The psychological status of people affected by the COVID-19 outbreak in China

Harmonizing the mind and body: The interrelationship between traditional Chinese medicine body constitution, mental health and sleep quality

BACKGROUND

Traditional Chinese medicine (TCM) body constitution is a key factor in determining and influencing the occurrence, development, and variation of diseases. As the mind interact with the body, TCM body constitution is useful in preventing and treating psychiatric disorders and insomnia.

AIM

To investigate the interrelationship between TCM body constitution, psychiatric disorders and sleep quality.

METHODS

A total of 2441 participants were enrolled in our study. TCM body constitution was measured using the Constitution in Chinese Medicine Questionnaire, sleep quality was assessed using the Chinese version of the Pittsburgh Sleep Quality Index, and psychopathological symptoms were evaluated using Symptom Checklist-90. Logistic regression was used to estimate the interrelationship between TCM body constitution, psychiatric disorders and sleep quality.

RESULTS

The Pittsburgh Sleep Quality Index score and the proportions of participants with Qi-deficiency constitution, Qi-stagnation constitution, and blood-stasis constitution were significantly higher in the psychiatric symptoms group. Additionally, psychiatric symptoms were considerably associated with sleep quality, Qi-deficiency constitution, and Qi-stagnation constitution, but were inversely associated with male sex. Obsessive-compulsive symptoms were considerably associated with sleep quality, Qi-deficiency constitution and Qi-stagnation constitution. Depression was considerably associated with sleep quality, hyperuricemia, and Qi-stagnation constitution. Anxiety was considerably associated with sleep quality, diabetes, and Qi-stagnation constitution. Finally, poor sleep quality was considerably associated with Qi-deficiency constitution, Qi-stagnation constitution, dampness-heat constitution, phlegm-dampness constitution, and blood-stasis constitution but was inversely associated with male sex and body mass index > 23.9.

CONCLUSION

TCM body constitutions are strongly associated with psychiatric symptoms and sleep quality. Further research is needed to verify whether TCM body constitution can be used to treat and prevent psychiatric conditions as well as enhance sleep quality.

How to implement pairing assistance during fighting COVID-19 in China: collaborative governance between local governments under the authoritative regulation

Background

The pairing assistance policy represents a distinctive instrument utilized by the Chinese government to address major public crises. This study examines the development of a pairing assistance policy by the Chinese Government through its central authority to foster collaborative governance among local governments in areas affected by COVID-19.

Methods

The aim of the study was to gain a clear understanding of how the policy of pairing assistance in public health emergencies is successfully implemented through the top-down application of authority. A case study design was used as a methodology to present an explanatory framework for implementing pairing assistance policies during major public crises. We focus on the operational process of pairing assistance, using the assistance provided by Jiangsu Province to Huangshi City in Hubei Province as an illustration.

Results

This paper finds that responding to a crisis requires the guidance of a central authority and the cooperation of local governments. The process is driven by three key factors: the vertical intervention of the crisis, the inevitability of horizontal cooperation and the policy allocation and incentives of the bureaucracy. The three stages of co-operative governance based on authoritative regulation work together in a step-by-step manner to enhance the effectiveness of crisis response.

Conclusion

The results of the study indicate that collaborative governance under the authoritative regulation is the main reason why provincial counterpart support mechanism plays a great role in COVID-19. This study is the first to approach the study of pairing assistance from the perspective of government authority. It broadens the research horizon of local government cooperation and provides a model for future collaboration.

Effects of different natural soundscapes on human psychophysiology in national forest park

Most of the current soundscape research content is limited to the discussion of the restoration effect of single-element soundscapes, but it is the combination of sounds that is common in outdoor activities, and there is no evidence that the restoration of natural soundscapes is better with multi-element combinations. In this study, the Zhangjiajie National Forest Park in China was used as the research object, and the physiological indices of the subjects were collected through electroencephalogram signals, and the POMS short-form psychological scale was used to understand the subjective psychological responses of the subjects to the soundscape. The results showed that (1) The psychophysiological restorative ability of the natural soundscape of the National Forest Park was confirmed, and the subjects' psychological and physiological indices changed significantly and positively after listening to each section of the natural soundscape (p = 0.001). (2) The restorative effect of the multi-natural sound combination was ranked first in the overall ranking of the five natural soundscapes, and the multi-natural sound combination did indeed provide better restorative effects than the single-element sounds. (3) Gender does not usually have a significant effect on the restoration effect, and only Windy Sound among the four single-element nature sound landscapes and one multi-element combination of nature sound landscapes showed a significant gender difference, so in general, the effect of gender on the restoration effect of nature sound landscapes is not significant. In terms of research methodology, this study used cluster analysis to cluster the five types of natural soundscapes according to psychological and physiological recovery ability, and used ridge regression to construct mathematical models of the psychological and physiological recovery of each of the four natural soundscapes. The study of human physiological and psychological recovery from different types of natural soundscapes in China's national forest parks will provide a basis for soundscape planning, design, and policy formulation in national forest parks.

Association between immune cells in peripheral blood and psychiatric symptoms

BACKGROUND

There are bidirectional associations between immunological dysfunction and psychiatric symptoms. However, the associations between the levels of immune cells in the peripheral blood and psychiatric symptoms remain unclear. The present study aimed to evaluate levels of immune cells in peripheral blood in people with positive psychiatric symptoms.

METHODS

This retrospective study analyzed data from routine blood tests and psychopathology and sleep quality assessments. Data were compared between a group of 45 patients with de novo psychological symptoms and 225 matched controls.

RESULTS

Patients with psychiatric symptoms had higher white blood cell and neutrophil counts compared with controls. However, in a subgroup analysis, neutrophil counts were significantly higher than in controls only in patients with multiple psychiatric symptoms. Furthermore, monocyte counts were significantly higher in patients with multiple psychiatric symptoms than in controls. Further, sleep quality was lower in patients with psychiatric symptoms than in controls.

CONCLUSION

White blood cell and neutrophil counts in the peripheral blood of patients with psychiatric symptoms were significantly higher and sleep quality was significantly lower than in controls. Participants with multiple psychiatric symptoms showed more significant differences in peripheral blood immune cell counts than other subgroups. These results provided evidence for the relationship between psychiatric symptoms, immunity, and sleep.

Symptoms and risk factors of depression and PTSD in the prolonged COVID-19 pandemic: a longitudinal survey conducted from 2020 to 2022 in Japan

BACKGROUND

The present study aimed to explore changes in depression and posttraumatic stress disorder (PTSD) among the general population during the prolonged COVID-19 pandemic and to investigate risk factors and adaptive/nonadaptive strategies.

METHODS

A web-based longitudinal survey was conducted across five timepoints from 2020 to 2022 in Japan. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9), PTSD was measured using Impact of Event Scale-Revised (IESR), and coping strategies were measured using Brief Coping Orientation to Problems Experienced (Brief COPE). Higher scores of PHQ-9 and IESR indicate more symptoms and Higher score of Brief COPE indicate that these means of coping are used very frequently.

RESULTS

A total of 1,366 participants (mean age = 52.76, SD = 15.57) were analyzed. Regarding levels of depression, PHQ-9 scores in 2022 were lower than in 2020 and 2021 (all p < 0.01). Regarding levels of PTSD, IESR scores in 2022 were lower than in 2021 among females (p < 0.001). Being younger (β = -0.08 and - 0.13, both p < 0.01) and engaging in self-blame (β = 0.12 and 0.18, both p < 0.01) increased PHQ-9 scores regardless of sex. For males, not working (β = 0.09, p = 0.004) and having suffered an economic impact (β = 0.07, p = 0.003) were risk factors for depressive symptoms, and active coping (β = -0.10, p = 0.005) was associated with decreased depressive symptoms. For females, substance use (β = 0.07, p = 0.032) and behavioral disengagement (β = 0.10, p = 0.006) increased depressive symptoms, and females did not show strategies that decreased the symptoms.

CONCLUSIONS

Levels of depression might have increased in the early stages of the pandemic and decreased in January 2022. Although males need to improve their economic situation to decrease depressive symptoms, adaptive strategies might be difficult to identify due to the prolonged pandemic among both sexes. In addition, the pandemic might be a depressive event but not a traumatic event among the general population, at least in Japan.

Predictive factors for enhanced community mental health vulnerability in this COVID-19 pandemic era

OBJECTIVE

Explore the mental health status and its influencing factors of local community residents under the post-epidemic era of coronavirus disease 2019 (COVID-19) in China.

METHODS

The basic information scale, self-rating depression scale and self-rating anxiety scale were used to carry out an online questionnaire survey among community residents in Jiangsu Province, China, and the influencing factors of depression and anxiety were analyzed by multivariate logistic regression.

RESULTS

A total of 993 residents completed the mental health survey. It was found that the incidence of depressive and anxiety symptoms was 37.06% and 22.86%. Multivariate logistic regression analysis showed that women [odds ratio (OR) 95% confidence interval (95% CI) = 26.239 (14.743-46.698)], college degree and above [OR (95% CI) = 1.843 (1.085-3.130)] and ordinary residents [OR (95% CI) = 2.222 (1.441-3.425)] were risk factors for depressive symptoms, urban residents had lower risk [OR (95% CI) = 0.655 (0.394-0.829)]. Women [OR (95% CI) = 33.595 (15.812-71.381)] and ordinary residents [OR (95% CI) = 3.017 (1.602-5.680)] were risk factors for anxiety symptoms while the incidence was reduced in professional and technical personnel [OR (95% CI) = 0.271 (0.123-0.597)], workers [OR (95% CI) = 0.383 (0.168-0.876)], soldiers or policemen [OR (95% CI) = 0.200 (0.042-0.961)], married residents [OR (95% CI) = 0.463 (0.230-0.931)] and urban residents [OR (95% CI) = 0.531 (0.251-0.824)].

CONCLUSION

The incidence of symptoms of depression and anxiety among residents was relatively high under the post-epidemic era of COVID-19, which could be affected by various factors.

Two-year impact of COVID-19 pandemic on hospitalized patients with skin diseases in China

To investigate the clinical characteristics of skin disorders among hospitalized patients before and during the coronavirus disease 2019 (COVID-19) pandemic, a retrospective study was conducted based on hospitalized patients with skin diseases from Xiangya Hospital of Central South University, the largest hospital in the south-central region of China, between January 1, 2018, and December 31, 2021. A total of 3039 hospitalized patients were enrolled in the study, including 1681 patients in the prepandemic group and 1358 patients in the pandemic group. The total number of hospitalized patients in the pandemic group decreased by 19.2%, with an increased proportion of patients over 60 years of age (39.8% vs. 35.8%). Moreover, compared with the prepandemic group, there were decreases in the occurrence of most skin diseases in the pandemic group, but the proportions of keratinolytic carcinoma (6.6% vs. 5.2%), dermatitis (24.0% vs. 18.9%), and psoriasis (18.0% vs. 14.8%) were higher in the pandemic group. In addition, longer hospital stays (β = 0.07, SE = 0.02, P = 1.35 × 10^-3 ) and higher hospital costs (β = 0.06, SE = 0.03, p = 0.031) were found in the pandemic group through general linear models, even after the corresponding adjustment. In summary, the COVID-19 pandemic has had a lasting impact on patients with skin diseases, with fewer hospitalized patients, increased proportions of older patients, longer hospital stays, and increased hospital costs. These findings will facilitate better preparation for the most effective response to future pandemics.

Association between smartphone overdependence and generalized anxiety disorder among Korean adolescents

BACKGROUND

This study aimed to investigate the association between smartphone overdependence and generalized anxiety disorder among South Korean adolescents.

METHODS

Participants were selected from the Korean Youth Health Behavior Survey 2020. The primary dependent variable was the generalized anxiety disorder that was measured based on seven item instrument (GAD-7). The main exposure of interest was the smartphone overdependence using the integrated scale developed by the National Information Society Agency in Korea. Weighted chi-square test and multiple logistic regression were used to assess the association between smartphone overdependence and generalized anxiety disorder.

RESULTS

The final participants comprised of 54,948 middle and high school students. 13,775 students (25.1 %) were classified as the smartphone overdependence group. Of those who reported overly dependent on smartphones, 2803 students (20.3 %) had generalized anxiety disorder. The risk for generalized anxiety disorder were 2.15 folds (95 % CI 2.01-2.30) higher among the overdependence group in compared to their counterparts. Specifically, the risk for generalized anxiety disorder increased when smartphone has negatively affected relationships with friends and colleagues (OR: 2.35, 95 % CI 2.08-2.64). The sensitivity of smartphone overdependence scale was verified and the risk for generalized anxiety disorder increased in magnitude with the severity of smartphone overdependence.

CONCLUSION

The findings of the study showed significant association between smartphone overdependence and generalized anxiety disorder among South Korean adolescents. The negative changes in social relationships due to excessive smartphone use and the severity of overdependence accounted for the risk for generalized anxiety disorder.

The effect of hopelessness on the perceived partner behaviors during Covid-19 pandemic process

PURPOSE

It is aimed to evaluate the effect of hopelessness on the perceived partner behaviors during Covid-19 pandemic process in Turkey.

DESIGN

Descriptive.

METHODS

Totally, 486 participants have been included in the study.

FINDINGS

It has been found that there is a positive correlation between codependence, disconnection, controlling subdimension and hopelessness in both women and men (p < 0.05).

PRACTICE IMPLICATIONS

In the study, the women and men who evaluate their partners as dependent, disconnected and controlling are hopeless.

Factors associated with depression in residents in the post-epidemic era

OBJECTIVE

To explore the factors associated with depression in residents in the post-epidemic era of COVID-19.

METHODS

A multi-stage stratified random sampling method was used to conduct a questionnaire survey among community residents through self-designed questionnaires and self-rating depression scale (SDS). Multivariate logistic regression analysis was performed on the influencing factors of depressive symptoms.

RESULTS

A total of 1993 residues completed the survey of depression status. The incidence of depressive symptoms was 27.04%. The multivariate logistic regression analysis showed that female (odds ratio (OR): 6.239, 95% confidence interval (CI): 2.743-10.698), body mass index (BMI) > 24 (OR: 2.684, 95% CI: 1.059-3.759) and drinking (OR: 1.730, 95% CI: 1.480-3.153) were the risk factors for developing depressive symptoms. Married (OR: 0.417, 95% CI: 0.240-0.652), monthly income (3001-5000 yuan, OR: 0.624, 95% CI: 0.280-0.756; >5000 yuan, OR: 0.348, 95% CI: 0.117-0.625), ordinary residents (OR: 0.722, 95% CI: 0.248-0.924) and urban residents (OR: 0.655, 95% CI: 0.394-0.829) were the protective factors of depressive symptoms.

CONCLUSIONS

Under the post-epidemic era of COVID-19, depressive symptoms are still common among community residents in China. Gender, BMI, drinking, marriage, monthly income and nature of personnel and residential area are associated with the incidence of depressive symptoms.

Neurological and Psychological Characteristics of Young Nitrous Oxide Abusers and Its Underlying Causes During the COVID-19 Lockdown

Background

The COVID-19 pandemic has a serious impact on the mental health of the public due to its economic and social impact. And psychological effects have led to drug and alcohol abuse. After the city lifted the lockdown, we consecutively encountered several young nitrous oxide abusers admitted to hospital for neurological treatment.

Purpose

To inform physician decisions and social intervention, this observational study aimed at investigating the neurological and psychological characteristics of nitrous oxide abusers and its underlying causes during the COVID-19 lockdown.

Methods

The nitrous oxide abusers who sought neurological treatment at our hospital between May 2020 and June 2020 were enrolled. Clinical data including socio-demographic, physical examination, laboratory examination, electromyography and neuroimaging were collected. Their motivations for inhaling nitrous oxide, knowledge about the nitrous oxide abuse and the accompanying of family were investigated face to face. Psychological status was assessed by the Symptom Checklist 90 (SCL-90) psychological evaluation.

Results

Six nitrous oxide abusers were enrolled and the age was 22 ± 4.3. Clinical presentations included varying degrees of limb numbness and an ataxic gait. Laboratory examination revealed that all the patients did not have pernicious anemia, 4 patients had decreased vitamin B12 while 3 patients exhibited elevated homocysteine levels. MR of the spinal cord revealed that 4 patients had abnormal signals in the cervical spinal cord of high symmetry with splayed or inverted V sign after T2WI. Electromyogram (EMG) test showed 5 patients had peripheral nerve damage. The SCL-90 psychological evaluation results indicated that all patients had severe anxiety, depression and psychosis and they had severer psychological problems than ordinary citizens. Their motives for inhaling nitrous oxide are to relieve boredom, curiosity and buddy pressure. Their family spent <1 day per week to stay with them during city lockdown.

Conclusion

The enrolled patients caused by abuse of nitrous oxide presented with symptoms of subacute combined with spinal degeneration. They had more serious psychological problems related to the COVID-19 pandemic. These cases make us value the psychological problems of young people under the outbreak and take multi-layered measures from families, schools (companies), hospitals, and governments to address it.

Age-related differences in depressive symptoms and coping strategies during the COVID-19 pandemic in Japan: A longitudinal study

OBJECTIVE

The coronavirus 2019 (COVID-19) pandemic has particularly influenced the mental health of younger adults; accordingly, this study investigated age-related factors related to mental health and provided suggestions related to mental health recovery.

METHODS

A web-based longitudinal survey was conducted from 2020 to 2021 in Japan. The survey consisted of the Patient Health Questionnaire-9 (PHQ-9), used to measure depressive symptoms as a response variable, and an anger questionnaire and coping strategy scale to assess explanatory variables.

RESULTS

A total of 1468 participants were analyzed (valid response rate = 54.2%); 368 were younger adults (age range = 20-39), 667 were middle-aged adults (age range = 40-64), and 433 were aged adults (age range = 65-79). The PHQ-9 scores in the younger adults worsened over the three survey timepoints. State anger was strongly related to PHQ-9 scores in all age groups (standardized beta = 0.39-0.47), and state anger in the younger group was highest at all survey times, In the younger group, only nonadaptive coping strategies were related to PHQ-9 scores. Emotional support, venting, and humor adaptive strategies used by middle-aged and aged adults were most commonly used by younger adults; however, there were no significant relationships of these strategies with PHQ-9 scores in the younger group.

CONCLUSION

The level of depressive symptoms among the younger adults might be considerably worse than the middle-aged and aged adult. The younger adults might not make use of strategies, hence, they might need advice and skill training of strategies.

On the Parental Influence on Children's Physical Activities and Mental Health During the COVID-19 Pandemic

Background

While neighborhood safety and stranger danger have been mostly canonized to play a part in parents' physical activity (PA) avoidance, less is known about the impact of parental stress and perceived risk on children's PA avoidance and consequently on children's level of PA and wellbeing. Understanding the contributors to children's wellbeing during pandemic disease is the first critical step in contributing to children's health during epidemic diseases.

Methods

This study employed 276 healthy children, aged 10-12 years, and their parents. Data were collected in October and November 2020, about 9 months after the local closing of schools due to the coronavirus disease 2019 (COVID-19) pandemic. Parents and children answered a separate set of questions. Besides the demographic information, the parents responded to questions on their stress level, perceived risk of COVID-19, and PA avoidance for children. Children responded to questions on their PA and wellbeing in the last week. Data were analyzed using SmartPLS and IBM SPSS 22.

Results

The result of the study supported the four directional research hypotheses of the sequential study model. As hypothesized, parents' stress and perceived risk levels of COVID-19 negatively affected children's PA. The PA level was shown to predict children's wellbeing and mental health. Housing type, parents' job security, number of siblings, number of members living together in-home, and history of death or hospitalization of relatives or family members due to COVID-19 were found to be associated with parents' stress and children's mental health.

Conclusion

This study sheds light on parents' role in children's wellbeing and mental health during the COVID-19 pandemic. Parents with higher stress and high restrictive behaviors might put their children at risk of mental disorders in the end.

Insomnia symptoms during the early and late stages of the COVID-19 pandemic in China: a systematic review and meta-analysis

BACKGROUND

Evidence suggests that the outbreak of the coronavirus disease 2019 (COVID-19) and the prevention/control measures for COVID-19 may cause insomnia during the acute phase of COVID-19 pandemic in China. However, it is unclear whether insomnia sustains during the later phases of the pandemic.

METHODS

We searched PubMed/Medline, EMBASE, PsycINFO and China National Knowledge Infrastructure from the 27th December 2019 to the 2nd February 2021. As early stage studies on COVID-19 pandemic in China were defined as those conducted prior to April 1st, 2020, while late stage studies were those conducted after April 1st, 2020.

RESULTS

A total of 98 studies with 193,889 participants were included. The pooled prevalence of insomnia symptoms among all populations was 39.1% (95% CI 36.2-42.0%); the pooled prevalence of insomnia symptoms during the early and late stages of COVID-19 in China were 37.0% (95% CI 34.1-39.9%) and 41.8% (95% CI 33.6-50.0%), respectively. Importantly, there was no significant difference regarding the prevalence of insomnia symptoms between the early and late stages of COVID-19. Meta-regression showed that healthcare workers, COVID-19 patients, patients with chronic medical conditions and patients with mental disorders had a higher prevalence of insomnia symptoms compared to the general population. This association remained significant in healthcare workers and patients with chronic medical conditions after adjusting for age, gender, areas of high or low prevalence of COVID-19 cases, anxiety and depression.

CONCLUSIONS

Over one third of our sample present insomnia symptoms during the early stage of COVID-19 pandemic in China. Interestingly, prevalence of insomnia symptoms sustains high during the late stage of the pandemic despite the control of the disease and the amelioration of its adverse effects. Our findings suggest that insomnia symptoms related to COVID-19 appear to persist of over time.

Benefit finding: understanding the impact and public health factors among COVID-19 patients in China

BACKGROUND

This study aimed to determine the level of benefit finding among COVID-19 patients in a hospital in mainland China, and to identify its associated impact and public health factors.

METHODS

Using a cross-sectional design, a total of 288 COVID-19 patients were recruited in Huoshenshan Hospital in Wuhan, China to complete a survey on benefit finding. The level of benefit finding evaluated by the Benefit Finding Scale (BFS), mental resilience evaluated by the Connor-Davidson Resilience Scale (CD-RISC), social support evaluated by the Multidimensional Scale of Perceived Social Support (MSPSS), medical coping modes evaluated by the Medical Coping Modes Questionnaire (MCMQ), and general information was collected by self-designed questionnaires. T-test and chi-square test were used for single-factor analyses. For multiple factor analyses, multivariate regression analyses were performed.

RESULT

The mean BFS score of 288 participants was 61.26±10.25. Multivariate regression analysis showed that the factors associated with the level of benefit finding among COVID-19 patients in China included education level, having experienced major event, social support, optimism, confrontive coping and resigned coping mode.

CONCLUSIONS

In general, the patients with COVID-19 in this study had a middle level of benefit finding. Health professionals should take measures to identify the influencing factors on the quality of the life and take targeted intervention measures.

The relationships among perceived stress, conflict resolution styles, spousal support and marital satisfaction during the COVID-19 quarantine

This study investigated the relationships among perceived stress, conflict resolution styles, spousal support and marital satisfaction of heterosexual married couples during the 2019 Novel Coronavirus (COVID-19) quarantine. This was a descriptive study that employed a correlational survey model. The sample consisted of 511 Turkish married couples recruited using snowball sampling. Data were collected online using a demographic characteristic questionnaire, the Perceived Stress Scale, the Conflict Resolution Styles Scale, the Spousal Support Scale, and the Marital Life Scale. The mean age of participants was 37.00 (SD = 7.88) years. The mean duration of marriage of participants was 11.15 (SD = 8.97) years. Higher marital satisfaction was associated with lower perceived stress, lower negative conflict resolution style, higher spousal support, and higher positive resolution styles. The Conflict Resolution Styles Scale and Spousal Support Scale scores explained 48.3% of the total variance of the Marital Life Scale, indicating that higher positive conflict resolution styles and higher spousal support were significantly associated with higher marital satisfaction. The COVID-19 quarantine has resulted in changes in marital life and family dynamics. Stress, negative conflict resolution style, and a lack of spousal support during the COVID-19 quarantine contribute to marital dissatisfaction.

Two-stage mental health survey of first-line medical staff after ending COVID-19 epidemic assistance and isolation

Facing with COVID-19 epidemic such a catastrophic health emergency, the mental health status of medical staff deserves attention. We conducted a two-stage of psychological status monitoring after the end of the assistance and 14 days of isolation, further targeted the vulnerable groups in need of intervention. The study is a cross-sectional survey on 1156 Yunnan medical staff aid to Hubei. Used Cluster sampling method to collect data at 2 time points (at the end of returning from Wuhan and the 14th day of isolation), from March 18, 2020 to April 6, 2020. Female and nurse had higher rates of depressive symptoms than male and doctors and other occupations. The proportion of female with mild and above moderate anxiety levels (22.91%, 2.61%) was higher than male (17.35%, 1.03%) (p < 0.05). Female had a better impaired sleep quality (45.06%, 17.49%) more than male (28.57%, 7.94%). Medical staff supported in Wuhan and with junior professional titles reported a higher proportion of sleep quality impairment. At the 14th isolation day stage, the proportion of nurses changed from depression to health (9.15%) and from health to depression (6.1%) better than doctors. The front-line medical staffs had suffered greater psychological pressure in the treatment process of major public health emergency. Researches on the dynamic monitor for the change of psychological status after aiding epidemic areas were still in relatively blank stage. Targeting the vulnerable characteristics of aiding medical staff is significant for effective psychological intervention and sustainable operation of health system.

Scientometric Analysis of Public Health Emergencies: 1994-2020

The purpose of this paper is to summarize the research hotspots and frontiers in the field of public health emergencies (PHE) between 1994–2020 through the scientometric analysis method. In total, 2247 literature works retrieved from the Web of Science core database were analyzed by CiteSpace software, and the results were displayed in knowledge mapping. The overall characteristics analysis showed that the number of publications and authors in the field of PHE kept an upward trend during the past decades, and the United States was in the leading position, followed by China and England. Switzerland has the highest central value and plays an important intermediary role in promoting the integration and exchange of international PHE research achievements. The keyword co-occurrence analysis indicated that COVID-19 was the most high-frequency keyword in this field, and there had been no new keywords for a long time until the outbreak of COVID-19 in 2019. The burst detection analysis showed that the top five burst keywords in terms of burst intensity were zika virus, Ebola, United States, emergency preparedness and microcephaly. The results indicated that the research theme of PHE is closely related to the major infectious diseases in a specific period. It will continue to develop with more attention paid to public health. The conclusions can provide help and reference for the PHE potential researchers.

Associations between parent-child relationship, and children's externalizing and internalizing symptoms, and lifestyle behaviors in China during the COVID-19 epidemic

To investigate associations between parent–child relationships, children’s externalizing and internalizing symptoms, and lifestyle responses to the COVID-19 epidemic, we conducted an online survey of a random, representative sample of residents with children aged 3–17 years during mid-March 2020 in Wuhan and Shanghai, China. A total of 1655 parents and children were surveyed with a response rate of 80.1% in the survey. During the epidemic, the frequency of children enquiring about the epidemic (AOR = 1.46, 95% CI: 1.04, 2.06), parents explaining the epidemic to them (AOR = 2.87, 95% CI: 1.80, 4.58), parents expressing negative emotions in front of them (AOR = 2.62; 95% CI = 2.08–3.30), and parents with more irritable attitudes (AOR = 1.93; 95% CI = 1.33–2.81) were significantly associated with children’s externalizing symptoms. For internalizing symptoms, significant associations were found with worse parent–child closeness (AOR = 2.93; 95% CI = 1.80–4.79), the frequency of parents expressing negative emotions in front of them (AOR = 2.64; 95% CI = 1.68, 4.12), and more irritable attitudes (AOR = 2.24; 95% CI = 1.42–3.55). We also found that each indicator of parent–child relationships had the significantly similar associations with children’s lifestyle behaviors. These findings suggest that improving parents’ attitudes towards their children and parent–child closeness during the epidemic, especially among parents with lower educational levels, are important to ensure the wellbeing of children.

The burden & contributing factors of psychological distress across India during the COVID pandemic

The unprecedented COVID-19 pandemic spread rapidly and engulfing the entire world, forcing people to stay home, muting the hustle and bustle of modern world with tide of fear for contracting disease and death. This brutal disease has infected millions of people worldwide, many lost their job, world economies have ravaged and many more uncountable consequences.

OBJECTIVE

To assess the psychological distress due to COVID-19 outbreak and to determine contributing factors towards psychological distress.

METHOD

A cross-sectional survey was conducted between 12th May to 20th June 2020 & 1537 valid responses were received. Modified K10 scale was used to assess psychological distress. Binary logistic regression analysis was used to determine extent of relationship between the contributing factors and psychological distress scale by estimating the odds of having significant stress with P ≤ 0.05.

RESULT

A total of 1537 valid responses were obtained. The overall psychological distress score was 19.79 ± .75 which implies mild psychological distress. Analysis of degree of psychological distress revealed 815 (53.0%) with no psychological distress, 385 (25.0%) mild, 194 (12.6%) moderate and 143 respondents (9.3%) had severe degree of psychological distress. Females psychological distress was 1.448 times as compared to male (CI 0.191-10.986). The odds of having significant psychological distress for above 60 years as compared to 16-30 years. Shop owner & business man had more stress in compared to professionals (OR 1.176, CI 0.058-2.362). As compared to married, the psychological distress was 13.203 times higher among divorcee/separated (0.786-221.787) and 3.629 times higher among unmarried (0.376-35.054).

CONCLUSION

This study showed 39.2% of the subject had psychological distress which is quite high. So, government and other policy makers have to develop strategy to relieve psychological distress among Indian population.

A nationwide evaluation of the prevalence of and risk factors associated with anxiety, depression and insomnia symptoms during the return-to-work period of coronavirus disease 2019 in China

PURPOSE

To evaluate the prevalence of and risk factors associated with anxiety, depression, and insomnia symptoms during the return-to-work period of coronavirus disease 2019 in China.

METHODS

The authors conducted a large-scale, nationwide, multicenter, cross-sectional study in China. A population-based quota and snowball sampling were designed to recruit a representative sample. Online questionnaires and telephone reviews were used to collect characteristics and assess psychological and sleep problems. Anxiety, depression, and insomnia symptoms were measured by the generalized anxiety disorder-7, patient health questionnaire-9, and insomnia severity index tools.

RESULTS

A total of 42,000 participants were recruited from 15 centers, and 36,795 valid questionnaires were received. Generally, 18.3, 14.9, and 17.9% of the participants had anxiety, depression, and insomnia symptoms, respectively, and 2.2-2.7% had severe symptoms. Engaging in outside activity once in ≥ 30 days (OR = 2.719, OR = 2.074, OR = 2.225) and age 50-64 years (OR = 2.431, OR = 1.936, OR = 2.036) were common risk factors for anxiety, depression and insomnia symptoms. Living in Hubei Province (OR = 1.304, OR = 1.242) was a common risk factor for anxiety and insomnia symptoms. Working as frontline medical staff (OR = 2.150) was another risk factor for anxiety symptoms. The health education rate of the samples reached 98.9%. However, the psychological intervention rate was only 16.2%, and 2.5% received targeted interventions.

CONCLUSIONS

An increasing number of people might have psychological and sleep problems. However, the current psychological interventions are not sufficient. Efforts should be made to strengthen interventions for high-risk populations.

Health Literacy and Disparities in Knowledge, Attitude and Practice Regarding COVID-19 Among College Students During the COVID-19 Outbreak in China: A Cross-Sectional Study

Purpose

This study aimed to assess the knowledge, attitude and practice (KAP) towards COVID-19 of Chinese college students during the COVID-19 outbreak and identify the determinants considerably associated with KAP.

Methods

An online cross-sectional questionnaire survey was conducted in February 2020 in China to recruit participants on the Wen-Juan-Xing online platform. A self-made questionnaire was used to assess the KAP towards COVID-19.

Results

The average scores of COVID-19-related KAP among college students were 32.16 ± 4.09, 16.84 ± 3.18 and 15.36 ± 1.83, respectively. The average correct response rate of COVID-19-related knowledge was 84.62%. 94.59% of the respondents believed China could control and conquer the pandemic; 98.92% of the respondents wore a mask when they went out. The multiple linear regression showed that the female students had higher scores of COVID-19-related knowledge than male students (β = 0.79, P = 0.01), and the students from 985 or 211 universities (β = -2.22, P < 0.01) were significantly associated with higher knowledge scores. Furthermore, a significantly positive correlation was found between the scores of COVID-19-related KAP among students.

Conclusion

The college students had a good KAP towards the COVID-19 pandemic. The present study was able to access the COVID-19-related KAP among college students during the pandemic and identify their weaknesses in pandemic prevention. Consequently, the results of this study provide theoretical basis for implementing precision health education among college students and reference for campuses to conduct scientific prevention and control during a pandemic. Results also provide beneficial experience to curb similar major public health emergencies in the future.

Analysis of Psychological Trends and Policy Recommendations of Medical Staff in Northern China in the Latter Stages of the COVID-19 Pandemic

Aim: Since the 2019 coronavirus disease (COVID-19) outbreak, medical staff have faced greater psychological stress and are prone to psychological problems such as anxiety and depression, as confirmed by several studies. This study further clarifies the psychological status of Chinese medical staff during the stable phase of the pandemic through a cross-sectional investigation in a large population sample in northern China.

Methods: Subjects: Clinical frontline medical staff from seven hospitals in Liaoning Province were recruited from November 2020 to February 2021.

Research Tools: The research tools used were the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Simplified Coping Style Questionnaire (SCSQ), and General Status Questionnaire.

Statistical Analysis: SPSS 22.0, ANOVA variance analysis, and multiple logistics regression were used for statistical analysis. P-values of <0.05 indicated significant statistical differences.

Results: A total of 3,144 medical staff completed the survey (599 men [19.1%] and 2,545 women [80.9%]; 1,020 doctors [32.4%] and 2,124 nurses [67.6%]). Among all subjects, the rates of anxiety and depression were 21.1% (663/3, 144) and 43.9% (1,381/3,144), respectively. Multiple logistic comparative analysis revealed that age (OR = 1.272, 95% CI = 1.036–1.561, P = 0.022), the need for psychological counseling (OR = 1.566, 95% CI = 1.339–1.830, P < 0.001), and the coexistence of depression (OR = 0.050, 95% CI = 0.038–0.066, P < 0.001) were significantly associated with anxiety. Coexisting anxiety was also associated with the occurrence of depression (OR = 0.050, 95% CI = 0.038–0.065, P < 0.001).

Conclusions: In the later stages of the pandemic in China, the occurrence rates of anxiety and depression among medical staff remain high. In addition to age, there is little correlation between anxiety or depression and general factors such as gender and profession. As a special group, medical staff show different psychological changes at various times during a stressful event. Concerning for the psychological needs of medical staff and different psychologically oriented policy implementation are needed.

Social Isolation and Anxiety Disorder During the COVID-19 Pandemic and Lockdown in China

The COVID-19 pandemic and lockdown measures have had a profound impact on the emotions, anxiety, and mental health of affected communities. Despite this, there is a lack of knowledge about the possible generational and geographical differences in the effects on the mental health of individuals. This study examines the impact of COVID-19 related quarantine on symptoms of generalized anxiety disorders (GAD) among parents and children (N = 4503). It also compares the outcomes of residents from the initial COVID-19 epicenter of Wuhan to those in surrounding areas. Subgroup analyses were conducted by child and parent samples, and by Wuhan city and other cities in the Hubei province. Propensity score radius matching and ordinary least squares regressions were used to examine the relationship between quarantine and GAD symptoms. Results showed that quarantine had more psychological impact on parents than children, regardless of geographic location. Parents that experienced quarantine in Wuhan city, reported a significantly higher level of symptoms of GAD than those that did not. Parents from other cities showed no such difference. For both children and parents, interpersonal communication about COVID-19 and social media exposure to pandemic-related information were linked to GAD symptoms. Targeted policies and interventions are needed to address the psychological impacts of COVID-19 lockdown.

Domestic violence and psychological problems in married women during COVID-19 pandemic and lockdown: A community-based survey

BACKGROUND

Following the declaration of Coronavirus disease-2019 as a pandemic, a nation-wide lockdown was announced in India. This led to increase in psychological problems, especially in women.

OBJECTIVES

To assess the prevalence of psychological problems and domestic violence (DV) in married women during the pandemic and lockdown in a panchayat in Southern India and to study the association of socio-demographic and clinical variables with psychological problems.

MATERIALS AND METHODS

A cross-sectional study was undertaken in 209 married women of 18-55 years residing in a village panchayat of northern Kerala, India. Socio-demographic variables and clinical variables, like depressive symptoms, anxiety symptoms, perceived stress and DV, among others, were evaluated. The participants were interviewed by trained community health workers in the post-lockdown period.

RESULTS

The prevalence of depressive symptoms was found to be 10.0 %, anxiety symptoms 7.2 % and perceived stress 66.0 %. Severe DV was reported by 6.2 %; but at least one form of DV was experienced by 25.8 % of the women. Significant positive correlation was observed for DV with depression and anxiety. DV was also found to be a significant predictor of depression (adjusted OR [aOR] = 4.26, P = 0.006) and anxiety (aOR=4.34, P=0.02). Being a homemaker (aOR=4.51, P = 0.03) and having past history of mental illness (aOR=5.39, P = 0.03) were also found to increase the risk for depression significantly.

CONCLUSION

There is a high prevalence of psychological problems in married women during the pandemic and lockdown. DV was found to be a significant predictor of depression and anxiety in this population.

A longitudinal study on psychological burden of medical students during COVID-19 outbreak and remission period in China

BACKGROUND AND OBJECTIVES

Due to their professional characteristics and future career orientation, medical students have a deeper understanding of COVID-19 and enact disease prevention and control measures, which may cause psychological burden. We aimed to assess the psychological impact during the COVID-19 outbreak period(OP) and remission period(RP) among medical students.

METHODS

We surveyed the medical students in Shantou University Medical College twice-during the OP and the RP, surveying psychological burden of COVID-19 lockdowns and its associated factors. 1069 respondents were recruited in OP and 1511 participants were recruited in RP. We constructed nomograms to predict the risk of psychological burden using risk factors that were screened through univariate analysis of the surveyed data set.

RESULTS

There was a statistically significant longitudinal increment in psychological burden from OP to RP, and stress as well as cognition in psychological distress were the most dominant ones. Common impact factors of the depression, anxiety and stress included frequency of outdoor activities, mask-wearing adherence, self-perceived unhealthy status and exposure to COVID-19. In addition, the high frequency of handwashing was a protective factor for depression and anxiety. The C-index was 0.67, 0.74 and 0.72 for depression, anxiety and stress, respectively.

CONCLUSION

The psychological impact of COVID-19 was worse during the RP than during the OP. Thus, it's necessary to continue to emphasize the importance of mental health in medical students during the pandemic and our proposed nomograms can be useful tools for screening high-risk groups for psychological burden risk in medical students.

Substance and Internet use during the COVID-19 pandemic in China

The coronavirus disease 2019 (COVID-19) has adversely influenced human physical and mental health, including emotional disorders and addictions. This study examined substance and Internet use behavior and their associations with anxiety and depression during the COVID-19 pandemic. An online self-report questionnaire was administered to 2196 Chinese adults between February 17 and 29, 2020. The questionnaire contained the seven-item Generalized Anxiety Disorder Scale (GAD-7) and Patient Health Questionnaire (PHQ-9), questions on demographic information, and items about substance and Internet use characteristics. Our results revealed that males consumed less alcohol (p < 0.001) and areca-nut (p = 0.012) during the pandemic than before the pandemic. Age, gender, education status, and occupation significantly differed among increased substance users, regular substance users, and nonsubstance users. Time spent on the Internet was significantly longer during the pandemic (p < 0.001) and 72% of participants reported increased dependence on the Internet. Compared to regular Internet users, increased users were more likely to be younger and female. Multiple logistic regression analysis revealed that age <33 years (OR = 2.034, p < 0.001), increased substance use (OR = 3.439, p < 0.001), and increased Internet use (OR = 1.914, p < 0.001) were significantly associated with depression. Moreover, anxiety was significantly related to female gender (OR = 2.065, p < 0.001), "unmarried" status (OR = 1.480, p = 0.017), nonstudents (OR = 1.946-3.030, p = 0.001), and increased substance use (OR = 4.291, p < 0.001). Although there was a significant decrease in social substance use during the pandemic, more attention should be paid to increased Internet use. Increased Internet use was significantly associated with both anxiety and depression, and increased substance use was related to depression. Professional support should be provided to vulnerable individuals to prevent addiction.

Adolescent psychopathological profiles and the outcome of the COVID-19 pandemic: Longitudinal findings from the UK Millennium Cohort Study

BACKGROUND

Public health measures to contain the spread of COVID-19 have resulted in adverse effects, including high level of psychological distress, anxiety, and depression.

AIMS

This study explored adolescent psychopathological profiles at age 17, and their role in predicting the impact of the COVID-19 pandemic at age 19.

METHODS

The analyses used a sample of 904 participants (mean age = 19.17 years) from the Millennium Cohort Study (MCS) sweep 7 who completed the mental health questions from January 2018 to March 2019 (mean age = 17.18 years) and the COVID-19 Survey in May 2020. Adolescent psychopathological profiles were identified by means of latent class analysis.

RESULTS

Four psychopathological profiles were identified: "low-symptom class" (60.17% of participants), "high-symptom class" (23.01% of participants), "substance/behavioural addictions class" (12.03% of participants), and "emotion-dysregulation class" (4.79% of participants). Adolescents in the high-symptom and emotional-dysregulation classes had the worst outcome during the lockdown. Specifically, they experienced more stress, conflict and loneliness, and lower levels of perceived social support than adolescents in the other psychopathological classes. Adolescents in the emotional-dysregulation class also consumed more alcohol and had worse financial situation during the lockdown compared to pre- lockdown period.

CONCLUSION

Adolescent psychopathological profiles predicted mental health impacts of the COVID-19 outbreak.

Needs, gaps and opportunities for standard and e-mental health care among at-risk populations in the Asia Pacific in the context of COVID-19: a rapid scoping review

BACKGROUND

The COVID-19 pandemic is expected to have profound mental health impact, including in the Asia Pacific Economic Cooperation (APEC) region. Some populations might be at higher risk of experiencing negative mental health impacts and may encounter increased barriers to accessing mental health care. The pandemic and related restrictions have led to changes in care delivery, including a rapid shift to the use of e-mental health and digital technologies. It is therefore essential to consider needs and opportunities for equitable mental health care delivery to the most at-risk populations. This rapid scoping review: 1) identifies populations in the APEC region that are at higher risk of the negative mental health impacts of COVID-19, 2) identifies needs and gaps in access to standard and e-mental health care among these populations, and 3) explores the potential of e-mental health to address these needs.

METHODS

We conducted a rapid scoping review following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). We searched Medline, Embase and PsychInfo databases and Google Scholar using a search strategy developed in consultation with a biomedical librarian. We included records related to mental health or psychosocial risk factors and COVID-19 among at-risk groups; that referred to one or more APEC member economies or had a global, thus generalizable, scope; English language papers, and papers with full text available.

RESULTS

A total of 132 records published between December 2019 and August 2020 were included in the final analysis. Several priority at-risk populations, risk factors, challenges and recommendations for standard and e-mental health care were identified. Results demonstrate that e-mental health care can be a viable option for care delivery but that specific accessibility and acceptability considerations must be considered. Options for in-person, hybrid or "low-tech" care must also remain available.

CONCLUSIONS

The COVID-19 pandemic has highlighted the urgent need for equitable standard and e-mental health care. It has also highlighted the persistent social and structural inequities that contribute to poor mental health. The APEC region is vast and diverse; findings from the region can guide policy and practice in the delivery of equitable mental health care in the region and beyond.

Age-related differences in the perception of COVID-19 emergency during the Italian outbreak

Older adults have been identified as a high-risk population for COVID-19, therefore it is crucial to understand how they perceived and reacted to the emergency. We examined age-related differences in emotions, cognitive attitudes, and behavioral responses to the COVID-19 crisis. Based on the Socioemotional Selectivity Theory, we expected to find a positive approach in older adults, which may translate into lower compliance with restrictive measures.Methods: We analyzed data (n = 306) from a nation-wide online survey conducted between April 1st and April 16th, 2020. We compared young (18-29 years), middle-aged (30-50 years), and older (65-85 years) adults' self-reported emotions, attitudes toward the emergency, and compliance with governmental rules.Results: Older adults showed lower negative emotions than young and middle-aged adults. Also, older adults were more confident about COVID-related information received, more favorable toward the restrictive measures, and perceived lower underestimation of the emergency compared to the other age groups. However, older people anticipated a longer time for the emergency to resolve. No age-related differences in compliance with the rules emerged.Conclusion: Older people showed a positive attitude toward the emergency. This attitude was confined in the here and now and did not extend to expectations for the future. Compliance with rules was high across our sample. However, less compliant individuals were also less confident in COVID-related information received by the media and official sources, suggesting the importance of providing precise and reliable information to promote adherence to restrictive measures.

The Change of Public Individual Prevention Practice and Psychological Effect From the Early Outbreak Stage to the Controlled Stage of COVID-19 in China in 2020: Two Cross-Sectional Studies

Background

COVID-19 broke out in China and spread rapidly in January and February 2020. Following the prevention and control measures of the Chinese government, the outbreak was gradually brought under control after March. The changes in people’s attention to the epidemic, individual prevention practice and psychological effect from the early outbreak stage to the under controlled stage need to be evaluated.

Methods

Two cross-sectional, population-based online surveys were conducted from January 28 to February 1, 2020 and from February1 to March 18, 2020. Socio-demographic information and individual protective practice were collected and the State-Trait Anxiety Inventory (STAI) was used for measuring anxiety. The range of STAI score was 5–25, and the higher the score, the more anxious it was. The respondents of the two surveys were matched on a one-to-one basis according to their province, gender, age, education, and marriage. Wilcoxon signed ranks test and Mann-Whitney U test were used to compare STAI score changes in two stages and in different demographic characteristics.

Results

We included 9,764 individuals in the first survey and 1,669 in the second survey, covering 30 provincial administrative regions in Mainland China. COVID-19 has affected almost every aspect of people’s normal life, especially lifestyle. The proportion of people who paid attention to it every day had dropped from 97.6 to 88.9%. We identified that vast majority people wore masks when they went out. The proportion has declined from 96.5 to 92.4% for hand hygiene and from 98.4 to 95.3% for not attending parties. People’s anxiety (STAI score) across the country has decreased from a median of 19 in the early outbreak stage to a median of 12, including people with all demographic characteristics, but some have increased in 16 provinces.

Conclusion

People’s attention to information about the epidemic has declined slightly, but a high proportion of people maintained good practices such as wearing masks, hand hygiene, and not attending parties. People’s anxiety had generally declined from the early outbreak stage to the under controlled stage, but it was still at a high level.

Automated detection of Covid-19 disease using deep fused features from chest radiography images

The health systems of many countries are desperate in the face of Covid-19, which has become a pandemic worldwide and caused the death of hundreds of thousands of people. In order to keep Covid-19, which has a very high propagation rate, under control, it is necessary to develop faster, low-cost and highly accurate methods, rather than a costly Polymerase Chain Reaction test that can yield results in a few hours. In this study, a deep learning-based approach that can detect Covid-19 quickly and with high accuracy on X-ray images, which are common in every hospital and can be obtained at low cost, was proposed. Deep features were extracted from X-Ray images in RGB, CIE Lab and RGB CIE color spaces using DenseNet121 and EfficientNet B0 pre-trained deep learning architectures and then obtained features were fed into a two-stage classifier approach. Each of the classifiers in the proposed approach performed binary classification. In the first stage, healthy and infected samples were separated, and in the second stage, infected samples were detected as Covid-19 or pneumonia. In the experiments, Bi-LSTM network and well-known ensemble approaches such as Gradient Boosting, Random Forest and Extreme Gradient Boosting were used as the classifier model and it was seen that the Bi-LSTM network had a superior performance than other classifiers with 92.489% accuracy.

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

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

The Psychological Status of General Population in Hubei Province During the COVID-19 Outbreak: A Cross-Sectional Survey Study

Introduction: The current outbreak of the novel coronavirus disease 2019 (COVID-19), originating from Wuhan (Hubei, China), has rapidly spread across China and several other countries. During the outbreak of COVID-19, mental health of the general population in Hubei province may be affected. This study aimed to assess the psychological status and associated risk factors of the general population in Hubei province during the COVID-19 outbreak.

Methods: A cross-sectional online survey was used to evaluate the symptoms of posttraumatic stress disorder (PTSD), depression, and anxiety, which were assessed by the Chinese version of the Impact of Event Scale—Revised, the Patient Health Questionnaire 9, and the seven-item Generalized Anxiety Disorder Scale, respectively. Coping style was assessed by the Simplified Coping Style Questionnaire. Multivariate logistic regression analysis was carried out to detect factors associated with mental health outcomes.

Results: Among 9,225 participants, 44.5% rated symptoms of PTSD, and 17.9 and 12.7% suffered from moderate and severe symptoms of depression and anxiety, respectively. Individuals who were geographically located in Wuhan and familiar with someone who has COVID-19 had more severe symptoms of PTSD, depression, and anxiety, as well as a higher score in passive coping style (P < 0.05). Multivariate logistic regression analysis showed that people who were geographically located in Wuhan [odds ratio (OR) = 1.25, 95% confidence interval (CI) = 1.14–1.36, P < 0.001] were associated with severe symptoms of PTSD. Besides, individuals who were familiar with someone who had COVID-19 (OR = 2.33, 95% CI = 2.07–2.63, P < 0.001; OR = 1.90, 95% CI = 1.66–2.17, P < 0.001; OR = 2.06, 95% CI = 1.78–2.39, P < 0.001) and had a higher score in passive coping style (OR = 1.16, 95% CI = 1.14–1.17, P < 0.001; OR = 1.17, 95% CI = 1.15–1.19, P < 0.001; OR = 1.17, 95% CI = 1.15–1.19, P < 0.001) were associated with severe symptoms of PTSD, depression, and anxiety. Moreover, a higher score in active coping style (OR = 0.96, 95% CI = 0.95–0.97, P < 0.001; OR = 0.94, 95% CI = 0.93–0.94, P < 0.001; OR = 0.95, 95% CI = 0.94–0.96, P < 0.001) was associated with a lower risk of symptoms of PTSD, depression, and anxiety.

Conclusions: During the midphase of COVID-19 outbreak, quite a few people have mental health problems; nearly half of the respondents rated symptoms of PTSD, and approximately one-fifth reported moderate to severe symptoms of anxiety and depression. Our findings may lead to better comprehend the psychological status of the general public and alleviate the public mental health crisis during the COVID-19 outbreak.

Pathways Improving Compliance with Preventive Behaviors during the Remission Period of the COVID-19 Pandemic

The COVID-19 pandemic poses a significant threat to people's lives. Compliance with preventive behaviors, recommended by public health authorities, is essential for infection control. In the remission stage, one year after the initial COVID-19 outbreak in China, we advanced a moderated parallel mediation model of the link between risk perception and compliance with preventive behaviors as well as a serial mediation model of the link between optimism and compliance with preventive behaviors, explaining the roles of various psychosocial factors in these associations. In January 2021, 200 participants under 50 years of age, located in 80 Chinese cities, participated in an online survey assessing risk perception, compliance with preventive behaviors, fear, anxiety, political trust, government dependency, and dispositional optimism. The results showed that the effect of risk perception on compliance with preventive behaviors was mediated by political trust and fear, and was moderated by government dependency. Anxiety and fear serially mediated the effect of optimism on compliance with preventive behaviors. Our study provided implications for future research to reduce negative emotions, strengthen confidence in the government, and sustain moderate government dependency accompanied by individual self-efficacy.

Covid-19 pandemic and lockdown impacts: A description in a longitudinal study of bipolar disorder

OBJECTIVES

To investigate the impact of the SAR-Cov-2 pandemic and lockdown on individuals with bipolar disorder in comparison to healthy controls.

METHODS

A longitudinal study of 560 participants including 147 healthy controls was conducted between April 30 and May 30, 2020 during a state-wide lockdown. Bi-weekly measures included the Coronavirus Impact Scale, the Pittsburg Sleep Quality Index, the Patient Health Questionnaire, 9-item, and the Generalized Anxiety Disorder scale, 7-item. Generalized estimating equations method was used to examine the longitudinal change of the measures within the lockdown and the change from pre-pandemic period to pandemic period.

RESULTS

All participants reported an impact of lockdown. Individuals with bipolar disorder reported greater impact from the stay-at-home orders with disruptions in routines, income/employment, social support and pandemic related stress. While these measures improved over time, healthy controls recovered quicker and with greater magnitude than persons with bipolar disorder. Comparing mood symptom severity measures in mid-March through May 2020 to the same time window in 2015-2019 (pre- verses post-pandemic), there were no significant differences among individuals with bipolar disorder, whereas healthy controls showed a significant, albeit transient, increase in mood symptoms.

CONCLUSION

Everyone was impacted by the SARs-CoV pandemic; however, those with bipolar disorder experienced more life impacting changes from the stay-at-home orders vs healthy controls. These disruptions improved over time but much more slowly than healthy controls. Pre- vs post-pandemic comparisons show a modest but significant increase in mood severity in the healthy controls which was not observed in those with bipolar disorder.

COVID-19 and Personality: A Cross-Sectional Multicenter Study of the Relationship Between Personality Factors and COVID-19-Related Impacts, Concerns, and Behaviors

Background: This cross-sectional observational study aimed to evaluate coronavirus disease 2019 (COVID-19)-related precautions to avoid COVID-19 infection, distress and behavioral changes, fears and concerns, and effects on opinions and beliefs among participants from different backgrounds and also to identify the relationships between personality factors and COVID-19-related changes and impacts. Methods: One thousand and three hundred nineteen participants (744 females and 575 males, mean age ± SD = 32.7 ± 11.6 years) completed a three-section survey collecting data regarding demographic information, personality factors [using the NEO Five-Factor Inventory (NEO-FFI)], and COVID-19-related issues (using the VAS scale). Findings: COVID-19 was associated with changes related to precautions to avoid COVID-19 infection, distress and behavioral changes, fears and concerns, and effects on opinions and beliefs (P < 0.05). Higher neuroticism scores were associated with more negative COVID-19-related changes and impacts (P < 0.05). Higher extraversion, agreeableness, and conscientiousness scores were associated with more acceptance of COVID-19 containment measures as well as less COVID-19-related changes and impacts (P < 0.05). Conclusions: Personality factors were associated with COVID-19-related impacts. These findings demonstrate the importance of the relationship between personality factors and COVID-19-related changes.

Knowledge-attitude-practice and psychological status of college students during the early stage of COVID-19 outbreak in China: a cross-sectional study

OBJECTIVES

This study aimed to investigate the knowledge-attitude-practice (KAP) of Chinese college students regarding COVID-19 and evaluate their psychological status against the background of the COVID-19 outbreak.

DESIGN

This was a cross-sectional study.

SETTING

This study covered 31 provinces, municipalities and autonomous regions of mainland China.

PARTICIPANTS

The participants, who were college students with ordinary full-time status, were surveyed anonymously on their KAP regarding COVID-19 by using self-made questionnaires. In addition, the Self-Rating Anxiety Scale was used to assess the psychological status of the students.

METHODS

The online cross-sectional study among Chinese college students was conducted in February 2020. Logistic regression analysis was used to analyse the predictors of anxiety symptoms.

PRIMARY OUTCOME MEASURES

The level of KAP and anxiety symptoms.

RESULTS

A total of 740 college students from 31 provinces, municipalities and autonomous regions in China were recruited in the survey. Among them, 139 (18.78%) revealed having anxiety. Multivariable logistic regression analysis revealed that female gender was the risk factor for anxiety symptoms with an increased 2.164-fold risk than male gender (OR=2.164, 95% CI=1.279 to 3.662). The knowledge (OR=0.825, 95% CI=0.779 to 0.873) and attitude (OR=0.822, 95% CI=0.762 to 0.887) regarding COVID-19 were protective factors against anxiety symptoms.

CONCLUSIONS

The level of KAP regarding COVID-19 was significantly negatively correlated with anxiety symptoms. Thus, understanding the level of KAP among college students during the early stages of major public health emergencies, such as a pandemic, is important. Such understanding plays an important role in adopting targeted health education strategies and reducing the psychological damage caused by these emergencies.

Depression, risk factors, and coping strategies in the context of social dislocations resulting from the second wave of COVID-19 in Japan

BACKGROUND

Social dislocations resulting from coronavirus disease 2019 (COVID-19) pandemic have been prolonged, which has led to general population social suppression. The present study aimed to reveal risk factors associated with mental health problems and suggest concrete coping strategies in the context of COVID-19.

METHODS

A web-based survey was conducted in July when Japan was experiencing a second wave of COVID-19. Demographics, Patient Health Questionnaire-9 (PHQ-9), state anger, anger control, and the Brief Coping Orientation to Problems Experienced were measured. Multivariate logistic regression analysis on PHQ-9 scores by set variables was conducted.

RESULTS

The participants were 2708 individuals, and 18.35% of them were depressed. Logistic regression analysis showed that in the order of odds ratios (ORs), underlying disease (OR = 1.96, 95% confidence interval (CI) = 1.32-2.92), not working (OR = 1.85, CI = 1.22-2.80), negative economic impact (OR = 1.33, CI = 1.01-1.77), state anger (OR = 1.17, CI = 1.14-1.21), anger control (OR = 1.08, CI = 1.04-1.13), age (OR = 0.97, CI = 0.96-0.98), high income (OR = 0.45, CI = 0.25-0.80), and being married (OR = 0.53, CI = 0.38-0.74) were predictors of depressive symptoms. Regarding coping strategies, planning (OR = 0.84, CI = 0.74-0.94), use of instrumental support (OR = 0.85, CI = 0.76-0.95), denial (OR = 0.88, CI = 0.77-0.99), behavioural disengagement (OR = 1.28, CI = 1.13-1.44), and self-blame (OR = 1.47, CI = 1.31-1.65) were associated with probable depression.

CONCLUSIONS

During prolonged psychological distress caused by COVID-19 pandemic, the prevalence of depressive symptoms in Japan was two to nine times as high as before the COVID-19 pandemic, even though Japan was not a lockdown country. Although some coping strategies were useful for maintaining mental health, such as developing ways, alone or with others, to address or avoid social dislocations, the influence of demographics was more powerful than these coping strategies, and medical treatments are needed for high-risk individuals.

COVID-19 and mental health in Brazil: Psychiatric symptoms in the general population

Public health interventions at general population level are imperative in order to decrease the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but they may contribute to widespread emotional distress and increased risk for psychiatric illnesses. We report on the results of an investigation into the occurrence and determinants of psychiatric symptoms among the Brazilian general population (N = 1996). We assessed sociodemographic variables and general mental health (DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure), depression (PROMIS depression v.8a), anxiety (PROMIS anxiety v.8a), and post-traumatic stress symptoms (Impact of Event Scale-IES-R scale) using an online web-based survey. Anxiety (81.9%), depression (68%), anger (64.5%), somatic symptoms (62.6%) and sleep problems (55.3%) were the most common psychiatric symptoms. Younger age, female gender, low income, lower level of education, longer period of social distancing, and self-reported history of previous psychiatric illness were strongly associated with higher severity of symptoms. Our results support the negative impact of the COVID-19 pandemic on the mental health of the Brazilian population. The high prevalence of psychiatric symptoms observed in our sample indicates that the mental health impact of the COVID-19 pandemic should be considered a public health problem in Brazil. The health systems and individual clinicians must be prepared to offer and implement specific interventions in order to identify and treat psychiatric issues.

Factors associated with psychological distress during the coronavirus disease 2019 (COVID-19) pandemic on the predominantly general population: A systematic review and meta-analysis

BACKGROUND

The Coronavirus Disease 2019 (COVID-19) outbreak has escalated the burden of psychological distress. We aimed to evaluate factors associated with psychological distress among the predominantly general population during the COVID-19 pandemic.

METHODS

We searched PubMed, EMBASE, Scopus, Cochrane Library, PsycINFO, and World Health Organization COVID-19 databases (Dec 2019-15 July 2020). We included cross-sectional studies that reported factors associated with psychological distress during the COVID-19 pandemic. Primary outcomes were self-reported symptoms of anxiety and depression. Random-effects models were used to pool odds ratios (OR) and 95% confidence intervals (CI). The protocol was registered in PROSPERO (#CRD42020186735).

FINDINGS

We included 68 studies comprising 288,830 participants from 19 countries. The prevalence of anxiety and depression was 33% (95% CI: 28%-39%) and 30% (26%-36%). Women versus men (OR: 1.48 [95% CI: 1.29-1.71; I2 = 90.8%]), younger versus older (< versus ≥35 years) adults (1.20 [1.13-1.26]; I2 = 91.7%), living in rural versus urban areas (1.13 [1.00-1.29]; I2 = 82.9%), lower versus higher socioeconomic status (e.g. lower versus higher income: 1.45 [1.24-1.69; I2 = 82.3%]) were associated with higher anxiety odds. These factors (except for residential area) were also associated with higher depression odds. Furthermore, higher COVID-19 infection risk (suspected/confirmed cases, living in hard-hit areas, having pre-existing physical or mental conditions) and longer media exposure were associated with higher odds of anxiety and depression.

INTERPRETATION

One in three adults in the predominantly general population have COVID-19 related psychological distress. Concerted efforts are urgently needed for interventions in high-risk populations to reduce urban-rural, socioeconomic and gender disparities in COVID-19 related psychological distress.

Psychological distress and sleep problems when people are under interpersonal isolation during an epidemic: A nationwide multicenter cross-sectional study

BACKGROUND.

During the outbreak of coronavirus disease 2019 (COVID-19), people are under the dual pressure of interpersonal isolation and concerns about infection. An evaluation of people's psychological status and risk factors is needed to conduct target interventions.

METHODS.

This was a nationwide, multicenter, cross-sectional study using quota and snowball sampling methods during the COVID-19 epidemic in China. Participants' characteristics and experiences were obtained by an online questionnaire and telephone review. Psychological distress and sleep problems were measured by the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, and the Insomnia Severity Index.

RESULTS.

A total of 23,500 participants were recruited, and 19,372 valid questionnaires were received from 11 centers. Overall, 11.0-13.3% of the participants had anxiety, depression, or insomnia symptoms, and 1.9-2.7% had severe symptoms. The prevalence of psychological and sleep problems has increased. Working as frontline medical staff (Odds Ratio OR = 3.406), living in Hubei Province (OR = 2.237), close contacts with COVID-19 (OR = 1.808), and age 35-49 years (OR = 1.310) were risk factors for anxiety symptoms; no outside activity for 2 weeks (OR = 2.167) and age 35-49 years (OR = 1.198) were risk factors for depression symptoms; and living in Hubei Province (OR = 2.376), no outside activity for 2 weeks (OR = 1.927), and age 35-49 years (OR = 1.262) were risk factors for insomnia symptoms. Only 1.9% of participants received counseling during the epidemic.

CONCLUSIONS.

Psychological and sleep problems increased during interpersonal isolation due to COVID-19. Current psychological interventions are far from sufficient.