-5D index score of 0.90 and a mean VAS score of 85, whereas it was 0.80 and 78.5, respectively, for FI. The cost estimated for home isolation was Rs 549 (7.43 US $) per person, whereas it was Rs 2440 (33.02 US $) for facility Isolation.

Conclusion

Though HI seems advantageous in terms of a better quality of life and cost-saving over FI, both the strategies are context-specific having their own trade-offs.

Prevalence of Depression and Associated Factors Among Quarantined Individuals During the COVID-19 Pandemic in Tigrai Treatment and Quarantine Centers, Tigrai, Ethiopia, 2020: A Cross-Sectional Study

Aim

The global impact of COVID-19 on mental health increases from time to time. Several studies show that depression is highly prevalent among quarantined individuals. COVID-19 is a pandemic with a rapidly increasing incidence of infections and deaths. People are depressed and psychologically overwhelmed by the illness and possible loss of their friends and loved ones.

Objective

To assess the prevalence and associated factors of depression symptoms among quarantined individuals in Tigrai treatment center, Tigrai, Ethiopia, 2020.

Methods

A multicenter Institution-based cross-sectional study was employed among individuals in the Tigrai quarantine centers. A simple random sampling technique was used between April and October 2020 until an adequate sample size was reached. Depression was assessed by using the depression, anxiety, and stress scale (DASS). Epi data manager version 4.4 was used to enter data and data was analyzed using SPSS version 20. Logistic regression was carried out and an odds ratio with 95% confidence intervals (CI) was computed to identify factors associated with depression. A P-value of less than 0.05 was considered as statistically significant and the strength of the association was presented by an odds ratio of 95% CI.

Results

The finding of the present study on the prevalence of depression among quarantined individuals was 18.1 with 95% CI (14.8–22.9). Bivariate and multivariable logistic regression analysis was performed and factors such as being female, duration of quarantine, unemployment, and having perceived stigma were significantly associated with depression.

Recommendation and Conclusion

The prevalence of depression symptoms among quarantined individuals during the COVID-19 pandemic was 18.1%. In multivariable logistic regression analysis, being female, duration of quarantine, unemployment, and having perceived stigma were significantly associated with depression. So, clinicians, mental health professionals, and policymakers should work together to address the problem.

Effects of the COVID-19 pandemic on the sexual and mental health of adolescent and adult men who have sex with men and transgender women participating in two PrEP cohort studies in Brazil: COBra study protocol

INTRODUCTION

The COVID-19 pandemic and its control measures have impacted health and healthcare provision in various levels. Physical distancing measures, for instance, may affect sexual health, impacting access to HIV prevention supplies and changing sexual behaviour, as well as mental health, increasing feelings of unsafety and weakening community support ties. These effects can be worsened among socially marginalised groups, such as men who have sex with men (MSM) and transgender women (TGW). Brazil is among the countries most affected by COVID-19 in the world, where control measures have been inconsistently implemented. We aim to investigate the effects of the COVID-19 pandemic on the sexual and mental health of adolescent and adult MSM and TGW in Brazil.

METHODS

Convergent mixed-method prospective cohort study, nested in two ongoing HIV pre-exposure prophylaxis (PrEP) cohorts in Brazil, named PrEP1519 and Combina. Participants will be invited to answer, at baseline and after 6 months, a questionnaire about the effects of the COVID-19 pandemic on sexual behaviour, HIV prevention and mental health. Data on HIV infection and sexually transmitted infections (STI) will be collected as part of routine follow-up from the cohorts. Main outcome measures (HIV infection, STI and depression symptoms) will be observed within 12 months after baseline. Sample size is estimated at 426 participants. Complementarily, 50 participants will be invited to in-depth interviews through video calls or interactive voice response, and 20 will be invited to chronicle their lives during the pandemic through digital diaries. Triangulation will be done across qualitative methods and with the quantitative data.

ETHICS AND DISSEMINATION

The study was approved by Research Ethics Committees from the Brazilian Universities coordinating the study. Findings will be published in scientific journals and presented at meetings. Informative flyers will be elaborated to communicate study findings to participants and key stakeholders.

The psychological symptoms of patients with mild symptoms of coronavirus disease (2019) in China: A cross-sectional study

AIMS

To determine psychological symptoms of patients with mild symptoms of coronavirus disease 2019 in China and to explore the influencing factors.

DESIGN

A cross-sectional study.

METHODS

A convenience sample of 296 mild coronavirus disease 2019 patients were recruited from a Fangcang hospital in Wuhan, Hubei Province, from 3-5 March, 2020. Participants were assessed using a sociodemographic and clinical characteristics questionnaire, and Symptom Check List 90. The binary logistic regression was utilized to explore the influencing factors of psychological symptoms of patients with mild symptoms of coronavirus disease 2019.

RESULTS

In total, 296 of 299 patients with mild symptoms of coronavirus disease 2019 participated in the study (response rate: 99.0%). The findings revealed that 12.8% patients with mild symptoms have mental health problems; the most common psychological symptoms are phobic anxiety (58.4%), paranoid ideation (50.7%) and psychoticism (40.2%). Female patients [OR = 3.587, 95% CI (1.694-7.598)] and those having physical symptoms currently [OR = 2.813, 95% CI (1.210-6.539)] are at higher risk, while those in the middle duration of hospitalization [OR = 0.278, 95% CI (0.121-0.639)] protect against mental-health problems.

CONCLUSIONS

The minority of patients with mild symptoms of coronavirus disease 2019 were still suffering from psychological symptoms. Healthcare providers are recommended to pay particular attention to screening these high-risk groups (women, those in the initial stages of hospitalization and those with physical symptoms currently) and implement targeted psychological care as required.

IMPACT

This study found that most patients of coronavirus disease 2019 in Fangcang hospital exhibited normal mental health at par with the general Chinese norm and the minority of them were suffering from psychological symptoms. The findings can provide a reference for healthcare providers to screen high-risk psychological symptoms groups and implement targeted psychological intervention for patients with coronavirus disease 2019.

The Relationship Between Anxiety Levels, Sleep, and Physical Activity During COVID-19 Lockdown: An Exploratory Study

Nowadays and worldwide, the attention is focused on coronavirus disease (COVID-19), and its consequences on mental health are yet to be fully understood. It is important to capture differences in anxiety levels among populations, groups, and the gender-related variation. Therefore, the present study had two main purposes: (1) to characterize the levels of state anxiety and trait anxiety by examining gender-related, sleep-related, and physical activity-related variations in a nonrepresentative sample of the Portuguese population during the first weeks of lockdown; and (2) to explore the possible relationship between trait anxiety and state anxiety and the possible role of gender as a moderator. This cross-sectional study comprised 1,332 Portuguese adults (aged 18-55 years old) recruited online during COVID-19 outbreak measures. Participants answered to sociodemographic data and the Portuguese version of the State-Trait Anxiety Inventory (STAI). Gender differences were found in both state anxiety (p = < 0.001; d = 0.385) and trait anxiety (p = < 0.001; d = 0.467) with females presenting higher values. People reporting doing more physical activity than usual during COVID-19 lockdown presented lower levels of state anxiety (p = < 0.001; d = 0.200). People reporting more satisfaction with the quality of sleep presented lower levels of both state anxiety (p = < 0.001; d = 0.701) and trait anxiety (p = < 0.001; d = 0.899). Variation associated with the physical activity level (low, moderate, and high) was significantly different among groups in both state anxiety (p = < 0.001) and trait anxiety (p = < 0.001). When analyzing in more detail separating the levels of physical activity, participants performing moderate and high physical activity showed lower values of state and trait anxiety compared to participants with low physical activity. Participants performing high physical activity also showed lower values of state anxiety compared to participants performing moderate physical activity. Higher levels of trait anxiety were related to higher levels of state anxiety, but this association was not moderated by gender. Interventions aiming to support people psychologically during this outbreak should consider anxiety as well as gender and possible behavioral changes in sleep and physical activity, for example. Health professionals should not only consider the anxiety related to the situation we are living but also address trait anxiety to help overcome COVID-19 psychological consequences.

Association of Visitor Contact Precautions With Estimated Hospital-Onset Clostridioides difficile Infection Rates in Acute Care Hospitals

IMPORTANCE

Visitor contact precautions (VCPs) are commonly used to reduce the transmission of Clostridioides difficile at health care institutions. Implementing VCPs requires considerable personnel and personal protective equipment resources. However, it is unknown whether VCPs are associated with reduced hospital-onset C difficile infection (HO-CDI) rates.

OBJECTIVE

To estimate the association between VCPs and HO-CDI rates using simulation modeling.

DESIGN, SETTING, AND PARTICIPANTS

This simulation study, conducted between July 27, 2020, and August 11, 2020, used an established agent-based simulation model of C difficile transmission in a 200-bed acute care adult hospital to estimate the association between VCPs and HO-CDI while varying assumptions about factors such as patient susceptibility, behavior, and C difficile transmission. The model simulated hospital activity for 1 year among a homogeneous, simulated adult population.

INTERVENTIONS

No VCP use vs ideal use of VCPs under different hospital configurations.

MAIN OUTCOMES AND MEASURES

The rate of HO-CDI per 10 000 patient-days according to the Centers for Disease Control and Prevention's definition of HO-CDI.

RESULTS

With use of the simulation model, the baseline rate of HO-CDI was 7.94 10 000 patient-days (95% CI, 7.91-7.98 per 10 000 patient-days) with no VCP use compared with 7.97 per 10 000 patient-days (95% CI, 7.93-8.01 per 10 000 patient-days) with ideal VCP use. Visitor contact precautions were not associated with a reduction of more than 1% in HO-CDI rates in any of the tested scenarios and hospital settings. Independently increasing the hand-hygiene compliance of the average health care worker and environmental cleaning compliance by no more than 2% each was associated with greater HO-CDI reduction compared with all other scenarios, including VCPs.

CONCLUSIONS AND RELEVANCE

In this simulation study, the association between VCPs and HO-CDI was minimal, but improvements in health care worker hand hygiene and environmental cleaning were associated with greater reductions in estimated HO-CDI. Hospitals may achieve a higher rate of reduction for HO-CDI by focusing on making small improvements in compliance with interventions other than VCP.

A new therapeutic communication model "TAGEET" to help nurses engage therapeutically with patients suspected of or confirmed with COVID-19

AIM

To design and present a new communication model "TAGEET" to help nurses engage therapeutically with patients suspected of or confirmed with COVID-19.

BACKGROUND

COVID-19 is a highly contagious disease that brings with it fear and anxiety for all involved inclusive of nurses and patients. New guidelines for nurses to follow such as attention to physical distance coupled with the wearing of defined personal protective equipment, gloves, long-sleeved disposable gown, FFP2 face mask and eye protection place additional strain on nurses to engage therapeutically with patients. Evidence suggests that the wearing of face masks and personal protective equipment acts as barriers to effective therapeutic engagement with patients. We found an absence of communication models to help nurses engage therapeutically with patients.

DESIGN

This is a position paper that draws on previous research to inform the design of a new model for nurses to engage therapeutically with patients suspected of or confirmed with COVID-19.

METHOD

We reviewed the literature on caring for patients in isolation, the barriers to therapeutic communication and the psychological impact of infectious diseases on nurses and patients.

CONCLUSION

Remaining emotionally present to self, whilst being present to others can be challenging for nurses in a pandemic environment. We believe that the "TAGEET" model (T-Tune-in, A-Approach and introduce, G-Ground self, E-Engage and respond, E-End encounter, T-Tune-out), although devised for nurses to engage therapeutically with patients suspected of or confirmed with COVID-19 could be used by all healthcare professionals in any challenging clinical environment.

RELEVANCE TO CLINICAL PRACTICE

This new therapeutic communication model will provide support for nurses with how to manage self in the context of caring for others in a COVID-19 environment.

Gender Differences in Anxiety, Depression, and Nursing Needs Among Isolated Coronavirus Disease 2019 Patients

OBJECTIVE

This study explored gender differences in anxiety, depression, and nursing needs among isolated Coronavirus Disease 2019 (COVID-19) patients, with a particular focus on the influencing factors. The main goal was to elucidate breakthrough points and intervention targets for psychological counseling aimed at the promotion of overall health during isolation treatment.

METHODS

A survey was conducted to obtain information about the nursing needs of COVID-19 patients, with mental health assessed via the Hospital Anxiety and Depression Scale (HADS). Participants included 219 isolated COVID-19 patients at a Wuhan module hospital in Hubei province, China.

RESULTS

A total of 216 valid questionnaires were collected (98.63% retrieval rate). Of these participants, 21.76% had anxiety symptoms, while 17.59% had depression symptoms. Colleagues infected with COVID-19 (OR = 3.896, 95%CI: 1.555-9.764, P = 0.004) were the main influencing factors for anxiety symptoms, while marital status (OR = 2.700, 95% CI: 1.033-7.055, P = 0.043) and family members infected with COVID-19 (OR = 2.969, 95% CI: 1.243-7.095, P = 0.014) were the main influencing factors for depression symptoms. As for gender, male patients were generally more prone to depression and anxiety than female patients, especially those who were infected with colleagues. On the other hand, female patients reported greater concerns about safe treatment environments and communication with medical staff.

CONCLUSION

This study found gender-based differences regarding the factors influencing anxiety and depression in isolated COVID-19 patients, with males reporting a greater general tendency for symptoms. On the other hand, female patients reported greater overall psychological nursing needs than males. Targeted nursing should thus be implemented to address specific psychological characteristics and nursing needs.

Mood Reactive Disorders among COVID-19 Inpatients: Experience from a Monocentric Cohort

OBJECTIVE

We aimed to investigate the presence and severity of depressive symptoms among coronavirus disease 2019 (COVID-19) inpatients and any possible changes after their discharge.

SUBJECT AND METHODS

We collected data of patients admitted to the Infectious Disease Unit in Sassari, Italy, for COVID-19, from March 8 to May 8, 2020. The Beck Depression Inventory-II (BDI-II) was performed 1 week after admission (T0) and 1 week after discharge (T1). The cutoff point chosen to define the clinical significance of depressive symptoms was 20 (at least moderate).

RESULTS

Forty-eight subjects were included. Mean age was 64.3 ± 17.6 years, and 32 (66.7%) were male. Most frequent comorbidities were cardiovascular diseases (19; 39.6%) and hypertension (17; 35.4%). When performing BDI-II at T0, 21 (43.7%) patients reported depressive symptoms at T0, according to the chosen cutoff point (BDI-II = 20). Eight (16.7%) patients had minimal symptoms. Mild mood disturbance and moderate and severe depressive symptoms were found in 24 (50%), 14 (29.2%), and 2 (4.2%) patients, respectively, at T0. The comparison of the BDI-II questionnaire at T0 with T1 showed a significant improvement in the total score (p < 0.0001), as well as in 4 out of the 5 selected questions of interest (p < 0.05). Univariate analysis showed that kidney failure and the death of a roommate were significantly associated with severity of mood disorders.

CONCLUSION

Mood disturbances and depressive symptoms commonly occur among COVID-19 inpatients. Our results show that COVID-19 inpatients might be at higher risk for developing depressive reactive disorders and could benefit from an early psychological evaluation and strategies improving sleep quality.

COVID-19 Rehab Fright Management

Being diagnosed as positive for SARS-2 CoV RNA on PCR generates anxiety and stress as well as depression due to the prospects of being isolated. With genetically varied forms of virus on the rise the widely adopted manner to protect oneself is social distancing. This is frightening for rehabilitation professionals who at times are exposed at close quarters to the patients as rehabilitation is essential. Data in this backdrop is lacking, as this is a recent and ongoing pandemic. As such the current study was conducted with an attempt to review and highlight the causes of fright among rehabilitation professionals and possible management options in the wake of current pandemic of COVID-19 in the perspective of Pakistan. For this purpose literature was searched from major electronic databases including PubMed, Google, Google Scholar and Web-of-science, with keywords "Covid-19, mental health, telehealth, telemedicine, tele-rehabilitation and combination of words". Eighty English, full text articles were studied out of which 36 were used for the literature review. With this literature review we conclude that COVID-19 has resulted in fear of contracting and transmitting this disease among health professionals and can be reduced and managed by provision of tele-rehabilitation and telehealth facilities. Patients emerging from prolonged mechanical ventilations require extensive rehabilitation to restore routine body functions. The role of the otolaryngologist and speech language pathologist (SLP) is formal and direct to ensure appropriate and timely long term intervention and rehabilitation to ensure that these individuals re-enter mainstream activities.

Experiences of Psychotherapists With Remote Psychotherapy During the COVID-19 Pandemic: Cross-sectional Web-Based Survey Study

BACKGROUND

The current situation around the COVID-19 pandemic and the measures necessary to fight it are creating challenges for psychotherapists, who usually treat patients face-to-face with personal contact. The pandemic is accelerating the use of remote psychotherapy (ie, psychotherapy provided via telephone or the internet). However, some psychotherapists have expressed reservations regarding remote psychotherapy. As psychotherapists are the individuals who determine the frequency of use of remote psychotherapy, the potential of enabling mental health care during the COVID-19 pandemic in line with the protective measures to fight COVID-19 can be realized only if psychotherapists are willing to use remote psychotherapy.

OBJECTIVE

This study aimed to investigate the experiences of psychotherapists with remote psychotherapy in the first weeks of the COVID-19 lockdown in Austria (between March 24 and April 1, 2020).

METHODS

Austrian psychotherapists were invited to take part in a web-based survey. The therapeutic orientations of the psychotherapists (behavioral, humanistic, psychodynamic, or systemic), their rating of the comparability of remote psychotherapy (web- or telephone-based) with face-to-face psychotherapy involving personal contact, and potential discrepancies between their actual experiences and previous expectations with remote psychotherapy were assessed. Data from 1162 psychotherapists practicing before and during the COVID-19 lockdown were analyzed.

RESULTS

Psychotherapy conducted via telephone or the internet was reported to not be totally comparable to psychotherapy with personal contact (P<.001). Psychodynamic (P=.001) and humanistic (P=.005) therapists reported a higher comparability of telephone-based psychotherapy to in-person psychotherapy than behavioral therapists. Experiences with remote therapy (both web- and telephone-based) were more positive than previously expected (P<.001). Psychodynamic therapists reported more positive experiences with telephone-based psychotherapy than expected compared to behavioral (P=.03) and systemic (P=.002) therapists. In general, web-based psychotherapy was rated more positively (regarding comparability to psychotherapy with personal contact and experiences vs expectations) than telephone-based psychotherapy (P<.001); however, psychodynamic therapists reported their previous expectations to be equal to their actual experiences for both telephone- and web-based psychotherapy.

CONCLUSIONS

Psychotherapists found their experiences with remote psychotherapy (ie, web- or telephone-based psychotherapy) to be better than expected but found that this mode was not totally comparable to face-to-face psychotherapy with personal contact. Especially, behavioral therapists were found to rate telephone-based psychotherapy less favorably than therapists with other theoretical backgrounds.

Clinical characteristics and online mental health care of asymptomatic or mildly symptomatic patients with coronavirus disease 2019

Comparing to data in patients with severe coronavirus diseases 2019 (COVID-19), there are few studies on the prevalence anxiety and/or depression in patients with asymptomatic or mildly symptomatic COVID-19. We investigated the clinical characteristics and the prevalence of anxiety and/or depression among asymptomatic or mildly symptomatic patients with COVID-19 and monitored their mental health using an online assessment. An online survey for monitoring and assessing the mental health of patients with COVID-19 using a mobile phone was conducted. We used the Hospital Anxiety and Depression Scale to measure anxiety and/or depression levels. Of the 234 patients, 66 patients were asymptomatic (28.2%), while the remaining 168 patients were mildly symptomatic. The prevalence of anosmia (p = 0.001) and ageusia (p = 0.008) significantly decreased with the increasing age. In addition, 19.8% and 14.0% patients had anxiety and/or depression in the first survey, and one week after the first survey, respectively. Compared to patients without anxiety and/or depression, those with anxiety and/or depression had a longer quarantine duration. We found that anomia and ageusia were relatively common in the young age group. Furthermore, one-fifth asymptomatic or mildly symptomatic patients with COVID-19 had anxiety and/or depression.

Psychological consequences of COVID-19 home confinement: The ECLB-COVID19 multicenter study

BACKGROUND

Public health recommendations and government measures during the COVID-19 pandemic have enforced restrictions on daily-living. While these measures are imperative to abate the spreading of COVID-19, the impact of these restrictions on mental health and emotional wellbeing is undefined. Therefore, an international online survey (ECLB-COVID19) was launched on April 6, 2020 in seven languages to elucidate the impact of COVID-19 restrictions on mental health and emotional wellbeing.

METHODS

The ECLB-COVID19 electronic survey was designed by a steering group of multidisciplinary scientists, following a structured review of the literature. The survey was uploaded and shared on the Google online-survey-platform and was promoted by thirty-five research organizations from Europe, North-Africa, Western-Asia and the Americas. All participants were asked for their mental wellbeing (SWEMWS) and depressive symptoms (SMFQ) with regard to "during" and "before" home confinement.

RESULTS

Analysis was conducted on the first 1047 replies (54% women) from Asia (36%), Africa (40%), Europe (21%) and other (3%). The COVID-19 home confinement had a negative effect on both mental-wellbeing and on mood and feelings. Specifically, a significant decrease (p < .001 and Δ% = 9.4%) in total score of the SWEMWS questionnaire was noted. More individuals (+12.89%) reported a low mental wellbeing "during" compared to "before" home confinement. Furthermore, results from the mood and feelings questionnaire showed a significant increase by 44.9% (p < .001) in SMFQ total score with more people (+10%) showing depressive symptoms "during" compared to "before" home confinement.

CONCLUSION

The ECLB-COVID19 survey revealed an increased psychosocial strain triggered by the home confinement. To mitigate this high risk of mental disorders and to foster an Active and Healthy Confinement Lifestyle (AHCL), a crisis-oriented interdisciplinary intervention is urgently needed.

Psychological distress during the COVID-19 lockdown: The young adults most at risk

To control the COVID-19 pandemic, governments have implemented restrictions. This study evaluates psychological distress related to the crisis and identifies predictive factors of anxiety/depression according to age. 2,871 adults were recruited through an online questionnaire during the lockdown. Three subsamples were identified: 18-30; 30-50; > 50 years. The population suffers from anxiety and depression. Young adults adu reported lower levels of living space, occupational activity, social contact and alcohol use, but higher anxiety, depression and uncertainty than older participants. This psychological distress can be explained by lockdown conditions (differently according to age) and by intolerance to uncertainty. Also, youth's alcohol intake has decreased. Deconfinement strategies have been discussed.

Prevalence, risk factors and clinical correlates of depression in quarantined population during the COVID-19 outbreak

BACKGROUND

The COVID-19 outbreak has brought tremendous psychological pressure to the general population, which may lead to depression. Therefore, this study aim to evaluate the prevalence and clinical correlates of depressive symptoms in the general population quarantined during the COVID-19 outbreak in Shenzhen.

METHODS

2237 quarantined general individuals participated in this cross-sectional study from February 14 to March 4, 2020, during their 14 days quarantine. They completed the Zung's Self-Rating Depression Scale (SDS) for depression, Zung's self-rating anxiety scale (SAS) for anxiety, the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, and the Impact of Events Scale-Revised (IES-R) for post-traumatic stress symptoms (PTSS).

RESULTS

The prevalence of depressive symptom was 6.21% in quarantined individuals. The depressed group were younger, less married and educated, and had higher SAS, PSQI, IES-R total scores (all p<0.05), as well as more avoidance, intrusion and hyperarousal symptoms than the non-depressed group. Correlation analysis showed significant correlations between SDS score and the following parameters: age, marriage, education, SAS, PSQI, IES-R total and its three subscale scores (Bonferroni corrected all p<0.05). Further multiple regression indicated that age, marriage, education, SAS, PSQI, IES-R total score, Avoidance and Hyperarousal factor were independent predictors of depressive symptom.

LIMITATIONS

This study adopted a cross-sectional design and used self-report questionnaires.

CONCLUSIONS

Our results suggest an elevated prevalence of depressive symptom in quarantined general individuals in Shenzhen. Some demographic and clinical variables were associated with depressive symptoms.

Being a Psychotherapist in Times of the Novel Coronavirus Disease: Stress-Level, Job Anxiety, and Fear of Coronavirus Disease Infection in More Than 1,500 Psychotherapists in Austria

This study investigated stress-level, degree of job-related anxiety, and fear of coronavirus disease (COVID-19) infection in psychotherapists in the early weeks of the COVID-19 lockdown in Austria. One thousand five hundred and forty-seven psychotherapists participated in an online survey, assessing stress [Perceived Stress Scale-10 (PSS-10)], work-related worries and fears of existence [Job Anxiety Scale (JAS)], fear of COVID-19 infection during face-to-face psychotherapy, and adherence to five protective measures against COVID-19 infection during face-to-face psychotherapy. Stress-levels were higher than in a representative sample (p < 0.001). When psychotherapy was the sole income, stress-level (p = 0.020) and job anxiety (p < 0.001) were higher. Experiences with teletherapy, the psychotherapy format used during COVID-19, as well as reductions in number of patients treated during COVID-19, had no effect on stress-level or job anxiety. Psychotherapists still conducting face-to-face psychotherapy during COVID-19 reported less fear of infection compared to those conducting no face-to-face psychotherapy (p < 0.001), whereby the fear of infection was further reduced when they were more able to adhere to protective measures against COVID-19 (p < 0.01). Mental hygiene is important for psychotherapists to manage stress and job-related anxiety during COVID-19, especially in those whose income relies on psychotherapy.

Effects of home confinement on mental health and lifestyle behaviours during the COVID-19 outbreak: insights from the ECLB-COVID19 multicentre study

Although recognised as effective measures to curb the spread of the COVID-19 outbreak, social distancing and self-isolation have been suggested to generate a burden throughout the population. To provide scientific data to help identify risk factors for the psychosocial strain during the COVID-19 outbreak, an international cross-disciplinary online survey was circulated in April 2020. This report outlines the mental, emotional and behavioural consequences of COVID-19 home confinement. The ECLB-COVID19 electronic survey was designed by a steering group of multidisciplinary scientists, following a structured review of the literature. The survey was uploaded and shared on the Google online survey platform and was promoted by thirty-five research organizations from Europe, North Africa, Western Asia and the Americas. Questions were presented in a differential format with questions related to responses “before” and “during” the confinement period. 1047 replies (54% women) from Western Asia (36%), North Africa (40%), Europe (21%) and other continents (3%) were analysed. The COVID-19 home confinement evoked a negative effect on mental wellbeing and emotional status (P < 0.001; 0.43 ≤ d ≤ 0.65) with a greater proportion of individuals experiencing psychosocial and emotional disorders (+10% to +16.5%). These psychosocial tolls were associated with unhealthy lifestyle behaviours with a greater proportion of individuals experiencing (i) physical (+15.2%) and social (+71.2%) inactivity, (ii) poor sleep quality (+12.8%), (iii) unhealthy diet behaviours (+10%), and (iv) unemployment (6%). Conversely, participants demonstrated a greater use (+15%) of technology during the confinement period. These findings elucidate the risk of psychosocial strain during the COVID-19 home confinement period and provide a clear remit for the urgent implementation of technology-based intervention to foster an Active and Healthy Confinement Lifestyle AHCL).

Psychological outcomes of MRSA isolation in spinal cord injury rehabilitation

STUDY DESIGN

Retrospective secondary analysis with a quantitative, matched-pairs design. Patients isolated due to methicillin-Resistant Staphylococcus aureus (MRSA) were matched with controls without MRSA infection admitted to a multi-bedded ward, based on: gender, injury level, injury severity (AIS grade), age at the time of injury and year of admission.

OBJECTIVES

Determine the implications of MRSA-related infection isolation on spinal cord injury patients' anxiety, depression, appraisals of disability, perceived manageability and pain intensity. Hypotheses predicted patients who were isolated due to MRSA during inpatient stay would demonstrate poorer psychological health outcomes at discharge in comparison with non-isolated matched controls.

SETTING

National Spinal Injuries Centre, England, UK.

METHODS

Secondary analyses were conducted on pre-existing data based on patients' first admission for primary rehabilitation. Psychometric scales were used to measure outcome variables. Assessments were repeated at the time of admission and discharge.

RESULTS

Nonparametric longitudinal analyses using the nparLD package in R were conducted. Relative treatment effects demonstrated that there were no significant differences between groups across all outcome measures. There was a significant effect of time (admission vs discharge) on perceived manageability and pain intensity, indicating improved outcomes at discharge. There was no difference in the overall length of stay between the isolated and non-isolated groups.

CONCLUSIONS

Isolation experienced by rehabilitation inpatients with spinal cord injury with MRSA had no effect on a series of psychological outcomes. Engaging with rehabilitation had a positive impact in reducing pain unpleasantness and increasing perceived manageability of spinal cord injury, irrespective of infection isolation.

Exploring Lifestyle Habits, Physical Activity, Anxiety and Basic Psychological Needs in a Sample of Portuguese Adults during COVID-19

This cross-sectional study aimed to characterize the lifestyle habits, anxiety levels and basic psychological needs (BPN), in Portuguese adults during the Coronavirus Disease 2019 (COVID-19) pandemic, including a comparison between genders and age groups. In total, 1404 adults (36.4 ± 11.7 years; 69.6% female) answered sociodemographic data and three instruments: the International Physical Activity Questionnaire, the Basic Need General Satisfaction Scale and the State-Trait Anxiety Inventory. Males revealed higher values for the total energy expenditure (z = -2.26; p = 0.024; η 2 = 0.004) and for the level of satisfaction of competence (z = -2.62; p = 0.009; η 2 = 0.005). Females showed higher scores for the anxiety state (z = -7.87; p ≤ 0.001; η 2 = 0.044) and anxiety trait (z = -6.49; p ≤ 0.001; η 2 = 0.030). Regarding age, higher values for the anxiety trait (p ≤ 0.001; η H 2 = 0.030) were found in the 18-34 years-old group compared to all the other age groups, also presenting significantly higher values of total energy expenditure (χ² = 13.93; p = 0.008; η H 2 = 0.007) when compared to the 35-44 years-old group. Significant differences were observed between the 18-34 years-old group and the other age groups for the satisfaction of competence (χ² = 40.97; p ≤ 0.001; η H 2 = 0.026), except for the >65 years-old group. Strategies for promoting well-being during periods of social isolation should consider the role of psychological dimensions and lifestyle habits according to the gender or age group.

Mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence

OBJECTIVES

Transmission of infectious diseases is often prevented by quarantine and isolation of the populations at risk. These approaches restrict the mobility, social interactions, and daily activities of the affected individuals. In recent coronavirus disease 2019 (COVID-19) pandemic, quarantine and isolation are being adopted in many contexts, which necessitates an evaluation of global evidence on how such measures impact the mental health outcomes among populations. This umbrella review aimed to synthesize the available evidence on mental health outcomes of quarantine and isolation for preventing infectious diseases.

METHODS

We searched nine major databases and additional sources and included articles if they were systematically conducted reviews, published as peer-reviewed journal articles, and reported mental health outcomes of quarantine or isolation in any population.

RESULTS

Among 1,364 citations, only eight reviews met our criteria. Most of the primary studies in those reviews were conducted in high-income nations and in hospital settings. These articles reported a high burden of mental health problems among patients, informal caregivers, and healthcare providers who experienced quarantine or isolation. Prevalent mental health problems among the affected individuals include depression, anxiety, mood disorders, psychological distress, posttraumatic stress disorder, insomnia, fear, stigmatization, low self-esteem, lack of self-control, and other adverse mental health outcomes.

CONCLUSIONS

This umbrella review found severe mental health problems among individuals and populations who have undergone quarantine and isolation in different contexts. This evidence necessitates multipronged interventions including policy measures for strengthening mental health services globally and promoting psychosocial wellbeing among high-risk populations.

Changes in Provision of Psychotherapy in the Early Weeks of the COVID-19 Lockdown in Austria

Reducing personal contacts is a central measure against the spreading of the novel coronavirus disease (COVID-19). This troubles mental health, but also mental health care as treatments usually take place in personal contact and switching to remote treatments might be necessary in times of COVID-19. The present study investigated the question how the provision of psychotherapy changed in the early weeks of the COVID-19 lockdown in Austria and whether there were differences between the four therapeutic orientations eligible in Austria (psychodynamic, humanistic, systemic, behavioral). Psychotherapists (N = 1547) completed an online survey. They entered their number of patients treated on average per week (in personal contact, via telephone, via Internet) in the early weeks of the COVID-19 lockdown in Austria as well as (retrospectively) in the months before. The number of patients treated on average per week in personal contact decreased (on average 81%; p < 0.001), whereas the number of patients treated on average per week via telephone and via Internet increased (on average 979% and 1561%; both p < 0.001). Yet, the decrease of psychotherapies through personal contact was not compensated for by increases of remote psychotherapies (p < 0.001). No differences between the four therapeutic orientations emerged. Results imply an undersupply of psychotherapy in the COVID-19 lockdown and that further changes are necessary to cover the increased need for timely psychotherapy in times of COVID-19.

Psychological consequences of COVID-19 home confinement: The ECLB-COVID19 multicenter study

BACKGROUND

Public health recommendations and government measures during the COVID-19 pandemic have enforced restrictions on daily-living. While these measures are imperative to abate the spreading of COVID-19, the impact of these restrictions on mental health and emotional wellbeing is undefined. Therefore, an international online survey (ECLB-COVID19) was launched on April 6, 2020 in seven languages to elucidate the impact of COVID-19 restrictions on mental health and emotional wellbeing.

METHODS

The ECLB-COVID19 electronic survey was designed by a steering group of multidisciplinary scientists, following a structured review of the literature. The survey was uploaded and shared on the Google online-survey-platform and was promoted by thirty-five research organizations from Europe, North-Africa, Western-Asia and the Americas. All participants were asked for their mental wellbeing (SWEMWS) and depressive symptoms (SMFQ) with regard to "during" and "before" home confinement.

RESULTS

Analysis was conducted on the first 1047 replies (54% women) from Asia (36%), Africa (40%), Europe (21%) and other (3%). The COVID-19 home confinement had a negative effect on both mental-wellbeing and on mood and feelings. Specifically, a significant decrease (p < .001 and Δ% = 9.4%) in total score of the SWEMWS questionnaire was noted. More individuals (+12.89%) reported a low mental wellbeing "during" compared to "before" home confinement. Furthermore, results from the mood and feelings questionnaire showed a significant increase by 44.9% (p < .001) in SMFQ total score with more people (+10%) showing depressive symptoms "during" compared to "before" home confinement.

CONCLUSION

The ECLB-COVID19 survey revealed an increased psychosocial strain triggered by the home confinement. To mitigate this high risk of mental disorders and to foster an Active and Healthy Confinement Lifestyle (AHCL), a crisis-oriented interdisciplinary intervention is urgently needed.