The enemy who sealed the world: effects quarantine due to the COVID-19 on sleep quality, anxiety, and psychological distress in the Italian population

Trajectories of sleep disturbance and self-management of chronic conditions during COVID-19 among middle-aged and older adults

The COVID-19 pandemic has had a widespread impact on sleep quality, yet little is known about the prevalence of sleep disturbance and its impact on self-management of chronic conditions during the ongoing pandemic. To evaluate trajectories of sleep disturbance and their associations with one's capacity to self-manage chronic conditions. A longitudinal cohort study linked to 3 active clinical trials and 2 cohort studies with 5 time points of sleep data collection (July 15, 2020-May 23, 2022). Adults living with chronic conditions who completed sleep questionnaires for two or more time points. Trajectories of self-reported sleep disturbance across 5 time points. Three self-reported measures of self-management capacity, including subjective cognitive decline, medication adherence, and self-efficacy for managing chronic disease. Five hundred and forty-nine adults aged 23 to 91 years were included in the analysis. Two-thirds had 3 or more chronic conditions; 42.4% of participants followed a trajectory of moderate or high likelihood of persistent sleep disturbance across the study period. Moderate or high likelihood of sleep disturbance was associated with age < 60 (RR 1.57, 95% CI 1.09, 2.26, P = 0.016), persistent stress (RR 1.54, 95% CI 1.16, 2.06, P = 0.003), poorer physical function (RR 1.57, 95% CI 1.17, 2.13, P = 0.003), greater anxiety (RR 1.40, 95% CI 1.04, 1.87, P = 0.03) and depression (RR 1.63, 95% CI 1.20, 2.22, P = 0.002). Moderate or high likelihood of sleep disturbance was also independently associated with subjective cognitive decline, poorer medication adherence, and worse self-efficacy for managing chronic diseases (all P < 0.001). Persistent sleep disturbance during the pandemic may be an important risk factor for inadequate chronic disease self-management and potentially poor health outcomes in adults living with chronic conditions. Public health and health system strategies might consider monitoring sleep quality in adults with chronic conditions to optimize health outcomes.

Pediatric SARS-CoV-2 infection and development of anxiety and depression

Objective

It remains unclear whether emerging mental health concerns in children infected with SARS-CoV-2 are a direct result of the infection or due to the indirect effects of the pandemic. Therefore, we sought to assess the frequency of new diagnoses of anxiety and/or depression among children diagnosed with and without SARS-CoV-2 infection who were tested in pediatric emergency departments.

Methods

A prospective cohort study with 6- and 12-month follow-ups was conducted across 14 Canadian tertiary-care pediatric emergency departments of the Pediatric Emergency Research Canada (PERC) network. The study included children aged <18 years who were tested for SARS-CoV-2 infection between August 2020 and February 2022. The primary outcome was the diagnosis of anxiety and/or depression reported during follow-up. The surveys incorporated a modified version of the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) Long-COVID Pediatric Questionnaire.

Results

Among the participants who were eligible for 6- and 12-month follow-ups, 64.7% (268/414) of SARS-CoV-2-positive and 71.9% (743/1,033) of SARS-CoV-2-negative participants completed follow-up at these time points, respectively. The median age was 7.0 [inter-quartile range (IQR): 5.0-11.0] years, and 54.2% (548/1,011) were male. New diagnoses of anxiety and/or depression reported on either survey did not differ significantly between test-positive (4.1%, 11/268) and test-negative (2.8%; 21/743) participants [difference = 1.3% (95% CI: -1.3 to 4.2)]. There was a higher prevalence of new diagnoses of anxiety and/or depression among SARS-CoV-2-negative participants aged ≥12 years relative to those aged <12 years [8.7% (13/149) vs. 1.3% (8/594); difference = 7.4%; 95% CI of the difference = 3.0-12.5], but not among SARS-CoV-2-positive participants [4.4% (2/45) vs. 4.0% (9/223); difference = 0.4%; 95% CI of the difference = -5.6 to 9.4]. At 6 or 12 months, SARS-CoV-2-positive participants were more likely to experience confusion and/or lack of concentration, abdominal pain, and insomnia.

Conclusions

Although no association was found between SARS-CoV-2 infection and new diagnoses of anxiety and/or depression, SARS-CoV-2-positive participants were more likely to experience confusion/lack of concentration, abdominal pain, and insomnia. This finding, in the context of an increased prevalence of new diagnoses of anxiety and depression, underscores the impacts of societal changes on the mental health of children. Our finding that some non-specific symptoms were more frequently reported by SARS-CoV-2-positive participants emphasizes the need for further investigation of the underlying pathophysiologic mechanisms.

Psychological Help-Seeking Among College Students: Applying the Multi-Theory Model of Health Behavior Change in Assessing Telehealth Use for Psychological Help-Seeking

Background

Due to the deleterious effects on psychological health and wellbeing spurred by the pandemic, utilization of telehealth-based care increased over the past few years. The rapid transition from in-person to telehealth-based health service delivery has yet to be fully understood. The aim of the current study was to examine telehealth use for psychological help-seeking among college students using the Multi-theory Model of health behavior change (MTM) as a theoretical framework.

Methods

A cross-sectional and survey-based study was conducted among students at a large US university (N = 356). Valid and reliable scales were used to measure domains of psychological distress and MTM constructs. Participants were grouped based on past 12-month utilization of telehealth for any mental, emotional, or substance use problems.

Results

Roughly 67% of the sample reported that they needed help dealing with psychological distress, and 56.1%,43.3%, and 38.7% screened positive for anxiety, depression, and suicidal ideation, respectively. Depression, anxiety, and suicidal ideation were positively associated with past 12-month telehealth-based help-seeking. Past 12-month telehealth users reported greater advantages, confidence, and emotion direction toward telehealth-based psychological help-seeking than their counterparts. Participants also perceived higher exhibition of behavioral skills and greater social support to aid help-seeking than their counterparts. Advantages and disadvantages as well as behavioral confidence predicted intentions for telehealth-based help-seeking after controlling for anxiety, depression, suicidal ideation, perceived stigma, and perceived need for help among both groups.

Conclusion

The MTM theoretical framework is a valuable framework for predicting telehealth-based psychological help-seeking among college students. Such framework can be used to design and implement mental health programing.

Gender Similarities and Differences in Time Perspective in the Age of COVID-19

Undoubtedly, COVID-19 represents the biggest global emergency of the twenty-first century. Far from being only an infectious disease, COVID-19 caused social and economic disruption, with an exacerbation of gender inequality across different spheres, including in family duties and responsibilities as well as in occupations and income levels. In this scenario, the study aimed at drawing a picture of gender-related differences about thoughts and feelings relating to time, namely time perspective, during the COVID-19 lockdown. Time perspective - a cognitive style revealing the individual's tendency to mainly focus on the past, the present or the future - influences motivational levels that, in turn, triggers behavior. In this sense, time perspective is a noteworthy factor in elucidating how people cope with adverse events. The Adolescent and Adult Time Inventory was administered to 852 emerging adults (Mage = 24.77; 50% female) through an online survey. Results showed that women had more negative views about time, spent more time thinking about temporal dimensions, and tended to use more negative emotional terms to define the present and the future compared to men. Albeit data were collected during COVID-19, the lack of studies comparing time perspective before and after the pandemic does not allow us to ascertain the pandemic's impact on gender differences. Hence, a further understanding of the impact of COVID-19 on thoughts and feelings about time by women and men needs to be addressed to successfully cope with future stressful events.

Sleep Alterations in the Population of the Metropolitan Area of Mexico and Their Association with Lifestyle Changes During COVID-19 Confinement

Home confinement due to Coronavirus Disease 2019 (COVID-19) led to lifestyle changes that increased sleep disturbances, particularly in areas with higher infection and mortality rates. This study is a retrospective study based on data collected through an online survey conducted during the COVID-19 confinement. It aims to analyze changes in sleep quantity and quality and their association with lifestyle changes in the metropolitan area of Mexico City. A total of 899 adults from this area completed an online questionnaire between June 2020 and February 2021. This study assessed sleep quantity, sleep quality, insomnia symptoms, and lifestyle changes during the confinement period. Results showed that sleep quantity increased (7.10 ± 1.37 vs. 7.43 ± 1.42 h, p < 0.0001), with more participants, especially young adults and women, reporting later bed and wake-up times. The Pittsburgh Sleep Quality Index increased by 1.4 units, with poor sleep quality associated with lifestyle during confinement. Insomnia symptoms, sleep latency, and poor sleep quality also increased, particularly in women. Males and those without chronic comorbidities were less likely to experience poor sleep quality, while tobacco use and later bedtimes increased this risk. This study concludes that, while sleep quantity increased, sleep quality declined, particularly among young adults, women, and those with unhealthy lifestyles. These findings could guide sleep health initiatives tailored to specific lifestyle changes in different population groups.

Pandemic policies and sleeping problems in older adults

Sleep quality is fundamental to physical and mental health. Recent research shows that the COVID-19 pandemic has affected individuals' sleep quality. This study aims to investigate whether the containment and health policies (Oxford Coronavirus Government Response Tracker indexes) adopted by European countries and Israel during the pandemic are related to sleep problems in people aged 50 and over. A cross-sectional study was conducted using a logistic regression analysis based on data from the Survey of Health, Ageing and Retirement in Europe, collected in 27 European countries and Israel, in 2021. The results show that containment and health policies affect older adults' sleep, once we neutralise the influence of the sociodemographic, economic, and health characteristics of the individuals and close contact with COVID-19. In fact, the more containment and health policies, the fewer chances of sleep problems. A possible explanation for this is that these policies give people over 50 a sense of safety and security in relation to COVID-19, which may reduce sleep problems.

Stress symptoms and Coronavirus disease 2019 (COVID-19): a comparative study between Attention Deficit Hyperactivity Disorder and typically developing children and adolescents

BACKGROUND

Coronavirus disease 2019 (COVID-19) related confinement severely impacted people wellbeing. Many studies focused on general population, although it is reasonable to expect that patients with neurodevelopmental disorders might have been at higher risk. Children/adolescents with attention deficit/hyperactivity disorder (ADHD) might be potentially more vulnerable, due to their intolerance to forced restrictions that limit stimulating experiences, to obligation to follow instructions and to acceptation of imposed rules. We aimed to compare stress-related behavioral changes of the first COVD-19 related confinement among 6-18 years old ADHD and typically developing subjects.

METHODS

Two parent-proxy online surveys have been employed, shared via social media. Symptoms of acute stress related to the pandemic and a question about family members/households' COVID-19 positivity have been listed in 8 yes/no items (χ2 tests were applied).

RESULTS

Final sample consisted of 1078 typically developing subjects and 979 ADHD. Exaggerated startle response, difficulties in waking-up, angry mood as well as COVID-19 related fears were more prevalent among ADHD vs. typically developing subjects. typically developing subjects showed higher prevalence of research for information about COVID-19 and worries about death.

CONCLUSIONS

In conclusion, the COVID-19 experience significantly impacted children and adolescents with ADHD to a great extent, similarly to typically developing subjects. ADHD showed more anxious-phobic responses, while typically developing subjects demonstrate more depressive attitudes. Differences in stress symptoms profiles between ADHD and typically developing subjects warrant to develop distinct strategies of therapeutic interviews.

Evaluation of sleep disorders in children and adolescents affected by Klinefelter syndrome

Klinefelter syndrome (KS) is the most common sex chromosomal aneuploidy in males (47,XXY karyotype in 80-90% of cases), primarily characterized by hypergonadotropic hypogonadism and infertility. It encompasses a broad phenotypic spectrum, leading to variability in neurocognitive and psychosocial outcomes among affected individuals. Despite the recognized correlation between KS and various neuropsychiatric conditions, studies investigating potential sleep disorders, particularly in pediatric subjects, are lacking. This study aimed to investigate the presence of sleep-related behaviors potentially suggestive of a sleep disorder in a cohort of pediatric patients with KS, in comparison with a group of healthy male age-matched controls. During the period from January to December 2023, a validated sleep questionnaire (Sleep Disturbance Scale for Children: SDSC) was administered to the primary caregivers of 80 children with KS: 40 of preschool age (3-5 years) and 40 of school age (6-16 years). Data were compared with a control group of 180 healthy age-matched male children: 90 of preschool age (3-5 years) and 90 of school age (6-16 years). Among preschoolers, the proportion of subjects with pathological non-restorative sleep T-scores was significantly higher in the KS group compared to controls (p = 0.03). In both KS and control groups, school-aged subjects had higher questionnaire scores compared to preschoolers. The school age KS group had significantly higher mean total T-scores and mean T-scores for disorders of initiating and maintaining sleep (DIMS), disorders of arousal (DA), and disorders of excessive somnolence (DOES) compared to controls (p < 0.01 for all). The KS group also showed significantly higher percentages of children with clinically relevant T-scores for DIMS, DA, DOES, sleep hyperhidrosis, and total T-scores.

CONCLUSION

Our study indicates that sleep disorders are more prevalent in children with KS than in the general population, especially in the school age group. Screening for sleep issues in the clinical setting using tools like the SDSC is warranted, and should start from age 6 for children with KS. Further research is needed to better understand the origins of these disturbances, the role of comorbidities, and their long-term effects to improve diagnosis and treatment strategies for these patients.

WHAT IS KNOWN

• Neurocognitive and psychosocial disorders can be observed in individuals with KS. • Sleep disorders may be associated with various neuropsychiatric conditions; however, they have not been sufficiently explored in individuals with KS, particularly in pediatric populations.

WHAT IS NEW

• Sleep-related problems are more common in children with KS compared to the general population, especially in the school age group with regard to DIMS, DA, and DOES factors. • Starting from 6 years of age, the SDSC might be a promising early diagnostic tool for sleep disorders in children with KS.

Scoping review of infectious disease prevention, mitigation and management in passenger ships and at ports: mapping the literature to develop comprehensive and effective public health measures

BACKGROUND

With various infectious disease risks to passenger ship travellers, guidance for infectious disease prevention, mitigation and management (PMM) exists. Emerging infections and emergencies necessitate updated, context-specific guidelines and practices. New evidence for infection PMM must be translated into guidance for governmental authorities and the passenger ship industry. Under the European HEALTHY SAILING project, we conducted a scoping review of publications in PubMed, Scopus and grey literature for scientific articles, regulations, guidelines and policies describing infectious disease PMM in seaports, cruise, ferry, expedition and river cruise ships between 1990 and 2023.

MAIN FINDINGS

Of 620 publications most were peer-reviewed articles (57.7%) and technical guidance (27.9%), followed by reports/other documents (9.1%), industry guidance (3.4%) and legislation (1.9%). Half (50.5%) of all publications addressed respiratory illnesses, fewer addressed gastroenteritis (11.5%), Legionnaire's (6.1%), other vaccine-preventable (3.2%), vector-borne (1.6%) and sexually transmitted (1.0%) diseases. Most publications focus on infectious disease in seagoing cruise ships (75.7%) compared to ferries, expedition and river cruise ships (26.6%, 16.9%, 16.3%, respectively). Fewer publications addressed seaports (39.0%), shore-side personnel (19.7%) and port communities (2.4%). Most literature was published between 2020 and 2023 (50.2%) with a peak addressing respiratory illnesses (264 publications) during this period. A trend in volume and type was observed based on public health emergencies associated with the publication year.

CONCLUSIONS

Peer-reviewed articles and guidance primarily address respiratory and gastrointestinal illnesses, seagoing cruise ships and onboard populations. Gaps on the following topics exist: other infectious disease types; other passenger ship types; land-based personnel and port communities. Future research could assess risk factors and PMM measure effectiveness considering vaccine-preventable, vector-borne and sexually transmitted diseases. The evidence-base should be strengthened to produce guidelines targeting specificities of seaports, ferries, expedition and river cruise ships. Developing guidelines to standardise passenger ship outbreak investigation reporting could help evaluate PMM measure effectiveness, the impact of passenger ship travel on port communities and vice versa. Modern passenger ship experiences-from educational to elderly focused cruising-present diverse public health risks, requiring continuous efforts by public health authorities and the shipping industry. While outside the review's scope, measures may impact travellers' mental health, necessitating strategies when designing and implementing PMM measures.

Investigating stress, anxiety, and coping strategies among higher education students in extreme contexts: insights from Romania during the COVID-19 pandemic

BACKGROUND

Using the perspective of the recent COVID-19 pandemic, which represents a public health challenge that also affects education and the psychological well-being of students, this paper aims to assess the vulnerability to anxiety and stress of the Romanian students from the Faculty of Administration and Business of the University of Bucharest pursuing their degrees in administration and business.

METHODS

Our study is based on the results of the survey that was administered to a sample of 422 students (39.6% females and 60.4% males) selected from the pool of 2000 recruited respondents. We employed the ANOVA/linear Dependent Dirichlet Process mixture model to explain the causes of stress and anxiety after various grouping variables represented by gender, specialisation, as well as labour market status.

RESULTS

Our results revealed that more than 80% of the students in the sample yielded medium and high vulnerability to stress, while 64% of the respondents were affected by severe anxiety (high frequency of psychological, social, and physical problems that were difficult for them to control). The most important stressors were the fear of getting infected and social distancing, while self-control was considered the most effective coping strategy by 62.6% of employed students.

CONCLUSIONS

These results allow us to provide practical recommendations for effectively coping with stress and anxiety among students in Romania and beyond and to help stakeholders and policymakers design strategies for strengthening students' resilience, mental health, and well-being in case of future pandemics or other extreme contexts.

University students' sleep during the COVID-19 pandemic in the State of Hawai'i

Objectives: This study assessed undergraduates' sleep in Hawai'i during the COVID-19 pandemic and whether demographic characteristics, health locus of control, substance use and campus features related to sleep outcomes. Implications are considered for programs to support students' sleep and health during pandemic conditions. Participants: About 1,288 undergraduate students from six universities in Hawai'i. Methods: Surveys assessing sleep, emotional wellbeing, ethnicity, body mass index, locus of health control, and substance use. Results: Students' reported increased sleep time but decreased sleep quality during the pandemic. Sleep disruption related to anxiety, depression, ethnicity, substance use, BMI, health locus of control, class rank, and whether students lived at home. All campuses were associated with disrupted sleep, regardless of size, location, religious affiliation, term structure, or method of instruction. Conclusions: In response to public health crises, such as the COVID-19 pandemic, all Hawai'i universities should screen students for sleep disruption, emotional adjustment, social isolation and substance misuse. Programs to promote sleep and behavioral health appear particularly warranted for graduating seniors, Pacific Islanders, students with high BMI, and students who commute to college.

Psychosocial Impact of Quarantines: A Systematic Review with Meta-Analysis

Background: Quarantine is one of the most effective strategies to control outbreaks of communicable diseases. Individuals under isolation or quarantine experience both physical and mental effects. Therefore, given its widespread implementation around the world, it is pertinent to analyze this effect on physical and mental health. The psychosocial impact model, which divides four dimensions into two main points, exposure or protection and positive or negative responses, was used to analyze the psychosocial impact of quarantine. Objectives: The present study aimed to investigate the psychosocial impact of people exposed to or protected from quarantine. Methods: We conducted a search for primary articles in the Web of Science and Scopus databases, and after applying the inclusion and exclusion criteria, we meta-analyzed five of them. Results: Quarantined individuals were more likely to experience anxiety (K = 4; OR = 2.62) and depressive symptoms (K = 6; OR = 1.61) compared to those who did not undergo quarantine. Researchers discuss a twofold increase in the probability of anxiety or depression among those in quarantine. As a result, advancing interventions that reduce this impact is critical for both health and the global economy. Conclusions: In terms of economic variables, the non-moderation of GDP per capita and the moderation of the GINI index stand out, demonstrating that countries must move toward policies that promote the reconstruction of more resilient and inclusive societies.

Effects of bottom-up and top-down attentional processes on change blindness for COVID-related stimuli: influence of heart rate variability

Introduction

Top-down mechanisms that regulate attentional control are influenced by task demands and individuals' goals, while bottom-up processes are influenced by salient stimuli. Analogous networks are involved in both processes (e.g., frontostriatal areas). However, they are affected differently by the emotional salience of stimuli, which determines the allocation of attention. This study aims to determine whether the recent pandemic experience continues to exert an influence on cognitive processes. To this end, the study will determine attentional biases toward pandemic-related stimuli compared to negative and neutral stimuli. Furthermore, the study will investigate whether pandemic-related stimuli influence top-down and bottom-up attentional processes and whether the latter affect autonomic control as indexed by Heart Rate Variability (HRV).

Methods

Ninety-six undergraduate students completed a Flicker Task with stimuli categorized by emotional valence (neutral, negative non-COVID, negative COVID-related). This paradigm involves the presentation of two different pictures, which are identical except for a specific detail. The task required to detect the specific detail that has been changed. Given that the task employs images of natural scenes, participants tend to focus more on specific areas of the scene than others. As a result, changes in central interest (CI) areas are detected more rapidly than changes in marginal interest (MI) areas. Participants' response times (RTs) at the task and their HRV data were used to assess attentional performance and the associated autonomic nervous system activity.

Results

The results indicate slower responses to COVID-related stimuli than negative and neutral stimuli for both CI and MI changes, requiring the involvement of bottom-up (CI changes) and top-down (MI changes) processes. The HRV was associated with a slower detection of CI changes in COVID-related scenes.

Discussion

These findings highlight the intricate interplay between emotional salience, attentional mechanisms, and physiological responses to threatening stimuli. Contextual factors, particularly those related to pandemic-related stress, influence attentional processing and its relationship with autonomic activity.

Tight control in patients with rheumatoid arthritis treated with targeted therapies across the COVID-19 pandemic era

OBJECTIVES

To analyze the impact of different patterns of healthcare delivery on remission of rheumatoid arthritis (RA) patients treated with targeted therapies during the first wave (2020) and second/third waves (2021) of the pandemic compared to the pre-pandemic period (2019).

METHODS

In this observational real-life study, data from RA patients treated with biologic or targeted synthetic drugs were extracted from a longitudinal registry. Clinical Disease Activity Index (CDAI) was analyzed in the same period from the 22nd of February to the 18th of May for three consecutive years. These three periods were characterized by different patterns of healthcare delivery: (1) before the pandemic (2019) only in-person visits, (2) during the first wave (2020) both in-person visits and telehealth, and (3) during the second/third waves (2021) only in-person visits. A generalized linear model with the binomial error was fitted to evaluate the difference in the proportion of patients in CDAI remission. Quantile regression was used to compare the median of CDAI in difficult-to-treat (D2T) patients.

RESULTS

In the three periods, we included 407, 450, and 540 RA patients respectively. The percentages of patients in CDAI remission were similar in the three periods (prevalence ratio 1.07, p value 0.423 between 2020 and 2019, and 1.01, p-value 0.934 between 2021 and 2019). The CDAI remission rate was 40.55% (N = 163), 43.18% (N = 155) and 40.82% (N = 220) in 2019, 2020 and 2021, respectively. Among our cohort of D2T patients, CDAI remission was similar across the three periods (N = 30, 22.22%; N = 27, 23.68%; and N = 34, 21.52% respectively).

CONCLUSION

Although the pandemic has imposed changes in our healthcare delivery, these different strategies seem to be effective in ensuring satisfactory management of RA treated with targeted therapies. The approaches modulated in the context of the different periods have been a feasible compensation for ensuring disease control even in D2T patients.

Depression, Anxiety and Associated Factors Among Korean Adolescent Students During COVID-19

Objectives

Depression and anxiety are emotional difficulties that are common among adolescents. Adolescents suffering from depression and anxiety can exhibit problems such as antisocial behavior, aggression, and academic slump. This study aimed to explore the factors influencing adolescents' depression and anxiety during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

This study examined the data from an online student health survey conducted by the Ministry of Education in 2022. The survey participants were 131194 students ranging from the first grade of middle school to the third grade of high school. The influence of each variable on depression and anxiety was examined.

Results

Factors that predicted depression and anxiety were sex (female), grade level (higher), financial difficulties (existing or unknown), physical activity (higher), sleep time (shorter), media usage time (higher), family/friends relationship (worse), and change in the health status of family, friends, and oneself due to COVID-19 (worse).

Conclusion

These results may help identify patterns of depression and anxiety among adolescents caused by COVID-19 and maximize the intervention effect.

Surviving the storm: Wave-wise comparison of the pandemic's impact on mental health dynamics, sleep patterns, and preventive behaviors among coronavirus patients in Northern India

Background

Different clinical manifestations were revealed by the distinct waves of the coronavirus. The pandemic had a multifaceted impact on mental health, sleep patterns, and associated fear.

Materials and Methods

It was an observational online survey using by using Google Forms in the city of Chandigarh between April 2020 and April 2021 across three waves of the coronavirus outbreak (first wave from March 2020 to May 2020, second wave from June 2020 to January 2021, and third wave from February 2021 to April 2021). Fear of coronavirus disease (COVID), preventive behaviors, insomnia-related problems, and impact of the event were assessed by using standardized scales.

Results

The participants who were infected during the first phase exhibited significantly higher levels of distress, loss of control over their reactions, increased fear of coronavirus and sleep problems, and also greater adherence to preventive behaviors compared to those who were infected during the second and third waves. A tendency to emerge post-traumatic stress disorder (PTSD) was seen in 68 (58.1%) of the participants (Peritraumatic Distress Inventory (PDI) score >14) and 34 (29.1%) of all the participants (PDI score >23). Overall, 66 (56.4%) participants reported having insomnia. About 24 people (20.5%) had clinical concerns about PTSD, 20 people (17.1%) had probable PTSD diagnoses, and 16 people (13.7%) experienced a severe coronavirus disease 2019 (COVID-19) pandemic impact on their lives.

Conclusion

The first wave of COVID-19 had a greater psychological impact than subsequent waves. Further research must fill important gaps in our knowledge of the clinical range and long-term effects.

Social Support at School for Students with Sensory Disabilities

Social support is the gratification of basic social needs (affection, belonging, esteem or approval, security, identity) through interaction with others. Social support at school allows students to perceive themselves as competent during learning and to enjoy school in general. Little is known about social support at school for students with sensory disabilities. This review aims to synthesize findings from studies examining social support at school for students with hearing and visual impairments. A search of computerized databases was supplemented by a manual search of the bibliographies of the main publications. The synthesis of the literature suggests that all students need adequate support devices in class and properly trained support teachers. However, visually impaired students are more likely to have access to resources compared to those with hearing impairments. Students with visual impairments attending regular schools are more positive about the availability of resources than those with hearing impairments attending special schools. Overall, senior secondary school students indicate higher resource availability than junior secondary school ones. Still, very few studies have investigated social support for students with sensory disabilities. Thus, further research is needed to confirm these results.

Coronavirus-Related Stressors, Resilient Mindset, Loneliness, Depressive Symptoms in College Students: Testing a Moderated Mediation Model

The coronavirus (COVID-19) outbreak alarmingly threats the mental health and functioning of people globally. The present study aims to examine the moderated mediation role of resilient mindset and loneliness in the association of coronavirus stress and depressive symptoms. We recruited 394 undergraduate students from a state university in Türkiye, ranging in age between 18 and 47 years (M = 22.76, SD = 3.88; 65% female). The main results revealed that resilient mindset mediated the relationship between coronavirus-related stress and depressive symptoms. Moreover, loneliness moderated the mediating effect of resilient mindset in the coronavirus stress and depressive symptoms association. Taken together, these findings pointed out that the effects of the coronavirus stress on depressive symptoms can be captured better by underlying psychological mechanisms, namely resilient mindset and loneliness.

Effects of the COVID-19 Pandemic on College Students in Brazil

The implementation of restrictive measures during the pandemic drastically changed the routine and habits of the population. In the academic sphere, the sudden closure of universities difficulted any advance planning. The objective of this study was to verify the effects of the pandemic on the routine, physical and mental health of students at a public university in southern Brazil. This is a cross-sectional study that applied a questionnaire from May to August 2020. The target population comprised 528 undergraduates. The questionnaire addressed questions about sociodemographic characteristics, physical and mental health. A response was obtained from 406 participants. During the quarantine period evaluated, the main results were: 66.2% reported worsening of anxiety symptoms; 57.6% declared that their physical health was "reasonable" to "bad". As for the quality of sleep there was an increase in 98.8% in the responses "bad sleep quality" and "very bad sleep quality"; increase in 26.6% for presence bruxism; 12.5% for orofacial pain, 3.8% for headache. It is concluded that there were several negative effects, among these effects, it was observed higher levels of anxiety, worsening physical health and quality of sleep, increase in the prevalence of bruxism, as well as the presence of orofacial pain and headache.

Adapting Minds: Exploring Cognition to Threatened Stimuli in the Post-COVID-19 Landscape Comparing Old and New Concerns about Pandemic

The global population has been significantly affected by the pandemic in terms of physical and mental health. According to transactional theory, individuals have undergone an adaptation process influenced by cognitive control abilities. Emotional responses to COVID-19-related stimuli may interfere with top-down attentional processes, thereby hindering adaptation. This study aimed to investigate the impact of COVID-19-related stimuli on attentional processing and to determine whether psychological factors could modulate these effects. A sample of 96 healthy undergraduate students participated in an emotional Stroop task in which they were presented with a series of stimuli, including both neutral and negative COVID-19-related as well as non-COVID-19 stimuli. COVID-19-related PTSD, as an index of distress (PTSS), and trait anxiety were evaluated. Results showed that participants were more accurate in identifying COVID-19-related stimuli compared to non-COVID-19 stimuli. Being female and having higher retrospective PTSS scores related to COVID-19 were predictive of faster reaction times for both neutral and negative COVID-19-related stimuli. This heightened attentional bias toward COVID-19-related stimuli suggests that individuals may be more sensitive to stimuli associated with the pandemic. The results suggest that the association between COVID-19 stimuli and attentional biases extends beyond emotional valence, being retrospectively influenced by mental health, suggesting potential pathways to future mental health challenges.

Assessing the impact of small firm dynamics on public mental health amid the pandemic in Latin America

OBJECTIVE

The aim of our study is to examine the relationship between the economic activity of small firms and the mental well-being of the population in five Latin American countries in the early stages of the pandemic.

METHODS

We utilize the search volume of certain keywords on Google Trends (GT), such as "boredom," "frustration," "loneliness," "sleep", "anxiety", and "depression", as an indicator of the well-being of the population. By examining the data from Facebook Business Activity Trends, we investigate how social attention reacts to the activity levels of different economic sectors.

RESULTS

Increased business activity is generally associated with reduced levels of boredom, loneliness, sleep problems and anxiety. The effect on depression varies by sector, with positive associations concentrated in onsite jobs. In addition, we observe that strict Non-Pharmaceutical Interventions (NPIs) tend to exacerbate feelings of boredom and loneliness, sleep issues, and anxiety.

CONCLUSIONS

Our findings suggest a strong association between different indicators of psychological well-being and the level of activity in different sectors of the economy. Given the essential role of small and medium-sized enterprises (SMEs) in generating employment, especially during crises like the pandemic, it is imperative that they remain resilient and adaptable to support economic recovery and job preservation. To accomplish this, policymakers need to focus on providing financial stability and support for SMEs, fostering social support networks within companies, and incorporating mental health services into workplace environments. This comprehensive strategy can alleviate mental health challenges and enhance public health resilience.

Prevalence of depression, anxiety and stress and their risk and protective factors among secondary students in Rwanda during the first wave of COVID-19 pandemic

INTRODUCTION

Compelling evidence shows that the COVID-19 pandemic has detrimental effects on the mental health of university students. However, little is known about the psychological distress experienced by students from high schools during the pandemic. This study, therefore, sought to examine the prevalence of depression, anxiety and stress and their associated factors among students from high schools in Rwanda.

METHODS AND MATERIALS

A retrospective, cross-sectional study was conducted on 384 students randomly selected from high schools. Data were collected using standardized measures of mental disorders and their associated factors. Bivariate and multivariate analyses based on the odds ratio were used to indicate the associated factors of anxiety, depression, and stress.

RESULTS

The results indicated that slightly above half of the participants (51%, n = 195) had clinically significant symptoms of depression, 30.3% (n = 116) had stress and 67.3% (n = 259) had anxiety. Our analyses identified several key risk factors associated with increased odds of these mental disorders. These include exposure to domestic violence, COVID-19 symptoms like cough and myalgia, eating twice per day, having one of the three mental disorders, gender, with females showing higher susceptibility, and direct contact with the people who positively tested covid-19. Conversely, protective factors such as heightened awareness about Covid-19, positive mental health, social support, eating three times, belonging to the third Ubudehe category, and a high resilience emerged as significant elements mitigating the risks of these mental health challenges within our sample. Intriguingly, religious affiliation emerged as a notable factor, with students affiliated with the Witness of Jehovah and Adventist denominations exhibited lower risks for depression and anxiety.

CONCLUSION

Our findings highlighted a high prevalence of depression, anxiety, and stress among students from secondary schools. Interestingly, this study also revealed the associated risk and protective factors of depression, anxiety, and stress in Rwandan students in high schools. Therefore, mental health interventions targeting the impact of COVID-19 on students, as young people are needed.

Psychological Factors Associated with General Quality of Life in the Context of COVID-19 Pandemic: A Cross-Sectional Study on a Multicultural Sample of Romanian Medical Students

The COVID-19 pandemic had a significant impact on the general quality of life (GQOL) of a large number of individuals, including those in the academic environment. This study investigated GQOL in a sample of 613 Romanian medicine students (81.57% were female; mean age = 21.40 ± 1.749 years) in relation to their Big Five personality characteristics, Perceived Stress and Fear of COVID-19. The study was conducted between June 2020 and March 2022. These variables were investigated with the Big Five Inventory-2: Extra-Short Form, the Fear of COVID-19 Scale (FCV-19S), the Perceived Stress Scale-10 and the Satisfaction with Life Scale (SWLS). Statistical analysis included hierarchical linear regression and t-tests. The results indicated a significant direct relationship between GQOL and the personality traits of Conscientiousness, Extraversion and Agreeableness. However, a significant inverse relationship was observed between GQOL and Perceived Stress and Neuroticism. Fear of COVID-19 was significantly higher in women, while no other socio-demographic variables were associated with GQOL. A total of 61.7% of the studied population returned to their original residency during the pandemic years. These results could be important for better understanding the vulnerability to significant epidemiological events in academic populations and for planning adequate preventive or interventional measures.

Sleep and mental health during the COVID-19 pandemic: findings from an online questionnaire survey in China

Introduction

The online study investigated the sleep, psychological conditions, and risk factors during the wave of transmission of COVID-19 since December 7, 2022.

Methods

We distributed questionnaires through networking mediums to residents to gather information about COVID-19 infection, sleep, and mental status.

Results

During the extraordinary period in China, 91.9% of 1094 participants claimed to be infected with COVID-19, 36.8% reported poor sleep quality, 75.9% reported anxiety, and 65.5% reported depression. In retrospect, people have experienced lower sleep quality, longer sleep latency, enhanced rising time, and decreased sleep efficiency after the infection wave. After adjusting confounding factors, the elderly, women, urban residents, people with comorbidity, anxiety, depression, stress state, and COVID-19 infection have high risks for sleep disorders during the period.

Discussion

The survey indicates that sleep disturbance caused by COVID-19 involves multiple dimensions, such as physiology, psychology, and society. The COVID-19 infection-related sleep problem should be taken seriously. Apart from conventional treatment, psychological issues of insomnia can not be ignored.

An online behavioral self-help intervention rapidly improves acute insomnia severity and subjective mood during the coronavirus disease-2019 pandemic: a stratified randomized controlled trial

STUDY OBJECTIVES

Stressful life events, such as the coronavirus disease-2019 (COVID-19) pandemic, can cause acute insomnia. Cognitive behavioral therapy for acute insomnia is effective but is both time and resource-intensive. This study investigated if an online behavioral self-help intervention, which has been successfully used alongside sleep restriction for acute insomnia, reduced insomnia severity and improved mood in acute insomnia. This study also assessed good sleepers to explore if a "sleep vaccination" approach was feasible.

METHODS

In this online stratified randomized controlled trial, 344 participants (103 good sleepers and 241 participants with DSM-5 acute insomnia) were randomized to receive the intervention/no intervention (good sleepers) or intervention/intervention after 28 days (poor sleepers). Insomnia severity was assessed using the ISI (primary outcome), and anxiety and depression using the GAD-7/PHQ-9 (secondary outcomes) at baseline, 1 week, 1 month, and 3-month follow-up.

RESULTS

In people with acute insomnia, relative to baseline, there were significant reductions in ISI (dz = 1.17), GAD-7 (dz = 0.70), and PHQ-9 (dz = 0.60) scores at 1-week follow-up. ISI, GAD-7, and PHQ-9 scores were significantly lower at all follow-up time points, relative to baseline. Subjective diary-derived sleep continuity was unaffected. No beneficial effects on sleep or mood were observed in good sleepers.

CONCLUSIONS

An online behavioral self-help intervention rapidly reduces acute insomnia severity (within 1 week), and benefits mood in people with acute insomnia. These beneficial effects are maintained up to 3 months later. Although the use of the intervention is feasible in good sleepers, their subjective sleep was unaffected.

CLINICAL TRIAL REGISTRATION

Testing an early online intervention for the treatment of disturbed sleep during the COVID-19 pandemic; prospectively registered at ISRCTN on 8 April 2020 (identifier: ISRCTN43900695).

Self-perception of health and physical activity levels among the youth and adults before and amidst the COVID-19 pandemic

Background

Emerging research indicates that the COVID-19 pandemic and associated restrictions led to decreased physical activity levels and poorer health globally. However, most studies on this topic have focused on advanced countries, leaving a gap in understanding the impact in countries like Ghana. This study aimed to fill this gap by assessing self-perceived health status and physical activity levels among youth and adults in Ghana before, during, and after the COVID-19 restrictions. Understanding these dynamics is crucial for informing public health interventions and policies to promote well-being during and beyond the pandemic.

Methods

A cross-sectional survey using online data collection methods was conducted, involving 937 participants. Data included demographic information, and International Physical Activity Questionnaire-Short Form (IPAQ-SF). Analysis was done using SPSS version 25, with descriptive statistics and multinomial regression.

Results

Most participants (89.6%) reported good health. Male participants were significantly more likely to engage in moderate (1.78 times) and high (3.17 times) physical activity during the COVID-19 period compared to females.

Conclusion

This study highlights gender disparities in physical activity levels during the pandemic in Ghana. Addressing these disparities and promoting healthier lifestyles, especially during crises, is crucial for general and mental health. Further research should explore socio-demographic factors' role in health behaviors during pandemics.

Long-term gastrointestinal symptoms and sleep quality sequelae in adolescents after COVID-19: a retrospective study

Objective

To evaluate the long-term gastrointestinal (GI) symptoms and sleep quality sequelae in adolescents with COVID-19.

Methods

Between June and July 2023, an online survey was done in Xiaoshan District, Hangzhou City, Zhejiang Province, China, using the GI Symptom Rating Scale (GSRS) and the Pittsburgh Sleep Quality Inventory (PSQI).

Results

GI symptoms in COVID-19 patients increased by 11.86% compared to before infection, while sleep quality decreased by 10.9%. Over time, there was a significant increase in the cumulative incidence rate of GI symptoms and sleep disorders (p < 0.001). Follow-up of COVID-19 positive patients within 6 months of infection showed that GI symptoms and sleep quality began to ease starting from the first month after infection. Further analysis indicated a significant linear relationship between the severity of GI symptoms and sleep quality (R > 0.5, p < 0.001). Moreover, females, older age, and higher education were identified as risk factors influencing the long-term effects of COVID-19.

Conclusion

SARS-CoV-2 affects GI symptoms and sleep quality in adolescents during both the acute phase and post-infection periods. Over time, these symptoms gradually alleviate. A significant correlation exists between GI symptoms and sleep quality.

How COVID-19 Affected Sleep Talking Episodes, Sleep and Dreams?

BACKGROUND

The COVID-19 pandemic increased symptoms of stress and anxiety and induced changes in sleep quality, dream activity, and parasomnia episodes. It has been shown that stressful factors and/or bad sleep habits can affect parasomnia behaviors. However, investigations on how COVID-19 has affected sleep, dreams, and episode frequency in parasomnias are rare. The current study focuses on the impact of the pandemic on a specific parasomnia characterized by speech production (sleep talking, ST).

METHODS

We selected 27 participants with frequent ST episodes (STs) during the pandemic and compared them with 27 participants with frequent STs from a previous study conducted during a pre-pandemic period. All participants performed home monitoring through sleep logs and recorded their nocturnal STs for one week.

RESULTS

We observed a higher frequency of STs in the pandemic group. Moreover, STs were related to the emotional intensity of dreams, independent of the pandemic condition. The pandemic was associated with lower bizarreness of dreams in the pandemic group. There were no differences in sleep variables between the two groups.

CONCLUSION

Overall, these results suggest a stressful effect of COVID-19 on the frequency of STs. Both the pandemic and the frequency of STs affect qualitative characteristics of dreams in this population.

Reevaluating Sleep Quality During COVID-19 and Associations With Quarantine, Mental Health, Stress, and Screen Time in Young Adults: Results From a Cross-Sectional Online Survey

The COVID-19 pandemic affected individual sleep quality, especially with high-stress levels. We assessed sleep quality in young adults during COVID-19, and mental health, stress, and screen time (ST) use. An international cross-sectional study was conducted from September 2020 to January 2021. The surveys assessed sleep quality (PSQI), ST use, and mental health. 183 participants were eligible for analysis. The average global PSQI score was 7.29 (sd = 3.58, n = 99). Associations were found between global PSQI scores and Fear of COVID-19 (r (98) = .223, P = .027), anxiety scores (r (99) = -.541, P < .001), increased total stress scores (r (88) = .486, P < .001), and depression (r (97) = .628, P < .001). Those currently quarantining had statistically higher PSQI scores than those who quarantined in the past (F (2,175) = 3.397, P = .036), but not for those who did not quarantine. Differences were found between genders for global PSQI (F (4,94) = 2.865, P < .027) and poor vs good sleep (X2 (1,98) = 3.982, P = .046). There was also a relationship between ethnicity and poor vs good sleep quality (X2 (2,94) = 6.538, P = .038). We did not find associations between ST and sleep quality but found poor sleep quality significantly related to mental health during COVID-19. We found no direct evidence that quarantining itself results in poor sleep quality. Interventions need to maximize sleep quality in certain groups, like females and ethnic minorities.

Association between sleep quality with maternal and neonatal outcomes during the covid-19 pandemic

AIM

Sleep disorders during pregnancy can impact maternal and neonatal outcomes. The objective of this study is to examine the relationship between sleep quality and maternal and neonatal outcomes during the COVID-19 pandemic.

METHOD

This prospective cohort study was conducted at the Educational-Therapeutic Center of Shohadaye Yaftabad Referral Hospital in Tehran, Iran, from December 2020 to September 2022. A total of 198 eligible participants were randomly assigned to either the sleep disorders group or the no sleep disorders group. Data were collected through demographic questionnaires, the Corona Disease Anxiety Scale (CDAS) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the checklist for maternal and neonatal outcomes.

RESULTS

At baseline, the sleep disorders and no sleep disorders groups were similar in terms of age, body mass index (before pregnancy), education level, employment status, gravida, parity, abortion, and history of COVID-19. Within the sleep disorders group, there was a statistically significant, direct linear correlation between sleep disorders and FBS 34-36 weeks (r = 0.33, P < 0.001) as well as Corona Disease Anxiety (CDA) (r = 0.35, P < 0.001). The linear regression results indicated that for every unit increase in sleep disorders, the risk of FBS 34-36 weeks increased by 1.09 times (β = 1.09, P < 0.001). Additionally, sleep disorders increased the risk of CDA by 1.36 times (β = 1.36, P < 0.001). The results showed no statistically significant differences in terms of birth weight, type of delivery (vaginal or cesarean section), gestational age (preterm or full term), length of labor stages (first and second stage), Apgar score at minutes 1 and 5, and NICU admission between the two groups.

CONCLUSION

Based on the results, a certain degree of correlation exists between sleep quality and FBS at 34-36 weeks and CDA. These findings underscore the need for future public health guidelines to formulate detailed strategies to improve sleep quality during the COVID-19 pandemic.

Associations of Anxiety, Insomnia, and Physical Activity during the COVID-19 Pandemic

PURPOSE

Anxiety, insomnia, and physical activity (PA) are interrelated, but the bi-directional relationships between these three variables are not well understood. Less is known of these relationships in settings of disrupted daily activities and acute stress. This study aimed to characterize and examine relationships between insomnia, anxiety, and PA throughout the first year of the COVID-19 pandemic, when many lifestyle behaviors were disrupted.

METHODS

Participants comprised a convenience sample of 204 adults (55.4% female; 43.85 ± 15.85 years old) who completed the Generalized Anxiety Disorder Questionnaire (GAD-7), Insomnia Severity Index (ISI), and the International Physical Activity Questionnaire (IPAQ) at three time points through the first year of the COVID-19 pandemic. A cross-lagged panel model was used to evaluate these variables' concurrent, autoregressive, and cross-lagged relationships across time. Follow-up dynamic panel modeling using maximum likelihood and structural equation modeling was employed.

RESULTS

Approximately 64% of participants reported their work/occupation as affected by the pandemic. At baseline, associations between anxiety and insomnia were observed (β-coefficient: 15.87; p < 0.001). Insomnia was a positive future predictor of anxiety (ISI time point 2: 7.9 ± 5.6 points; GAD-7 at time point 3: 4.1 ± 4.2 points; β-coefficient: 0.16; p < 0.01). No associations were observed between PA and anxiety or insomnia (all p > 0.05).

CONCLUSIONS

Insomnia and anxiety were interrelated, and effects were cross-lagged. These data can inform future work focused on improving anxiety in settings of acute stress and disruptions to daily life, such as changes in occupational structure and stability. Specifically, targeting sleep parameters may be of interest to elicit downstream positive health behaviors.

Astrocyte-derived lactate in stress disorders

Stress disorders are psychiatric disorders arising following stressful or traumatic events. They could deleteriously affect an individual's health because they often co-occur with mental illnesses. Considerable attention has been focused on neurons when considering the neurobiology of stress disorders. However, like other mental health conditions, recent studies have highlighted the importance of astrocytes in the pathophysiology of stress-related disorders. In addition to their structural and homeostatic support role, astrocytes actively serve several functions in regulating synaptic transmission and plasticity, protecting neurons from toxic compounds, and providing metabolic support for neurons. The astrocyte-neuron lactate shuttle model sets forth the importance of astrocytes in providing lactate for the metabolic supply of neurons under intense activity. Lactate also plays a role as a signaling molecule and has been recently studied regarding its antidepressant activity. This review discusses the involvement of astrocytes and brain energy metabolism in stress and further reflects on the importance of lactate as an energy supply in the brain and its emerging antidepressant role in stress-related disorders.

Sleep quality, quality of life, fatigue, and mental health in COVID-19 post-pandemic Türkiye: a cross-sectional study

Aim

This study explores the predictors and associated risk factors of sleep quality, quality of life, fatigue, and mental health among the Turkish population during the COVID-19 post-pandemic period.

Materials and methods

A cross-sectional survey using multi-stage, stratified random sampling was employed. In total, 3,200 persons were approached. Of these, 2,624 (82%) completed the questionnaire package consisting of socio-demographic information, Pittsburgh Sleep Quality Index (PSQI), the WHO Quality of Life Brief Version (WHOQOL-BREF), Fatigue Assessment Scale (FAS), Patients Health Questionnaire (PHQ-15), GAD-7 anxiety scale, and the 21-item Depression, Anxiety, Stress Scale (DASS-21).

Results

Significant differences between genders were found regarding socio-demographic characteristics (p < 0.01). Using PHQ-15 for depressive disorders, significant differences were found between normal and high severity scores (≥ 10), regarding age group (p < 0.001), gender (p = 0.049), educational level (p < 0.001), occupational status (p = 0.019), cigarette smoking (p = 0.002), waterpipe-narghile smoking (p = 0.039), and co-morbidity (p = 0.003). The WHOQOL-BREF indicated strong correlations between public health, physical health, psychological status, social relationships, environmental conditions, and sleep disorders (p < 0.01). Furthermore, comparisons of the prevalence of mental health symptoms and sleeping with PHQ-15 scores ≥ 10 (p = 0.039), fatigue (p = 0.012), depression (p = 0.009), anxiety (p = 0.032), stress (p = 0.045), and GAD-7 (p < 0.001), were significantly higher among the mental health condition according to sleeping disorder status. Multiple regression analysis revealed that DASS21 stress (p < 0.001), DASS21 depression (p < 0.001), DASS21 anxiety (p = 0.002), physical health (WHOQOL-BREF) (p = 0.007), patient health depression-PHQ-15 (p = 0.011), psychological health (WHOQOL-BREF) (p = 0.012), fatigue (p = 0.017), and environmental factors (WHOQOL-BREF) (p = 0.041) were the main predictor risk factors associated with sleep when adjusted for gender and age.

Conclusion

The current study has shown that sleep quality was associated with the mental health symptoms of depression, anxiety, stress, and fatigue. In addition, insufficient sleep duration and unsatisfactory sleep quality seemed to affect physical and mental health functioning.

How can sleep disorders affect our reaction towards external stressors: a lesson from the COVID-19 outbreak

BACKGROUND

The COVID-19 outbreak produced extensive psychological consequences, especially among vulnerable populations. Sleep was identified as one of the most common "indirect targets" of the pandemia, with up to 74.8% of patients surviving from COVID-19 complaining of new-onset sleep disorders. However, so far, the clinic-psychological impact of the outbreak in patients affected by pre-existing sleep disorders has not been examined in details.

MATERIALS AND METHODS

In the present study, we aim to assess the effect of the COVID-19 outbreak in a cohort of 190 adult patients affected by sleep disorders, compared to 265 age and sex-matched healthy sleepers. The assessment was implemented throughout the use of ad hoc anamnestic questions, exploration of dream content, and validated questionnaires, aiming to capture the broad range of the neuropsychological nuances of the COVID-19 impact.

RESULTS

Subjects with pre-existent sleep disorders faced a more severe impact in terms of sleep quality and amount compared to healthy sleepers, presenting longer sleep latency, reduced sleep efficacy, and greater use of hypnotics and medications. On the other hand, healthy sleepers experienced deeper variation in sleeping habits, sleep duration, and greater impact on dream activity in terms of content, emotionality, and presence of recurrent dreams. Finally, in our sample, being female represents an important aggravating factor in the pandemic experience, both in terms of sleep deterioration and with respect to physical and mental health. For instance, females indeed presented the highest scores of Pittsburgh Sleep Quality Index (PSQI) both in cases and control groups (respectively 10 ± 3.8 vs 7.3 ± 3.9 in cases and 6.6 ± 3.6 vs 6.0 ± 3.4 in controls, p-value < 0.001).

CONCLUSION

Pre-existent sleep disorders and the female sex might represent risk factors increasing the clinic-psychological burden in dramatic scenarios, such as the COVID-19 pandemia, requiring dedicated attention from clinicians.

Lonely and scrolling during the COVID-19 pandemic: understanding the problematic social media use and mental health link among university students

Introduction

Undergraduate university students experienced many academic and non-academic stressors during the first year of the coronavirus (COVID-19) pandemic, putting them at a greater risk of negative mental health outcomes. Reports worldwide have shown high incidences of depressive, anxiety, and stress scores among university students at the beginning of the pandemic. Emerging evidence also suggests that to cope with the stress and loneliness of the pandemic, many youth and young adults increased the amount of time they spent on social media platforms.

Methods

Undergraduate students participated in an online study aimed to understand the link between time spent on social media, coping through the use of social media and problematic social media use (PSMU) with mental health symptoms, such as stress, depression, anxiety, and loneliness, during the COVID-19 pandemic.

Results

While time spent on social media was only weakly associated with stress, depression, anxiety and loneliness scores, PSMU more strongly mapped onto these outcomes. Additionally, students who were coping highly using social media displayed elevated stress, depression, anxiety and loneliness levels in comparison to those reporting low levels of coping with social media. Finally, students who reported high levels of coping using social media displayed higher PSMU scores, with this relationship appearing more pronounced in students who had higher levels of loneliness.

Conclusion

These data support evidence that it is not necessarily time spent on social media but rather PSMU that is relevant for mental health symptoms, and that PSMU is exacerbated by loneliness. Moreover, the current results highlight the effects of maladaptive coping on mental health symptoms and PSMU among university students during the COVID-19 pandemic.

Differential Impact of Emotional and Contextual Factors Associated with COVID-19 on Adolescent Mental Health

Background

During the confinement, there was an increase in the incidence of mental disorders such as depression and anxiety. In this regard, affectivity is of particular interest, as emotions play a fundamental role in overall mental health. The literature on COVID-19 in this population has often focused on the analysis of risk factors for mental health, while less attention has been paid to protective factors. In this paper, we propose an inclusive model of risk and protective factors for adolescent mental health through the indirect effect of negative and positive affect.

Methods

This was a cross-sectional study with a Spanish community sample of 477 adolescents (Mage = 16.23, range:14 to 20 years old; 43.4% were boys; response rate: 100%). We measured the perceived hardness of confinement, worrying about contagion, quality of relationships at home, pleasant activities, affect (positive and negative), and mental health.

Results

The results revealed a positive relationship between the perceived hardness of confinement and worrying about contagion with mental health, through the indirect effect of negative affect, and a positive relationship between home relationships and pleasant activities with mental health through an indirect effect of positive affect.

Conclusion

Our results suggest that different types of emotions generated by the various contextual variables associated with COVID-19 may have a differential impact on mental health. These findings support the inclusive model of risk and protective factors for adolescent mental health. Practical implications, future studies, and limitations are discussed.

The quality of sleep: evaluation among university students

Introduction

This study explored the quality of sleep among university students in the South of Italy during the Covid-19 pandemic.

Methods

A cross-sectional study was conducted between March 2022 and January 2023 and involved students over the age of 18, who were invited to complete a self-administered questionnaire using an online application.

Results

Overall, 88% of men and 94.5% of women had Pittsburgh Sleep Quality Index (PSQI) scores of ≥5 and a mean PSQI score of 9.2 ± 3. Students with severe or extremely depression score, with sever or extremely stress score, male and who did not had Covid-19 infection were more likely to have a PSQI global score. Moreover, 62.6% of the students declared a reduction in social relations and 72.3% an increase in the use of social media during the pandemic period. The majority of respondents reported an extremely severe level of depression (68.1%), anxiety (84.4%) and stress (71.9%).

Conclusion

This finding indicate that a relevant percentage of students are poor sleepers with a higher overall PSQI score with depression and stress and underline the role the implementation of public health interventions to promote healthy life styles and in particular focus on the duration of long night sleep.

Undergraduate Student Stress, Sleep, and Health Before and during the COVID-19 Pandemic

Before the COVID-19 pandemic, undergraduate students experienced sleep problems and mental health issues that were negatively associated with academic achievement. Studies comparing undergraduate sleep and health pre- to mid-pandemic have yielded mixed results, necessitating additional research on other cohorts and examination of potential moderators. The present study was conducted to examine whether American undergraduate students tested mid-pandemic experienced poorer sleep, health, and academic achievement relative to students tested pre-pandemic, as well as to examine whether poor sleep during the pandemic was preferentially associated with poorer health in women. The current cross-sectional study included 217 participants tested pre-pandemic (February-December 2019) and a separate sample of 313 participants tested mid-pandemic (November-December 2020). Participants in both samples provided demographic information and completed questionnaires inquiring about participant sleep quality, insomnia, and cumulative grade point average (GPA); participants in the mid-pandemic sample also reported on measures of general, physical, and mental health. Participants tested mid-pandemic reported poorer global sleep quality, greater insomnia severity, greater stress, and higher cumulative GPAs relative to participants tested pre-pandemic. For the mid-pandemic sample only, poorer sleep quality was associated with reduced physical health; interactions indicated that women with poor sleep quality reported poorer mental health relative to both women with good sleep quality and men with poor quality sleep. Perceived stress mediated the association between sleep problems and GPA. These findings indicate that the pandemic negatively impacted the functioning of undergraduate students and highlights the need for future studies examining additional moderators of the reported effects.

A Systematic Review of the Bidirectional Association Between Consumption of Ultra-processed Food and Sleep Parameters Among Adults

PURPOSE OF REVIEW

We summarized research on the bidirectional association between intake of ultra-processed food (UPF) and sleep.

RECENT FINDINGS

Sleep contributes to cardiometabolic health in part via food intake patterns. Restricting sleep increases intakes of high-carbohydrate/high-fat foods, a profile representative of UPF. This systematic review covers the association of UPF intake, as an exposure or an outcome, and sleep. UPF was defined as NOVA Group 4. MEDLINE and EMBASE were searched through April 2023 for epidemiological studies with general-population adult samples. Fifteen studies met the inclusion criteria; all were cross-sectional, published between 2016 and 2023, with samples from Brazil (n = 8), Spain (n = 2), Italy (n = 1), the UK (n = 1), Paraguay (n = 1), Iran (n = 1) and China (n = 1). Thirteen studies examined UPF intake as the exposure whereas two tested UPF intake as the outcome. UPF intakes were determined using food frequency questionnaires (73%) or 24-h recalls (27%). Two studies assessed sleep via accelerometry; the remaining studies relied on self-reports of sleep quality, duration, anxiety-induced insomnia, and napping, with 60% using a single question. The average methodological quality across the studies was deemed "fair". Six of the 13 studies that examined UPF consumption as the exposure revealed inverse associations with sleep outcomes in adjusted (n = 5) or bivariate (n = 1) analyses. Both studies addressing UPF consumption as the outcome and sleep as the exposure showed significant inverse associations. Evidence for UPF-sleep associations is accumulating, although sleep assessment limitations are apparent. This review can provide impetus for research using comprehensive and validated sleep measures and nudge policymakers towards refining dietary guidelines worldwide.

The effect of COVID-19 on fear, anxiety, and sleep in nursing students

PURPOSE

This research was conducted to determine the effect of COVID-19 on fear, anxiety, and sleep in nursing students.

METHODS

The sample of the study consisted of 1222 students in the 2019-2020 academic year who were members of the student nurses association. The data were collected online via Google Form between June and August 2020 using the student information form containing socio-demographic characteristics, the Generalized Anxiety Disorder 7-Item (GAD-7) Scale, the fear of COVID-19 scale, and the Bergen Insomnia Scale.

RESULTS

In our study, the mean score of the fear of COVID-19 scale of nursing students was 18.23 ± 6.31, and it was determined that 51.8% had sleep problems and 70.9% had anxiety (39.9% mild, 20.8% moderate, and 10.2% severe). In simple linear regression analysis, the fear of COVID-19 was found to be statistically significant and positively correlated with anxiety (β: 0.383, p = 0.001), and the fear of COVID-19 (β: 0.120, p = 0.001) and anxiety (β: 0.346, p = 0.001) was found to be statistically significant and positively correlated with sleep.

CONCLUSION

In our study, there is a relationship between nursing students' fear of COVID-19 and anxiety and sleep quality. Accordingly, it is recommended to train students in effective methods for coping with the fear of COVID-19, and to take initiatives to reduce related anxiety and sleep problems.

Sleep Patterns and Influencing Factors in Romanian Medical Students During the COVID-19 Pandemic: A Two-Wave Ecological Study

Introduction Sleep quality among students is variable with sleep disturbances being common worldwide. The coronavirus disease 2019 (COVID-19) pandemic led to major changes, including in the educational system. In this study, we aimed to analyze sleep patterns and screen time of medical students, and the effect of COVID-19. Material and methods We conducted a two-wave questionnaire-based ecological study on Romanian medical students from Târgu Mureș. For data collection, a 43-item questionnaire, structured into six categories, was designed and distributed through social networks and official online teaching platforms. Results Out of 751 answers from both waves, it was seen that most of the responders were female (76.23%, n=571) and in their preclinic years of study (61.33%, n=460). There was a statistically significant association between the form of education and students' general sleep quality (p=0.0010, OR=1.670, 95%CI: 1.228-2.271), their study time (5.5 hours, IQR: 4-7.5 versus five hours, IQR: 2.5-5, p<0.001) and their sleep disturbances (p=0.0008, OR=0.5859, 95%CI: 0.4284-0.8011). Also, there was a statistically significant association between the year of study and their study time (five hours, IQR: 4-7 versus four hours, IQR: 3-6, p<0.001) and their sleep satisfaction (p=0.0027, OR=0.6360, 95%CI: 0.4729-0.8554). Conclusions Students reported better general sleep quality, less trouble sleeping, and less study while studying online full-time. Also, students in clinical years tended to study less and be more satisfied with their sleep compared to students in preclinical years.

The relationship between sleep quality and anxiety and depression among older caregivers of centenarians in China: A cross-sectional study

To explore the relationship between sleep quality and anxiety and depression in older caregivers. From April 2020 to November 2022, GAD-7, GDS-15, and PSQI were used to measure anxiety, depression, and sleep quality. The correlation of each variable was explored by regression analysis. Among 442 caregivers ≥ 65 years old, the prevalence of sleep disorders, anxiety, and depression was 40.5 %, 20.2 %, and 26.4 %. After adjustment for multiple potential confounders, anxiety (OR1.1; 95 % CI 1-1.2) and depression (OR 1.29; 95 % CI 1.21-1.38) were associated with sleep disorders. Daytime dysfunction components of PSQI measurements were associated with anxiety(P < 0.05). Meanwhile, sleep efficiency, sleep medication use, and daytime dysfunction components of PSQI measurements were associated with depression(P < 0.05). Therefore, the sleep quality of older caregivers is strongly related to anxiety and depression. It is necessary to provide sleep guidance or professional intervention for older caregivers to reduce anxiety and depression.

Effects of digital sleep interventions on sleep and psychological health during the COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

Various digital sleep interventions have been implemented to address sleep and psychological complications during the coronavirus disease 2019 (COVID-19) pandemic. However, the characteristics and effectiveness of digital sleep interventions on sleep and psychological outcomes for people with sleep problems during the COVID-19 pandemic are unknown.

METHODS

The protocol of this systematic review and meta-analysis was registered on PROSPERO (ID: CRD42022325662), seven databases were searched from December 2019 to June 2023. Reference lists from digital sleep reviews were also identified and selected. Two reviewers independently screened eligible articles and extracted data. Quality appraisal was undertaken by two independent reviewers using the Cochrane Risk-of-Bias Tools. Data synthesis was conducted using fixed- or random-effects model based on the results of the heterogeneity test.

RESULTS

A total of 20 studies were identified, including nine randomised controlled trials (RCTs) and 11 non-RCTs, involving 3860 participants. Meta-analyses showed that digital sleep interventions significantly improve sleep quality, insomnia, and depression during the COVID-19 pandemic. Subgroup analysis showed that interventions of more than four weeks, healthcare workers as participants, and relaxation therapies may have the advantage of improving sleep quality. Most non-RCTs supported the efficacy of digital sleep interventions on sleep and psychological health.

CONCLUSION

Digital sleep interventions during the COVID-19 pandemic had significant effectiveness in improving sleep and psychological outcomes for people with sleep problems. More structured and personalised digital sleep interventions should be designed, and other diverse digital technologies could be used to improve sleep and psychological disorders.

Emotion regulation difficulties and sleep quality in adolescence during the early stages of the COVID-19 lockdown

INTRODUCTION

Adolescence is a period of vulnerability for emotion regulation and sleep difficulties, risks that might be compounded by intense COVID-19 lockdowns and challenges. The aim of this study was to investigate how sleep quality related to emotion regulation difficulties in adolescents during lockdown in Perú.

METHODS

Participants were 2563 adolescents enrolled in Innova school in Perú (11 - -17 years) in May 2020. Hypotheses were derived from exploring one half of the sample, preregistered at https://osf.io/fuetz/, and then confirmed in the second half of the sample. Participants completed subjective surveys of sleep quality (short PSQI) and the Difficulties in Emotion Regulation Scale Short Form (DERS-SF).

RESULTS

Worse sleep quality was robustly associated with more difficulties in emotion regulation across both samples. The association was found particularly for emotion regulation subscales related to the ability to engage in goal directed behavior in the face of distress, emotional clarity and strategies to deal with feeling distressed. In contrast, there was no robust association between sleep and the ability to regulate impulses in the context of negative emotions, and no association with the ability to accept emotions. Girls and older adolescents robustly endorsed worse sleep quality and more difficulties in emotion regulation.

LIMITATIONS

The cross-sectional nature of this study prevents us from determining the direction of the association. Data were collected using adolescent self-report which, while informative of adolescent perceptions, might diverge from objective measures of sleep or emotion regulation difficulties.

CONCLUSIONS

Our findings with adolescents in Perú contribute to our understanding of the association between sleep and emotion regulation at a broader global scale.

Relationship Between Physical Activity Level and Stress Perception: Exploring Factors During COVID-19 Pandemic

BACKGROUND

After the difficulty of the pandemic process, managing the long-term effects that may occur after the coronavirus disease 2019 (COVID-19) is among the biggest concerns in the present era. This study aimed to explore factors affecting the physical activity level and investigate the relationship between physical activity level and stress perception of university students during the COVID-19 pandemic. Study Design: A cross-sectional study.

METHODS

Study data were collected via online survey, and volunteer participants completed the survey through the survey link between October 21 and December 31, 2021. Physical activity level was evaluated by "The International Physical Activity Questionnaire- Short Form" (IPAQ-SF), and stress level was evaluated by "Perceived Stress Scale" (PSS). The participants were asked questions about barriers and motivators for physical activity before and during the pandemic.

RESULTS

The study included 444 participants (81.3% female and 18.7% male) with an average age of 21±2.95 years. The results showed a negative-significant linear relationship between perceived stress score and total physical activity, vigorous-intensity physical activity, and walking scores (r=-0.157, P<0.01; r=-0.16, P<0.01; r=-0.13, P<0.05 respectively). During the pandemic, the perception of insufficient finance became less important as a barrier (P=0.029), and healthcare professional (HCP) recommendation became more important as a motivator for physical activity than the pre-pandemic conditions (P=0.035).

CONCLUSION

The findings indicated that it is possible to reduce the level of perceived stress by increasing the level of physical activity. Current research will be a key for increasing and maintaining physical activity and reducing perceived stress.

Neuropsychiatric Outcomes and Sleep Dysfunction in COVID-19 Patients: Risk Factors and Mechanisms

The ongoing global health crisis due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has significantly impacted all aspects of life. While the majority of early research following the coronavirus disease caused by SARS-CoV-2 (COVID-19) has focused on the physiological effects of the virus, a substantial body of subsequent studies has shown that the psychological burden of the infection is also considerable. Patients, even without mental illness history, were at increased susceptibility to developing mental health and sleep disturbances during or after the COVID-19 infection. Viral neurotropism and inflammatory storm damaging the blood-brain barrier have been proposed as possible mechanisms for mental health manifestations, along with stressful psychological factors and indirect consequences such as thrombosis and hypoxia. The virus has been found to infect peripheral olfactory neurons and exploit axonal migration pathways, exhibiting metabolic changes in astrocytes that are detrimental to fueling neurons and building neurotransmitters. Patients with COVID-19 present dysregulated and overactive immune responses, resulting in impaired neuronal function and viability, adversely affecting sleep and emotion regulation. Additionally, several risk factors have been associated with the neuropsychiatric sequelae of the infection, such as female sex, age, preexisting neuropathologies, severity of initial disease and sociological status. This review aimed to provide an overview of mental health symptoms and sleep disturbances developed during COVID-19 and to analyze the underlying mechanisms and risk factors of psychological distress and sleep dysfunction.

The Influence of Multiple Community Level Traumatic Event Types on Mental Health Outcomes

Lebanon witnessed three large-scale negative community level events in 2020; a severe economic crisis, the COVID-19 pandemic, and an explosion in the port of the capital city, Beirut, which resulted in the deaths of 218 individuals and several thousand injured. The current study examined the relationship between the number of community level events individuals identified as personally impactful and corresponding levels of anxiety, depression, and symptoms of PTSD. The study also examined the roles of specific protective factors including perceived social support, resilience, and religious coping. A total of 406 participants aged between 18 to 64 years completed validated self-report measures online in February 2021. Results indicated elevated levels of mental health difficulties within the sample with over half of the participants reporting moderate to severe anxiety and moderate to severe depression and meeting the cut-off for probable PTSD. Females had significantly higher scores on measures of depression, anxiety, and PTSD. Individuals reporting all three events as negatively impactful were 47% more likely to meet the cut-off for PTSD than individuals identifying a single event. Resilience appeared to be the strongest protective factor against elevated scores on all three mental health outcomes. Higher scores on negative religious coping were also associated with elevated PTSD scores. Low levels of resilience, higher negative religious coping, and being a female were identified as significant predictors of reaching the PTSD cut-off using binary logistic regression analysis.

What a difference a year makes: Objective rest/activity patterns, circadian phase markers, and sleep quality before and during the COVID-19 pandemic

OBJECTIVES

The COVID-19 pandemic led to numerous changes in sleep duration, quality, and timing. The goal of this study was to examine objective and self-reported changes in sleep and circadian timing before and during the pandemic.

METHODS

Data were utilized from an ongoing longitudinal study of sleep and circadian timing with assessments at baseline and 1-year follow-up. Participants had baseline assessment between 2019 and March 2020 (before pandemic) and 12-month follow-up between September 2020 and March 2021 (during pandemic). Participants completed 7 days of wrist actigraphy, self-report questionnaires, and laboratory-collected circadian phase assessment (dim light melatonin onset).

RESULTS

Actigraphy and questionnaire data were available for 18 participants (11 women and 7 men, Mean = 38.8 years, SD = 11.8). Dim light melatonin onset was available for 11 participants. Participants demonstrated statistically significant decreases in sleep efficiency (Mean = -4.11%, SD = 3.22, P = .001), worse scores on Patient-Reported Outcome Measurement Information System sleep disturbance scale (Mean increase = 4.48, SD = 6.87, P = .017), and sleep end time delay (Mean = 22.4 mins, SD = 44.4 mins, P = .046). Chronotype was significantly correlated with change in dim light melatonin onset (r = 0.649, P = .031). This suggests that a later chronotype is associated with a greater delay in dim light melatonin onset. There were also non-significant increases in total sleep time (Mean = 12.4 mins, SD = 44.4 mins, P = .255), later dim light melatonin onset (Mean = 25.2 mins, SD = 1.15 hrs, P = .295), and earlier sleep start time (Mean = 11.4 mins, SD = 48 mins, P = .322).

CONCLUSION

Our data demonstrate objective and self-reported changes to sleep during the COVID-19 pandemic. Future studies should look at whether some individuals will require intervention to phase advance sleep when returning to previous routines such as returning to office and school settings.

The impact of the COVID-19 pandemic on sleep in children with Tourette syndrome in Ireland and the United Kingdom

STUDY OBJECTIVES

The aim of this mixed-methods study was to gain an insight through qualitative and quantitative means into the impact of the coronavirus disease 2019 (COVID-19) pandemic on children with and without Tourette syndrome (TS).

METHODS

Parents/guardians of children and adolescents with TS (n = 95; mean age = 11.2 years, standard deviation = 2.68 years) and typically developing controls (n = 86; mean age = 10.7 years, standard deviation = 2.8 years) in the United Kingdom and Ireland completed an online questionnaire examining sleep, with open-ended questions pertaining to their perceived impact of COVID-19 on the sleep of their children. Nine items from the Sleep Disturbance Scale for Children were used to supplement qualitative data.

RESULTS

A negative impact of the pandemic on the sleep of both groups was observed, including exacerbated tics, sleep deprivation, and anxiety, with particular disruption for children with TS. Parents of children with TS reported poorer sleep patterns than parents of typically developing children on the Sleep Disturbance Scale for Children. Analyses showed that group and age predicted 43.8% of variance in sleep duration: F (4, 176) = 34.2, P < .001.

CONCLUSIONS

Findings suggest that sleep patterns of children with TS may be more impacted by the pandemic than the average child. Given that there are generally more sleep issues reported in children with TS, further research is warranted in relation to the sleep health of children with TS in a postpandemic era. By identifying sleep issues potentially persisting after COVID-19, the true impact of the pandemic on the sleep of children and adolescents with Tourette syndrome may be ascertained.

CITATION

Colreavy E, Keenan L, Downes M. The impact of the COVID-19 pandemic on sleep in children with Tourette syndrome in Ireland and the United Kingdom. J Clin Sleep Med. 2023;19(8):1485-1493.

A decline in perceived social status leads to post-traumatic stress disorder symptoms in adults half a year after the outbreak of the COVID-19 pandemic: consideration of the mediation effect of perceived vulnerability to disease

Background/purpose

In December 2019, Wuhan, Hubei, China firstly reported the existence of the COVID-19 virus. It is crucial to prioritize the psychological well-being of citizens in lockdown cities and make more strides in the academic field of post-traumatic stress disorder (PTSD) to prepare for the post-pandemic era.

Methods

We took the cognitive-relational theory as our basis and collected Hubei province-level data (N = 3,465) to examine the impact of perceived social status decline on the prevalence of PTSD symptoms, and checked the mediating effect of perceived vulnerability to disease (PVD) during the period of psychological adjustment.

Results

Using propensity score matching, we estimate the average treatment effect of perceived social status decline on PTSD level, and we robustly regress the two with weight adjustment generated in matching. We found that more decline in perceived social status is associated with a worse degree of PTSD symptoms, and confirmed PVD's buffering role although the mediating effect was not as high as hypothesized.

Conclusion and implications

Our study confirmed the decisive role of subject social status in health prediction compared to traditional socioeconomic measures, which extends the cognitive-relational in examining socioeconomic status and contributes to the dialog on socioeconomic inequality. We also suggested providing more social support at the community level and enhancing individuals' positive understanding to protect mental health.