The relationship between fear of COVID-19 and mental health problems: A meta-analysis

The Role of Mindfulness in Reducing Depression During COVID-19 At-home Treatment

OBJECTIVE

Mindfulness is a promising psychological resource that can alleviate dysfunctional fear responses and promote mental health. We investigated how mindfulness affects fear and depression in isolated patients with coronavirus disease 2019 (COVID-19), and whether it acts as a mediator.

METHODS

We conducted an online survey of COVID-19 patients undergoing at-home treatment from February to April 2022. The survey included a questionnaire on fear of COVID-19 (measured by the Fear of COVID-19 Scale), mindfulness (measured by the Mindful Attention Awareness Scale), and depression (measured by the Patient Health Questionnaire). A total of 380 participants completed the questionnaire. We analyzed the correlation between each variable and performed a mediation analysis using hierarchical regression and bootstrapping to verify the statistical significance of the mediating effects.

RESULTS

Each variable was significantly correlated. Hierarchical regression analysis showed that the association between the fear of COVID-19 and depression decreased from 0.377-0.255, suggesting that mindfulness partially mediates the relationship between fear of COVID-19 and depression. Bootstrapping analysis showed that the indirect effect of the mediating variable (mindfulness) is 0.121, which accounts for 32.3% of the total effect.

CONCLUSIONS

Interventions that promote mindfulness in patients with acute COVID-19 may be beneficial for their mental health.

The impact of COVID-19 fear during the later stages of the pandemic on maladaptive eating, psychological distress and body weight: a global cross-sectional study

BACKGROUND

The COVID-19 pandemic significantly impacted global mental health, leading to increased levels of fear, stress, and anxiety [1]. Previous research has suggested associations between functional fear of detrimental mental health outcomes and psychological stressors which may drive maladaptive eating behaviors. This study explored the associations between COVID-19 fear during later stages of the pandemic, psychological distress (anxiety, depression, and stress), maladaptive eating behaviors (emotional, uncontrolled, binge, and nighttime eating), and self-reported body weight.

METHODS

This was a global cross-sectional survey conducted from February 2022 to February 2024, involving 4390 adults (70% female) from 25 countries. The survey collected information on demographics, psychosocial impact, eating behaviors, and COVID-19 related behaviors. General linear models, multinomial logistic regression modes, and structural equation modeling were used to analyze the data.

RESULTS

Higher fear of COVID-19 was significantly associated with increased emotional and uncontrolled eating, even after adjusting for psychological distress and other covariates. Specifically, each unit increase in fear of COVID-19 scores was associated with a corresponding increase in emotional eating (β = 0.018) and uncontrolled eating (β = 0.029) behaviors (p-values < 0.0001). Furthermore, fear of COVID-19 was linked to higher odds of engaging in binge eating (OR = 1.05, 95% CI: 1.03, 1.07, p-value < 0.0001) and nighttime eating behaviors (OR = 1.04, 95% CI: 1.03, 1.06, p-value < 0.0001) in models adjusted for covariates; however, these associations were no longer significant when psychological distress variables were included. Fear of COVID-19 was also associated with body weight (β = 0.18) and BMI (β = 0.08) even with adjustments of covariates and psychological distress variables (p-values < 0.01). Structural equation modeling showed that fear of COVID-19 was related to current body weight through its impact on psychological distress and maladaptive eating behaviors.

CONCLUSIONS

Maladaptive eating behaviors influenced by the psychological distress experienced during the COVID-19 pandemic have persisted into the later stages of the pandemic. These results underscore an interconnectedness between functional fear and its influence on maladaptive eating behaviors and body weight. Understanding this link is crucial and has the potential to inform the development of public health policies.

TRIAL REGISTRATION

Clinical Trials.gov NCT04896060 Date of Registration: May 21, 2021.

Validation of the Canadian English and French Versions of the Fear of COVID-19 Scale in Quebec Nursing Staff

Nursing staff have been at the forefront of the pandemic, reporting high traumatic stress and anxiety levels related to high fear of COVID-19. Recommendations from previous studies include using the Fear of COVID-19 Scale (FCV-19S) as a screening tool to identify any individuals who may benefit from targeted psychological support. Thus far, the accuracy of the Canadian English and French versions of FCV-19S to detect high levels of traumatic stress and anxiety symptoms has not been examined. The objectives of this methodological psychometric study were to examine among nursing staff: (a) the structure and internal consistency of the Canadian versions of the FCV-19S and (b) its ability in detecting high levels of traumatic stress and anxiety symptoms. An anonymous online survey was distributed among nursing staff (n = 387) in the province of Quebec (Canada). This survey included the FCV-19S and scales measuring their traumatic stress (PCL-5) and anxiety symptoms (GAD-7). Exploratory factor analysis and receiver operating characteristic (ROC) analyses were performed. The one-factor structure of the FCV-19S was supported (Cronbach alpha = 0.87). The FCV-19S showed better accuracy for the detection of traumatic stress (area under the curve (AUC) 0.75 [95% CI 0.68, 0.82]) in comparison to anxiety symptoms (AUC 0.65 [95% CI 0.60, 0.74]). The FCV-19S may benefit from adaptation for its use in nursing staff and in a future pandemic context.

Fear of COVID-19, traumatic growth, and traumatic stress symptoms: the mediating role of basic psychological needs

Although COVID-19 brought many negative psychological consequences, many people also experienced psychological growth. The present study investigated why this happened and hypothesized that self-determination theory's (SDT's) basic psychological needs (BPNs) may play a role in this explanation. Based on SDT, this cross-sectional study hypothesized that both the satisfaction and frustration of BPNs mediated the associations between fear of COVID-19, post-traumatic growth (PTG), and post-traumatic stress (PTS) symptoms. A sample of 391 Peruvian adults (70.6% women; Mage  = 35.04, age range between 18 and 84) responded to several valid and reliable questionnaires: Fear of COVID-19 Scale (FCV.19S); Basic Psychological Needs Satisfaction and Frustration Scale (BPNSFS); Impact Event Scale-Revised (IES-R); Post-Traumatic Growth Inventory (PTGI). The results showed that need satisfaction mediated the negative association between fear of COVID-19 and PTG, and need frustration mediated the positive association between fear of COVID-19 and PTG. In addition, a direct effect was found from fear of COVID-19 toward PTS symptoms. The results showed the importance of considering SDT's BPNs in explaining PTG and PTS after experiencing fear of COVID-19.

Imprint of ancestral and modern threats in human mind - experience of fear, disgust, and anger

Introduction

Threats to our survival are often posed by the environment in which humans have evolved or live today. Animal and human ancestors developed complex physiological and behavioral response systems to cope with two types of threats: immediate physical harm from predators or conspecifics, triggering fear, and the risk of infections from parasites and pathogens leading to the evolution of the behavioral immune system (BIS) with disgust as the key emotion. Here we ask whether the BIS has adapted to protect us from pandemic risks or poisoning by modern toxic substances.

Methods

We have developed a survey comprised of 60 vignettes describing threats evoking fear and disgust belonging to one of the three main categories of threats: (1) ancestral, (2) modern, and (3) pandemic of airborne disease. Each vignette was evaluated on a 7-point Likert scale based on fear, disgust, and anger. Respondents also completed an assessment battery.

Results

The results show that the strongest fear is triggered by modern threats (electricity, car accidents), while the highest disgust is evoked by ancient threats (body waste products, worms). Disgust does not respond to modern threat stimuli such as toxic substances or radioactivity as these evoke mainly fear and anger. A discriminant factor analysis classified nine out of 10 pandemic disgust vignettes into the ancestral disgust category, convincingly assigning the pandemic disgust threats to the ancestral type. Gender, age, and type of education were significant moderators of emotional responses across all threat categories.

Discussion

Our study reveals that while fear is more context-dependent, particularly triggered by modern threats, disgust operates on an evolutionarily hardwired basis, making it less effective against contemporary risks. Furthermore, disgust experienced during a pandemic outbreak is more closely aligned with ancestral disgust-related threats tapping into evolutionary ancient survival circuits of the BIS. However, as disgust declines with age, the brain must adaptatively shift the emotional processing from disgust to fear to protect older adults from contamination risks. Finally, our study reveals that pandemic fear is better predicted by specific behaviors rather than general anxiety, suggesting a need for new assessments.

Associations Between Transdiagnostic Psychological Processes and Global Symptom Severity Among Outpatients With Various Mental Disorders: A Cross-Sectional Study

OBJECTIVE

Knowledge about transdiagnostic factors associated with global symptom severity among patients diagnosed with various mental disorders remains limited. This study examined the cross-sectional associations between transdiagnostic processes including global emotion regulation and specific emotion regulation strategies (i.e., amount of physical activity and sedentary behaviour, repetitive negative thinking and sleep routines) with global symptom severity, while controlling for sociodemographic data (age, gender, employment status, relationship status, and educational level) and fear of the coronavirus.

METHODS

Data from 401 outpatients, aged 42.08 years on average (SD = 13.26; 71.3% female), diagnosed with depressive disorders, non-organic primary insomnia, agoraphobia, panic disorder and/or post-traumatic stress disorder were examined. This study is a secondary analysis of a randomized controlled trial. Data were collected from 10 different study sites between March 2021 and May 2022 for cross-sectional analysis. The influence of predictors of global symptom severity was determined using three-step hierarchical multiple regression: (1) control variables, (2) global emotion regulation and (3) specific emotion regulation strategies. Global symptom severity was measured using the Global Severity Index, derived from the Brief Symptom Inventory-18. Predictors were measured using validated scales, and physical activity was additionally assessed via accelerometer-based sensors.

RESULTS

In the first step, control variables accounted for 4% of variance in global symptom severity. The inclusion of global emotion regulation in the second step explained 26% of the outcome variance, and the incorporation of specific emotion regulation strategies in the third step increased the explained variance to 37%. Significant predictors included global emotion regulation (β = 0.28), repetitive negative thinking (β = 0.26) and sleep routines (β = 0.25).

CONCLUSION

Global emotion regulation along with repetitive negative thinking and sleep routines as specific emotion regulation strategies are identified as transdiagnostic psychological processes that may serve as treatment targets for evidence-based interventions designed to enhance emotion regulation, particularly in transdiagnostic samples of stress-related disorders. Additional prospective longitudinal studies with transdiagnostic samples are necessary to explore possible causal relationships.

Long-term impact of COVID-19 pandemic on fear of COVID-19 and psychological distress among the general population in Japan: a longitudinal study

OBJECTIVES

The long-term impact of the COVID-19 pandemic on the mental health issues of the general population in Japan is unclear. Thus, we examined the long-term effects of the COVID-19 pandemic on fear of COVID-19 and psychological distress and determined their causal relationships among the general population in Japan.

DESIGN AND SETTING

A longitudinal online survey was conducted by a Japanese online survey company to investigate the items regarding personal demographics, fear of COVID-19 (Japanese version of the fear of COVID-19 scale) and psychological distress (Japanese version of the Kessler 6 scale).

PARTICIPANTS

The participants were 274 individuals (women=44.2%) with a mean age of 51.6 years (SD=13.6) who responded to the online surveys in September 2020 (Time 1: T1) and January 2023 (Time 2: T2).

RESULTS

The paired t-test showed that fear of COVID-19 decreased significantly from T1 to T2 (t=2.79, df=273, p<0.01, d=0.16). The χ2 test showed that the proportion of those at high risk for psychological distress remained the same (χ2=1.33, df=1, n.s.). Furthermore, in a two-panel cross-lagged analysis to determine the causal relationship between fear of COVID-19 and psychological distress, fear of COVID-19 at T1 significantly predicted psychological distress at T2 (β=0.26, p<0.001). Additional multiple regression analyses adjusted for covariates (age, sex, marital status, COVID-19 status, etc) showed that worsening household finances (β=0.11, p<0.05) and avoiding contact with others (β=0.20, p<0.01) were associated with fear of COVID-19 at T2.

CONCLUSIONS

During the long-lasting COVID-19 pandemic, fear of COVID-19 decreased, but psychological distress did not change. In addition, fear of COVID-19 predicted psychological distress and was associated with poorer household finances and avoiding contact with others. Mental health professionals and policymakers should continue to support mental health issues following the long-lasting COVID-19 pandemic through interventions focused on promoting financial support and social interactions to reduce fear of COVID-19.

Impact of COVID-19 Infection and Related Social Concerns on Depressive Symptoms: Mediating Effects of Negative Changes in Daily Life and Moderating Effects of Age and Gender

OBJECTIVE

This study examined the mediating effect of negative changes in daily life due to the coronavirus disease-2019 (COVID-19) pandemic on depressive symptoms, considering COVID-19 infection and related social concerns. Additionally, comparisons of path coefficients between the groups were conducted based on age and gender.

METHODS

A cross-sectional study design used data from the 2020 Korean Community Health Survey consisting of 229,269 individuals. This study used a self-reported questionnaire, including the Patient Health Questionnaire-9 and three items addressing social concerns related to COVID-19 infection. A single question assessed whether individuals had experienced COVID-19 infection within the last 3 months, and scores of negative changes in daily life due to the COVID-19 pandemic. Correlation analysis was performed on the variables. Structural equation model analysis was conducted to identify the mediating role of negative changes in daily life. Chi-square tests were also performed to compare the path coefficients based on age and gender.

RESULTS

The structural equation models revealed that COVID-19 infection and related social concerns had both significant direct effects on depressive symptoms and indirect effects through negative changes in daily life. When comparing the path coefficients by age and gender, the coefficients related to depressive symptoms were highest in those under 65 years and in females.

CONCLUSION

Negative changes in daily life due to the COVID-19 pandemic serve as a partial mediator of the impact of COVID-19 infection and related social concerns on depressive symptoms. Special attention should be paid to depressive symptoms in those under 65 years of age and in females.

Unraveling the relationships among pandemic fear, cyberchondria, and alexithymia after China's exit from the zero-COVID policy: insights from a multi-center network analysis

Objective

China's abrupt exit from the zero-COVID policy in late 2022 led to a rapid surge in infections, overwhelming healthcare systems and exposing healthcare providers to intensified psychological pressures. This sudden shift exacerbated pandemic-related psychological issues, including fear, health anxiety, and emotional processing difficulties. This study aimed to unravel the relationships among pandemic fear, cyberchondria, and alexithymia following China's exit from the zero-COVID policy.

Methods

A multi-center cross-sectional survey was conducted among 4088 nurses from 43 public hospitals in China. The web-based survey comprised the Fear of COVID-19 Scale, Cyberchondria Severity Scale, and Toronto Alexithymia Scale. Network analysis was employed to explore the interconnections and identify central components within these psychological and behavioral constructs.

Results

The analysis revealed a dense network with predominantly positive connections. Specific aspects of cyberchondria and pandemic fear exhibited the highest strength centrality, indicating their critical influence. The externally oriented thinking dimension of alexithymia emerged as a crucial bridge node, linking pandemic fear and cyberchondria. The network structure demonstrated consistency across diverse educational backgrounds and career stages.

Conclusion

These findings highlight the need for targeted interventions focusing on key network components, particularly externally oriented thinking, to disrupt the detrimental cycle of pandemic fear and cyberchondria. Healthcare organizations should promote balanced objective fact-focused and problem-solving approaches while also fostering skills in emotional awareness and expression, thereby mitigating the risk of maladaptive pandemic fear responses and dysfunctional online health information-seeking behaviors.

Working from home and mental well-being at different stages of the COVID-19 pandemic

This paper analyses the relationship between working from home (WFH) and mental well-being at different stages during the first two critical years of the COVID-19 pandemic, when governments repeatedly imposed lockdowns and enacted WFH mandates to contain the spread of the virus. Using data from a representative survey conducted at four different time periods in 2020 (first lockdown, subsequent gradual reopening), 2021 (further lockdown) and 2022 (restrictions widely lifted) in the 27 EU member states, it examines the changing role of several mediators over time: work-family conflict, family-work conflict, stability, resilience, isolation, the importance of different support networks, workload, physical risk of contracting COVID-19 at work and housing conditions. For the first lockdown, it also differentiates by previous WFH experience, in terms of WFH novices and experienced WFH workers. It likewise differentiates by gender, in order to take the potential gendered nature of COVID-19 measures into account. The results point to several important mediators: for those who work from home, less family-work conflict and isolation, but greater stability, resilience, network support from family and friends, and superior housing conditions were associated with better mental well-being. The relevance of mediators was specific to certain stages of the pandemic. Stability was the most important mediator during the first lockdown. Work-family conflict and family-work conflict were only relevant during the first lockdown, while resilience and isolation mattered especially towards the end of the pandemic. Unlike established WFH workers, WFH novices had an advantage during the first lockdown, benefiting from lower family-work conflict and more helpful networks of family and friends. Our results differ by gender: for females who undertook WFH, important mediators were work-family conflict and family-work conflict. Both were related to adjustments they had to make in work and non-work hours in response to the enforced closure of schools and childcare facilities. For males who undertook WFH, support from networks of family and friends was an important mediator during the first lockdown.

"COVID-Collateral" Deaths

Study Design: This observational study focuses on select cases where death may have been related to COVID-related fears or the unintended consequences of protocols or public health mandates imposed during the COVID-19 pandemic. Objective: The objective of this study is to highlight examples of "COVID-collateral" deaths for the expressed purpose of preventing similar deaths in the future. Methods: The study represents a retrospective observational study from the case work at an academically-based regional medical examiners' office. Cases were selected based on identification of deaths that may have been related to COVID-19 fears, mandates or policies. Results: Six cases of COVID-collateral deaths are highlighted in this report, including cases where fear or isolation related to COVID-19 infection resulted in untreated exacerbation of an underlying disease/condition with eventual death, as well as cases where COVID-related psychological/mental stress or isolation played a role in suicide. Conclusions: Medical examiners/coroners should be aware of these cases if future pandemics or similar events occur, so that more thorough and accurate data regarding such deaths can be gathered. Public health officials, the medical community, and the general public also need to be aware of such cases so that appropriate preventive strategies can be employed.

Fear of COVID-19 predicts increases in anxiety, depressive symptoms, health anxiety, psychosocial distress, and loneliness: Findings from a prospective two-year follow-up study

The role of fear of COVID-19 in prospectively predicting changes in psychopathological symptoms during the COVID-19 pandemic remains unclear. The present data were obtained from a longitudinal non-probability sample in Germany, initially assessed at the beginning of the COVID-19 pandemic in Germany (April-May 2020) and reassessed after two years (n = 846; 83% female; mean age: 44.59 years, SD = 12.32; response rate: 19.5%). Multiple linear regressions were used to examine associations of fear of COVID-19 at baseline with depressive symptoms, anxiety, health anxiety, psychosocial distress, and loneliness controlling for (a) the respective symptom measure, and (b) all psychopathological symptoms at baseline. The data were weighted to minimize attrition and representativeness biases. Overall, loneliness decreased from the beginning of the COVID-19 pandemic until the two-year follow-up, whereas all other symptoms did not change. Fear of COVID-19 at the beginning of the pandemic predicted an increase in anxiety symptoms, health anxiety, psychosocial distress, and loneliness two years later. In addition, fear of COVID-19 predicted higher health anxiety, depressive symptoms, psychosocial distress, and loneliness, but not anxiety symptoms when controlling for all baseline symptom measures at once. Fear of COVID-19 seems to play a central role in predicting negative mental health outcomes, emphasizing the necessity of indicated prevention and intervention to decrease worry and manage anxiety, thereby reducing the negative impact on mental health caused by fear during future pandemics.

Intolerance of Uncertainty as a Situational Vulnerability Factor in the Context of the Pandemic: A Systematic Review and Meta-Analysis of COVID-19-Related Psychological Impacts

BACKGROUND

Intolerance of uncertainty (IU) is widely accepted as a transdiagnostic vulnerability factor for a range of mental health problems. It is considered a transsituational vulnerability factor associated with a range of responses to different stressful life situations. The aim of this systematic review and meta-analysis is to examine the association between IU and specific psychological responses to the COVID-19 pandemic and the moderators of this relationship drawn from IU research and other studies on COVID-19.

METHOD

The studies included were as follows: (i) English-language articles published in peer-reviewed journals or thesis/dissertations; (ii) reporting specific psychological impacts of COVID-19; (c) reporting IU; (iii) case-control studies, prospective cohort studies, experimental studies and cross-sectional studies of large populations and (iv) reporting correlation coefficients between the variables of interest. Studies on participants with a diagnosis of neurological and/or organic impairment were excluded. The databases searched were Google Scholar, PubMed, ScienceDirect, and ProQuest, up until 31 December 2022. The risk of bias was assessed using the Risk of Bias Utilized for Surveys Tool (ROBUST, Nudelman et al., 2020). Sensitivity analysis was conducted using the one-study remove method, and studentized residuals and Cook's distance were examined. A random effects model was used.

RESULTS

We examined the association between IU and COVID-19-related psychological impacts across 85 studies from 22 countries (N = 69,997; 64.95% female; mean sample age, 32.90 ± 9.70). There was no evidence of publication bias. We found a medium and positive association between IU and COVID-19-related psychological impacts (N = 69,562, r = 0.35, k = 89, 95% CI [0.32, 0.37]), which was independent of the IU measure used or whether the psychological impact was measured in relation to the virus alone or broader aspects of the pandemic. It was also independent of severity, publication year, sample type and size, study quality, age and sample levels of anxiety, depressive symptoms, stress, mental well-being and social support. However, the observed association varied significantly between countries and country income levels (stronger among low-incomes) and across genders (stronger among males) and was stronger for measures with greater reliability and more items, but lower among samples with more people who had been exposed to COVID-19.

CONCLUSIONS

The findings support that IU is a higher order transsituational vulnerability factor related to cognitive, behavioural and distress responses during the pandemic. Limitations include English-language-only sources, reliance on a wide range of measures that were coded using a novel system and variable risk of bias across studies. The implications are considered in relation to the management of psychological consequences of major situational stressors experienced at a global scale, but the variations at a national and socioeconomic level also have implications for different or localized stressors at a regional or community level.

An online game-based cognitive bias modification for interpretation (CBM-I) program to reduce fear during the COVID-19 pandemic: resilience as a moderator

Introduction

This study examined the training effects of an online game-based cognitive bias modification for interpretation (CBM-I) program in reducing fear during the COVID-19 pandemic in Hong Kong. In addition to investigating the changes in both proximal (i.e. negative and positive interpretations) and distal outcomes (i.e. fear of COVID-19), we examined whether individuals with higher baseline resilience levels would benefit more from the CBM-I program.

Methods

A total of 68 Hong Kong undergraduate students were randomized into either the CBM-I group or a control group, among which 66 participants completed the pretest, post-test, and follow-up on negative and positive interpretations, fear of COVID-19, and resilience.

Results

Compared to the control group, the CBM-I training group showed a significantly greater decrease in negative interpretations, a significantly greater increase in positive interpretations of COVID-19-related ambiguous scenarios, and a trend toward a greater reduction in fear of COVID-19. The CBM-I training was more effective at reducing fear among those with higher levels of resilience at baseline, whereas the control group showed the opposite effect, albeit to a lesser extent.

Conclusion

This online game-based CBM-I training shows the potential to modify the negative interpretation bias toward fear-inducing scenarios and contributes to the reduction of fear. Baseline screening of resilient individuals may optimize the training effects.

Religiosity of Latinas Living in the USA Curbs Depression and Anxiety During the COVID-19 Pandemic

This mixed-methods study was conducted to explore the role of faith in mental health among Latino women (Latinas) during the COVID-19 pandemic. As part of a lifestyle study, surveys were administered to 89 participants during the 1st year of the pandemic. Specifically, a focus group was conducted with participants (n = 6) directly affected by COVID-19 (i.e., self or family member). The results showed inverse correlations between religiosity and both depression and anxiety, as well as positive correlations among religious practices, religious coping, and religiosity. Given these associations, future interventions should explore the role of faith in supporting individuals during difficult times.

Sleep disorders during the COVID-19 pandemic: Results from the second phase of web-based EPICOVID19 study

The COVID-19 pandemic has induced significant impairments, including sleep disturbances. The present study aimed to explore the impact of fear in relation to stress on sleep disorders among Italian adults and older participants in the second phase of the EPICOVID19 web-based survey (January-February 2021). Sleep disturbances during the pandemic were evaluated using the Jenkins Sleep Scale, perceived stress through the 10-item Perceived Stress Scale and fear of contagion and about economic and job situation with four ad hoc items. The strength of the pathways between stress, sleep disturbances and fear was explored using structural equation modelling, hypothesising that stress was related to sleep disturbances and that fear was associated with both stress and sleep problems. Out of 41,473 participants (74.7% women; mean age 49.7 ± 13.1 years), 8.1% reported sleep disturbances and were more frequently women, employed in a work category at risk of infection or unemployed, and showed higher deprivation scores. Considering an a priori hypotheses model defining sleep and stress scores as endogenous variables and fear as an exogenous variable, we found that fear was associated with sleep problems and stress, and stress was associated with sleep problems; almost half of the total impact of fear on sleep quality was mediated by stress. The impact of stress on sleep quality was more evident in the younger age group, among individuals with a lower socioeconomic status and healthcare workers. Fear related to COVID-19 seem to be associated with sleep disturbances directly and indirectly through stress.

Insights from the EQUALS4COVID19 study on migrant mental health in Portugal: a cross-sectional mixed-methods approach

BACKGROUND

The COVID-19 pandemic and related disruptive consequences in the economic, health, and educational sectors have impacted people's lives, contributing to a context of increased economic and social vulnerability. The pandemic has revealed and accentuated social inequalities and discrimination based on racial or ethnic origin. This study aimed to contribute to the promotion of the mental health and well-being of migrant populations living in Portugal via the definition of an analytical framework and recommendations emerging from the EQUALS4COVID19 project.

METHODS

To gather information on the impact of the COVID-19 pandemic and resilience determinants among immigrants, a mixed-methods approach was implemented in 2022, combining a cross-sectional survey targeting immigrant adults in Portugal, focus groups with immigrants, focus groups with healthcare professionals, and in-depth individual interviews with stakeholders involved in the implementation of measures related to mental health and well-being during the pandemic. The analysis followed an integrated framework; quantitative data informed the script of qualitative data collection methods, and qualitative analysis informed the reinterpretation of quantitative data.

RESULTS

The survey with 604 Brazilian and Cape Verdean immigrants revealed that gender (being a woman) was associated with both psychological distress and depression-related symptomatology and that the perception of discrimination was a major risk factor for psychological suffering, while perceived social support and individuals' resilience characteristics were protective factors. Qualitative data provided deeper insights into these findings, revealing the ways mental health is affected by social structures, such as gender and ethnic hierarchies. Migrants tend to work in precarious jobs requiring physical presence, which, together with dense housing conditions, puts them at higher risk of infection. The deterioration of the economic conditions of the general population has also increased the perception of ethnic-racial discrimination, which was found to be related to the increase in insecurity and anxiety-related symptomatology among the migrant population. Newly arrived migrants, with reduced support networks, experienced a greater sense of insecurity as well as concern and anguish regarding relatives who live far away, in their home country. Migrant women reported greater family-related distress, including work-life balance problems.

CONCLUSIONS

Proposals to address mental health inequalities should be considered in the context of the necessary global changes both at the societal level and in the delivery of mental health services. Additionally, they should be considered with the active involvement of migrants, families, and communities in the design and delivery of mental health promotion and care processes.

Managing Fear During Pandemics: Risks and Opportunities

Fear is an emotion triggered by the perception of danger and motivates safety behaviors. Within the context of the COVID-19 pandemic, there were ample danger cues (e.g., images of patients on ventilators) and a high need for people to use appropriate safety behaviors (e.g., social distancing). Given this central role of fear within the context of a pandemic, it is important to review some of the emerging findings and lessons learned during the COVID-19 pandemic and their implications for managing fear. We highlight factors that determine fear (i.e., proximity, predictability, and controllability) and review several adaptive and maladaptive consequences of fear of COVID-19 (e.g., following governmental health policies and panic buying). Finally, we provide directions for future research and make policy recommendations that can promote adequate health behaviors and limit the negative consequences of fear during pandemics.

Leveraging Social Media to Predict COVID-19-Induced Disruptions to Mental Well-Being Among University Students: Modeling Study

BACKGROUND

Large-scale crisis events such as COVID-19 often have secondary impacts on individuals' mental well-being. University students are particularly vulnerable to such impacts. Traditional survey-based methods to identify those in need of support do not scale over large populations and they do not provide timely insights. We pursue an alternative approach through social media data and machine learning. Our models aim to complement surveys and provide early, precise, and objective predictions of students disrupted by COVID-19.

OBJECTIVE

This study aims to demonstrate the feasibility of language on private social media as an indicator of crisis-induced disruption to mental well-being.

METHODS

We modeled 4124 Facebook posts provided by 43 undergraduate students, spanning over 2 years. We extracted temporal trends in the psycholinguistic attributes of their posts and comments. These trends were used as features to predict how COVID-19 disrupted their mental well-being.

RESULTS

The social media-enabled model had an F1-score of 0.79, which was a 39% improvement over a model trained on the self-reported mental state of the participant. The features we used showed promise in predicting other mental states such as anxiety, depression, social, isolation, and suicidal behavior (F1-scores varied between 0.85 and 0.93). We also found that selecting the windows of time 7 months after the COVID-19-induced lockdown presented better results, therefore, paving the way for data minimization.

CONCLUSIONS

We predicted COVID-19-induced disruptions to mental well-being by developing a machine learning model that leveraged language on private social media. The language in these posts described psycholinguistic trends in students' online behavior. These longitudinal trends helped predict mental well-being disruption better than models trained on correlated mental health questionnaires. Our work inspires further research into the potential applications of early, precise, and automatic warnings for individuals concerned about their mental health in times of crisis.

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.

The Fear of COVID-19 Scale: Psychometric properties and measurement invariance across 10 months

The coronavirus disease 2019 (COVID-19) has led to various negative consequences including fear. The Fear of COVID-19 Scale (FCV-19S) has been widely used in diverse cultures, but no study has ever investigated its longitudinal measurement invariance and predictive validity. Therefore, we examined its longitudinal measurement invariance and predictive validity over 10 months. A sample of Chinese undergraduates (N = 682; first wave 842; 682 second wave) completed the FCV-19S as well as measures assessing depression, anxiety, and stress. Exploratory and confirmatory factor analyses were conducted along with measurement invariance testing. The results showed that the bifactor model fitted well, and significantly predicted stress and anxiety, but not depression. The FCV-19S demonstrated partial measurement invariance (i.e. configural and metric invariances) across time. These findings suggest that the Chinese version of FCV-19S is a reliable tool and could be used in evaluating the severity of fear of COVID-19 among Chinese young adults.

Multi-view graph-based interview representation to improve depression level estimation

Depression is a serious mental illness that affects millions worldwide and consequently has attracted considerable research interest in recent years. Within the field of automated depression estimation, most researchers focus on neural network architectures while ignoring other research directions. Within this paper, we explore an alternate approach and study the impact of input representations on the learning ability of the models. In particular, we work with graph-based representations to highlight different aspects of input transcripts, both at the interview and corpus levels. We use sentence similarity graphs and keyword correlation graphs to exemplify the advantages of graphical representations over sequential models for binary classification problems within depression estimation. Additionally, we design multi-view architectures that split interview transcripts into question and answer views in order to take into account dialogue structure. Our experiments show the benefits of multi-view based graphical input encodings over sequential models and provide new state-of-the-art results for binary classification on the gold standard DAIC-WOZ dataset. Further analysis establishes our method as a means for generating meaningful insights and visual summaries of interview transcripts that can be used by medical professionals.

Motivating Protective Behavior against COVID-19: Fear Versus Hope

OBJECTIVES

Based on protection motivation theory, we investigate how indicators of threat perception (perceived severity, perceived vulnerability, and fear arousal) and coping appraisal (hope) are associated with older people's motivation to engage in protective behavior after the outbreak of COVID-19.

METHODS

We use multivariate regression analyses with a sample of 40,282 individuals from 26 countries participating in the SHARE Corona Survey.

RESULTS

We find that 15% of all respondents stayed home completely-mainly the oldest and vulnerable people with prior health risk conditions. On average, older Europeans responded strongly to the recommended protective behavior measures (6 out of 7 measures adopted). Among the threat perception indicators, fear arousal is the main motivator for protective behavior, whereas the coping appraisal indicator hope shows an equally strong association.

DISCUSSION

Given the negative health effects of fear, our findings may help evaluate and revise governmental policy responses and communication strategies.

The burden of infectious diseases throughout and after the COVID-19 pandemic (2020-2023) and Russo-Ukrainian war migration

Understanding how the infectious disease burden was affected throughout the COVID-19 pandemic is pivotal to identifying potential hot spots and guiding future mitigation measures. Therefore, our study aimed to analyze the changes in the rate of new cases of Poland's most frequent infectious diseases during the entire COVID-19 pandemic and after the influx of war refugees from Ukraine. We performed a registry-based population-wide study in Poland to analyze the changes in the rate of 24 infectious disease cases from 2020 to 2023 and compared them to the prepandemic period (2016-2019). Data were collected from publicly archived datasets of the Epimeld database published by national epidemiological authority institutions. The rate of most of the studied diseases (66.6%) revealed significantly negative correlations with the rate of SARS-CoV-2 infections. For the majority of infectious diseases, it substantially decreased in 2020 (in case of 83%) and 2021 (63%), following which it mostly rebounded to the prepandemic levels and, in some cases, exceeded them in 2023 when the exceptionally high annual rates of new cases of scarlet fever, Streptococcus pneumoniae infections, HIV infections, syphilis, gonococcal infections, and tick-borne encephalitis were noted. The rate of Clostridioides difficile enterocolitis was two-fold higher than before the pandemic from 2021 onward. The rate of Legionnaires' disease in 2023 also exceeded the prepandemic threshold, although this was due to a local outbreak unrelated to lifted COVID-19 pandemic restrictions or migration of war refugees. The influx of war migrants from Ukraine could impact the epidemiology of sexually transmitted diseases. The present analysis indicates that continued efforts are needed to prevent COVID-19 from overwhelming healthcare systems again and decreasing the control over the burden of other infectious diseases. It also identifies the potential tipping points that require additional mitigation measures, which are also discussed in the paper, to avoid escalation in the future.

Prevalence of obsessive-compulsive symptoms and their psychosocial correlates among medical students during COVID-19 pandemic

This study aimed to assess the prevalence of obsessive-compulsive symptoms (OCS) among medical students during COVID-19 pandemic and to evaluate their association with related sociodemographic features and other psychological symptoms. In this cross-sectional study, students from Mashhad University of Medical Sciences with no major exam in the preceding or following month were surveyed during April to August 2021 through stratified available sampling. Data were collected by a structured online questionnaire distributed through social media platforms. OCS were assessed using Obsessive-Compulsive Inventory-Revised (OCI-R) and COVID-related stress was evaluated using COVID Stress Scale (CSS). Overall, 347 students with a mean age of 22.67 ± 2.56 years were included in this study, of whom 30.3% had probable obsessive-compulsive disorder (OCD; OCI-R score ≥21). Mean CSS scores in students with and without probable OCD were 38.64 ± 19.82 and 26.72 ± 16.63, respectively ( P  < 0.005). Total CSS score was significantly correlated with OCI-R score ( r  = 0.38, P  = 0.001). Around one-third of the medical students reported significant OCS during COVID-19 pandemic, which was associated with higher COVID-19-related stress. Further research provides insight into management of OCD and related disorders during the COVID-19 pandemic.

Determinants of Telemedicine Service Use Among Middle-Aged and Older Adults in Germany During the COVID-19 Pandemic: Cross-Sectional Survey Study

Background

The occurrence of the COVID-19 pandemic demanded fast changes in the delivery of health care. As a result, significant growth in the use of telemedicine services occurred. Research, especially from nationally representative German samples, is needed to better understand determinants of telemedicine use.

Objective

The purpose of this study was to identify determinants of telemedicine service use among middle-aged and older adults during the COVID-19 pandemic in Germany.

Methods

Cross-sectional, nationally representative data were taken from the German sample of the Survey of Health, Ageing and Retirement in Europe (SHARE). The German Corona Survey 2 (n=2039), which was conducted between June and August 2021, was used for this study. Reporting experience with remote medical consultations during the COVID-19 pandemic served as the outcome measure. Associations with socioeconomic, psychological, social, health-related, and COVID-19-related determinants were examined using multiple Firth logistic regressions.

Results

Psychological factors including feeling nervous, anxious, or on edge (odds ratio [OR] 1.61, 95% CI 1.04-2.50; P=.03), feeling sad or depressed (OR 1.62, 95% CI 1.05-2.51; P=.03) and feelings of loneliness (OR 1.66, 95% CI 1.07-2.58; P=.02) were positively associated with telemedicine use. Moreover, forgoing medical treatment because of being afraid of being infected by SARS-CoV-2 (OR 1.81, 95% CI 1.10-2.97; P=.02) and describing limitations because of a health problem as severe were positively associated with the outcome (OR 2.11, 95% CI 1.12-4.00; P=.02). Socioeconomic and social factors were not significantly associated with telemedicine use in our sample.

Conclusions

Middle-aged and older individuals in Germany seem to use telemedicine services according to psychological needs and health limitations. Especially when psychological symptoms are experienced, telemedicine seems to be a promising service option in this age group. Future research is needed to confirm these initial findings in postpandemic circumstances.

PTSD prevalence and factors in intern nursing students after COVID-19 full liberalization in China: a cross-sectional study

Objective

This study aimed to assess the prevalence of post-traumatic stress disorder (PTSD) and its influencing factors among intern nursing students after the full liberalization of the COVID-19 prevention and control policy in China.

Methods

Participants completed the online survey from January 14 to January 19, 2023. A demographic questionnaire, COVID-19 and internship-related questionnaire, the Fear of COVID-19 scale, the Primary Care PTSD Screen, and the Connor-Davidson Resilience Scale were used to conduct the online survey.

Results

Of 438 participants, 88.4% tested positive for COVID-19 in the last 6 months. The prevalence of fear, resilience, and PTSD was 16.9, 15.5, and 11.2%, respectively. Direct care of COVID patients in hospital (OR = 2.084, 95%CI 1.034 ~ 4.202), the experience of occupational exposure (OR = 2.856, 95%CI 1.436 ~ 5.681), working with an experienced team (OR = 2.120, 95%CI 1.070 ~ 4.198), and fear COVID-19 (OR = 8.269, 95%CI 4.150 ~ 16.479) were significantly and positively associated with PTSD in nursing internship students.

Conclusion

After COVID-19 full liberalization in China, intern nursing students still experienced pandemic-related mental distress, which can bring PTSD. Adequate support and counseling should be provided, as needed, to intern nursing students who are about to enter the workforce and have experienced severe PTSD symptoms related to COVID-19. Our findings indicated that should understand the importance of screening, formulate intervention strategies and preventive measures to address psychosocial problems, and provide coping skills training to intern nursing students.

Psychosocial stress, adult suicidal ideation, and the mediating effect of poor sleep quality during the COVID-19 pandemic in South Africa

OBJECTIVES

South Africa instituted one of the world's strictest lockdowns during the COVID-19 pandemic, which generated heightened conditions of psychosocial stress and posed widespread mental health risks. Despite the elevated burdens of suicidal behaviors and risk of psychiatric disease in the country, few studies have examined the impacts of psychosocial stress from the pandemic on suicidal ideation in South Africa. This study examined the association between psychosocial stress experienced under the COVID-19 pandemic and adult suicidal ideation, as well as degree to which sleep quality and duration mediated this relationship.

METHODS

An online survey assessed experiences of COVID-19 psychosocial stress, sleep quality and duration, and suicidal ideation in a sample of 189 South African adults during the second and third waves of the COVID-19 pandemic. A causal inference framework for mediation analysis was used to assess the degree to which sleep quality and duration explained the association between COVID-19 psychosocial stress and suicidal ideation.

RESULTS

Suicidal ideation was reported in 21% of adults. Adults described having moderate sleep quality and an average of 6.9 hours of sleep per night. COVID-19 psychosocial stress significantly predicted adult suicidal ideation in fully adjusted models. Sleep quality, but not sleep duration, significantly mediated the association between COVID-19 psychosocial stress and suicidal ideation, accounting for 25.9% of the total effect.

CONCLUSIONS

Poor sleep quality may play an important role in exacerbating the alarming stress-induced mental health effects of the COVID-19 pandemic. Further research is necessary to understand the underlying sleep dynamics and associated psychological and neurobiological processes that perpetuate adult suicidal ideation.

Relationship between fear of COVID-19 and mental health of Chinese nurses: The mediating effects of psychological capital and burnout

AIM

The aim of the study was to investigate the correlation between fear of COVID-19 and mental health of nurses and the effects of psychological capital and burnout in this relation.

DESIGN

A cross-sectional study.

METHODS

The online surveys were conducted among mainland Chinese nurses. Participants (n = 445; average age 32.89 ± 6.76 years) completed an online-questionnaire based on the Fear of COVID-19 Scale, the Psychological Capital Scale, Maslach Burnout Inventory Human Services Survey for Medical Professionals Scale and the 12-Item Short Form Health Survey. Data analysis was conducted by Pearson's correlation analysis, Harman single-factor test and the bootstrap method for mediating effect testing.

RESULTS

(1) The study demonstrated a significant direct effect of fear of COVID-19 on nurses' mental health, as well as on mediating factors such as burnout and psychological capital. (2) Regression analyses confirmed that while psychological capital bolstered mental health, burnout undermined it, with fear of COVID-19 further imposing a negative influence. (3) Fear of COVID-19 exerted an effect on the mental health of nurses by the independent and chain intermediary functions of psychological capital and burnout, resulting in a total mediating effect of -0.233.

Feeling safe together vs. longing for touch. Affective, multisensorial contact in inclusive intra-active virtual/physical dance during the COVID-19 pandemic

This article explores how feelings of safety were experienced through inclusive virtual/physical dance in relation to experiences of touch during the COVID-19 pandemic in Finland. The following are the measures I took to achieve the aim of this study. First, I introduce the context through previous studies and an example from the ethnographic material I gained from the inclusive X-Dance festival organized in June 2021 in Finland. Second, I explore how inclusive virtual/physical dance might help us experience feelings of safety through multisensorial experiences of touch related to communality when responding to wellbeing challenges caused by isolation. Using Laura U. Mark's theory about haptic looking and Karen Barad's term intra-action, I discuss different possibilities to approach touch as a feeling sense, as affective multisensorial contact, and through relations between different materialities. Third, I contrast these ideas with sensations of longing for the physical touch that virtual/physical dancing evokes. These experiences of longing invite me to reflect on the ambivalence about feelings of safety related to intentions to restore experiences of touch and communality through digitality. I introduce two examples from my interviews with dancers during the pandemic to discuss these ambivalences. I reflect on these interviews through Magdalena Górska's theory about corpo-materiality and corpo-affectivity. I contribute to discussions on feelings of safety by showing that multi-sensorial experiences and anti-normative understandings of body and touch enabled by the non-verbal language of dance may help us to contribute toward more inclusiveness in society, allowing us to generate holistic experiences of safety, which is another critical aim for post-pandemic times.

Social support, self-efficacy, self-esteem, and well-being during COVID-19 lockdown: A two-wave study of Danish students

Societal lockdown due to the COVID-19 pandemic has transformed everyday life across the globe, including requirements of social distancing that might limit the social support people derive from social interaction. Social support has proven to be a vital resource for well-being (i.e., perceived stress and satisfaction with life) and coping during societal challenges. The present study examined how social support is associated with perceived stress and life satisfaction through self-efficacy and self-esteem among Danish students (N = 204). These psychological constructs were examined both during and after lockdown, assessing the possible aversive psychological effects of the COVID-19 pandemic. Results did not yield any significant changes in either the mean scores of the constructs or the indirect effects model across the two time points. Moreover, the results indicate that social support derived from a significant person, family, and friends - but not student peers - is negatively linked with perceived stress and positively associated with life satisfaction through both self-efficacy and self-esteem. Although societal lockdown did not yield significant psychological impact, the results highlight the importance of social support among students, both during and after lockdown.

The relationship between perception of COVID-19, fear of COVID-19 and self-care management in individuals with chronic diseases during the pandemic process in Turkey

AIMS

To determine the relationship between perception of COVID-19, fear of COVID-19 and self-care management in individuals with chronic diseases during the pandemic process.

BACKGROUND

Individuals with chronic diseases are a sensitive group during the COVID-19 pandemic process; it is thought that self-care management may be adversely affected as a result of their more intense exposure to the psychological, physiological and economic effects of the pandemic. In the literature, there is no study examining the effect of perception of COVID-19 and fear of COVID-19 on self-care management in individuals with chronic diseases.

DESIGN

Descriptive study.

METHODS

The study was conducted with 322 individuals who applied to the internal medicine outpatient clinics of a university's Health Practice and Research Center, met the inclusion criteria, agreed to participate in the study and had a chronic disease. Questionnaire form, Perception of COVID-19 Scale (P-COVID-19), The Fear of COVID-19 Scale (FCV-19S) and Self-Care Management Process in Chronic Illness Scale (SCMP-G) were used to collect data. STROBE checklist was used to report the present study.

RESULTS

In the study, it can be stated that individuals with chronic diseases had a moderate to the high perception of contagiousness and dangerousness of COVID-19, they had a moderate-high level of fear of COVID-19 and their self-care care management was above moderate level. There was a significant positive correlation between P-COVID-19, FCV-19S and SCMP-G in the study.

CONCLUSIONS

It was found that the perception of COVID-19 contagiousness and the fear of COVID-19 had a positive effect on the self-care management of individuals with chronic diseases.

RELEVANCE TO CLINICAL PRACTICE

Determining the level of COVID-19 perception and fear of COVID-19 and their effects on the life of the individual, and evaluating self-care management during the difficult pandemic process will increase the success in the holistic nursing care and management of chronic diseases.

The Mediating Role of Fear of COVID-19 in the Association between COVID-19-Related Work Stressors and Subjective Well-being: Path Analysis by Cross-sectional Evidence in the Child Care Sector across Three Samples

OBJECTIVE

COVID-19 has changed work conditions and instilled fear. However, research overlooked the contributing factors to fear of COVID-19 and its impact on well-being. We addressed this research gap and focused on the essential workforce of child care.

METHODS

Three samples of early childhood professionals (ECPs) ( NT1 = 423, NT2 = 142, NT3 = 584) were gathered in Germany between June 2020 and May 2021. We tested via path analysis whether (1) fear of COVID-19 relates to well-being, (2) COVID-19-related work stressors relate to fear of COVID-19, and (3) fear of COVID-19 mediates the relationship of work stressors and well-being.

RESULTS

Findings of N T1 and N T3 lent support, while results of N T2 differed.

CONCLUSIONS

This study underlines the importance of adapting the work conditions during pandemics to reduce the fear of infection and thus preserve ECPs' well-being.

Oxytocin as a transdiagnostic biomarker of well-being in severe mental illness during the Covid-19 pandemic

Individuals with severe mental illness (SMI) have been found to suffer a greater decline in psychological well-being compared to the general population in times of stress. The present study aimed to examine clinical and endocrine resilience factors of psychological well-being in SMI patients during the Covid-19 pandemic.

METHODS

After Covid-19 crisis outburst in Israel 112 participants, 69 outpatients, and 43 inpatients and day treatment patients were recruited. Outpatients signed an online informed consent and filled in questionnaires regarding their level of mental health symptoms (OQ-45), fear of Covid-19 (FCV), and psychological well-being (PWB). Inpatients answered the same questionnaires and in addition, went through a positive social interaction paradigm while providing three saliva samples to measure their s-IgA and oxytocin (OT) levels.

RESULTS

A strong negative correlation was found in the whole sample between reported mental health symptoms, fear of Covid-19, and well-being. Hierarchical regression did not find additional contribution of the fear of the pandemic in predicting well-being beyond the impact of symptomatology. For inpatients (N = 39) only, hierarchical regression found that oxytocin, but not s-IgA could explain 5% of the variance of well-being (R2 = 0.05) in individuals with SMI regardless of their mental health symptoms (R2 = 0.46) and their marital status (R2 = 0.21).

CONCLUSIONS

OT is suggested as a possible independent biological resilience factor of well-being in times of major stress among SMI patients. It is still unknown whether OT is a mediator that contributes to well-being or a biological marker that indicates the degree of beneficial social interactions.

A Preference-Based Value Assessment of the Fear of COVID-19 Contagion

Purpose

To assess the preference-based value of the fear of COVID-19 contagion.

Patients and Methods

We conducted a web-based, cross-sectional discrete choice experiment among 544 US adults. We used a Bayesian efficient design to generate choice sets. Each choice set comprised two hypothetical COVID-19 vaccine options characterized by seven attributes: chance of COVID-19 infection, chance of having severe symptoms from COVID-19 infection, vaccine protection duration, chance of mild to moderate adverse events from vaccination, chance of serious adverse events from vaccination, chance of future exposure to COVID-19 after vaccination, and out-of-pocket cost. We used mixed logit (ML) and latent class (LC) models to analyze data. Furthermore, we calculated the willingness-to-pay for eliminating the chance of future exposure to COVID-19, shedding light on the value attributed to the fear of contagion.

Results

The ML model demonstrated all attributes, including the chance of future exposure to COVID-19, were statistically significant. The participants were willing to pay approximately $13,046 to eliminate the chance of future exposure to COVID-19 or their fear of contagion when COVID-19 was still pandemic. The LC model unveiled two participant classes with distinct preference weights for the chance of future exposure to COVID-19 and out-of-pocket cost attributes. Nevertheless, the chance of future exposure to COVID-19 exposure held a significant degree of importance in both classes.

Conclusion

The chance of future exposure to COVID-19 exposure or fear of contagion was a significant element in the value assessment of COVID-19 vaccines. Further studies should be conducted to verify the value of fear of contagion and include it in the value assessment of healthcare technologies for infectious diseases.

Association Between Negative Affect and Perceived Mortality Threat During the COVID-19 Pandemic: The Role of Brain Activity and Connectivity

The prevalence of the novel coronavirus (COVID-19) has been considered a major threat to physical and mental health around the world, causing great pressure and mortality threat to most people. The current study aimed to investigate the neurological markers underlying the relationship between perceived mortality threat (PMT) and negative affect (NA). We examined whether the regional amplitude of low-frequency fluctuations (ALFF) and resting-state functional connectivity (RSFC) before the COVID-19 outbreak (October 2019 to December 2019, wave 1) were predictive for NA and PMT during the mid-term of the COVID-19 pandemic (February 22 to 28, 2020, wave 2) among 603 young adults (age range 17-22, 70.8% females). Results indicated that PMT was associated with spontaneous activity in several regions (e.g., inferior temporal gyrus, medial occipital gyrus, medial frontal gyrus, angular gyrus, and cerebellum) and their RSFC with the distributed regions of the default mode network and cognitive control network. Furthermore, longitudinal mediation models showed that ALFF in the cerebellum, medial occipital gyrus, medial frontal gyrus, and angular gyrus (wave 1) predicted PMT (wave 2) through NA (wave 2). These findings revealed functional neural markers of PMT and suggest candidate mechanisms for explaining the complex relationship between NA and mental/neural processing related to PMT in the circumstance of a major crisis.

Factors Affecting COVID-19-Related Fear and Burnout in Surgical Nurses

BACKGROUND

Surgical nurses face the risk of psychological problems while trying to cope with the challenges arising from the COVID-19 pandemic.

AIM

This study aimed to determine levels of COVID-19-related fear and burnout and affecting factors in surgical nurses.

DESIGN

The study has a descriptive, cross-sectional design.

METHODS

The study sample included 321 nurses working in surgical units and operation rooms in Turkey. Data were gathered with a sociodemographic and occupational characteristics form, the Fear of COVID-19 Scale and the COVID-19 Burnout Scale through a Google form between 1 August and 15 October in 2021. Obtained data were analyzed with independent groups t-test, One-Way ANOVA and simple and multiple linear regression analyses.

RESULTS

The nurses had moderate levels of fear (20.00 ± 6.77; Min-Max: 7-35) and burnout (29.52 ± 10.03; Min-Max:10-50) due to COVID-19. The female gender and belief in health staff shortage were predictive of fear and burnout related to COVID-19. Age was not predictive of COVID-19 fear and receiving education about COVID-19, exposure to violence, having adequate supplies of goggles/face shields and having a limited number of aprons/work wear were not predictive of COVID-19-related burnout. Fear of COVID-19 was predictive of COVID-19 burnout.

CONCLUSIONS

Female nurses and nurses believing in health staff shortage had higher levels of fear and burnout due to COVID-19. As COVID-19 fear increased, so did COVID-19 burnout. Nurses working in surgical units should be provided with education about coping strategies taking account of the factors affecting COVID-19-related fear and burnout.

Social and Psychological Effects of COVID-19 Pandemic on Adolescents' and Young Adults' Mental Health: A Cross-Cultural Mediation Study

The ongoing pandemic has dramatically disrupted daily life, increasing the risk of developing psychiatric disorders and poor mental wellbeing. The compound effects of social, political and psychological stressors have increased psychological symptoms among adolescents and young people, with worries about COVID-19 playing a central role in the clinical course of their mental health problems caused by the pandemic. The aim of this cross-cultural study was to examine the social psychological effects of COVID-19 on adolescents' and young people's mental health and wellbeing in Ibero-American population. Participants involved 6,283 adolescents and young adults from five different Spanish-Speaking countries (83.7% female) aged between 12 and 30 years (M = 18.79; SD = 3.48). Participants completed the Worries about COVID-19 and its Consequences Scale (W-COV), the Satisfaction with Life Scale (SWLS), and the Depression, Anxiety and Stress Scale (DASS-21). Descriptive analyses, multivariate ANOVAs and Pearson correlations were performed, as well as Structural Equation Modelling (SEM) testing a mediational model. The results indicate cross-cultural difference in COVID-19 related worries, emotional symptoms and life satisfaction. Results from SEM confirmed the overall indirect effects of COVID-19 cases, political response and participants' conditions during lockdown on depression, anxiety, stress and life satisfaction mediated by COVID-19 related worries. These findings suggest that the social psychological factors underlying psychological symptoms could be partly explained by increased worries about COVID-19 and its personal, social, economic and political consequences, which may offer guidance to policy makers and health services for safeguarding youth mental well-being.

The Mental Health Impacts of a Pandemic: A Multiaxial Conceptual Model for COVID-19

The COVID-19 pandemic substantially impacted the mental health of the general population and particularly vulnerable individuals and groups. A wealth of research allows for estimating this impact and identifying relevant factors contributing to or mitigating it. The current paper presents and synthesizes this evidence into a multiaxial model of COVID-19 mental health impacts. Based on existing research, we propose four axes: (1) Exposure to COVID-related events; (2) Personal and social vulnerability, such as previous mental health problems or belonging to a vulnerable group; (3) Time, which accounts for the differential impacts throughout the development of the pandemic; and (4) Context, including healthcare and public policies, and social representations of the illness influencing individual emotional reactions and relevant behaviors. These axes help acknowledge the complexity of communities' reactions and are pragmatic in identifying and prioritizing factors. The axes can provide individual information (i.e., more exposure is harmful) and account for interactions (e.g., exposure in an early phase of the pandemic differs from a later stage). This model contributes to the reflections of the evidence and informs the mental health response to the next pandemic.

Prevalence of COVID-19 fear and its association with quality of life and network structure among Chinese mental health professionals after ending China's dynamic zero-COVID policy: a national survey

Background

China recorded a massive COVID-19 pandemic wave after ending its Dynamic Zero-COVID Policy on January 8, 2023. As a result, mental health professionals (MHPs) experienced negative mental health consequences, including an increased level of fear related to COVID-19. This study aimed to explore the prevalence and correlates of COVID-19 fear among MHPs following the end of the Policy, and its association with quality of life (QoL) from a network analysis perspective.

Methods

A cross-sectional national study was conducted across China. The correlates of COVID-19 fear were examined using both univariate and multivariate analyses. An analysis of covariance (ANCOVA) was conducted to determine the relationship between fear of COVID-19 and QoL. Central symptoms were identified using network analysis through the "Expected Influence" of the network model while specific symptoms directly correlated with QoL were identified through the "flow function."

Results

A total of 10,647 Chinese MHPs were included. The overall prevalence of COVID-19 fear (FCV-19S total score ≥ 16) was 60.8% (95% CI = 59.9-61.8%). The binary logistic regression analysis found that MHPs with fear of COVID-19 were more likely to be married (OR = 1.198; p < 0.001) and having COVID-19 infection (OR = 1.235; p = 0.005) and quarantine experience (OR = 1.189; p < 0.001). Having better economic status (good vs. poor: OR = 0.479; p < 0.001; fair vs. poor: OR = 0.646; p < 0.001) and health status (good vs. poor: OR = 0.410; p < 0.001; fair vs. poor: OR = 0.617; p < 0.001) were significantly associated with a lower risk of COVID-19 fear. The ANCOVA showed that MHPs with fear of COVID-19 had lower QoL [F = 228.0, p < 0.001]. "Palpitation when thinking about COVID-19" was the most central symptom in the COVID-19 fear network model, while "Uncomfortable thinking about COVID-19" had the strongest negative association with QoL (average edge weight = -0.048).

Conclusion

This study found a high prevalence of COVID-19 fear among Chinese MHPs following the end of China's Dynamic Zero-COVID Policy. Developing effective prevention and intervention measures that target the central symptoms as well as symptoms correlated with QoL in our network structure would be important to address COVID-19 fear and improve QoL.

Interrelations of resilience factors and their incremental impact for mental health: insights from network modeling using a prospective study across seven timepoints

Resilience can be viewed as trajectory of stable good mental health or the quick recovery of mental health during or after stressor exposure. Resilience factors (RFs) are psychological resources that buffer the potentially negative effects of stress on mental health. A problem of resilience research is the large number of conceptually overlapping RFs complicating their understanding. The current study sheds light on the interrelations of RFs in the face of the COVID-19 pandemic as a use case for major disruptions. The non-preregistered prospective study assessed a sample of 1275 German-speaking people from February 2020 to March 2021 at seven timepoints. We measured coping, hardiness, control beliefs, optimism, self-efficacy, sense of coherence (SOC), sense of mastery, social support and dispositional resilience as RFs in February 2020, and mental health (i.e., psychopathological symptoms, COVID-19-related rumination, stress-related growth) at all timepoints. Analyses used partial correlation network models and latent growth mixture modeling (LGMM). Pre-pandemic RFs were strongly interrelated, with SOC being the most central node. The strongest associations emerged between coping using emotional support and social support, SOC and sense of mastery, and dispositional resilience and self-efficacy. SOC and active coping were negatively linked. When we examined RFs as predictors of mental health trajectories, SOC was the strongest predictor of psychopathological symptoms and rumination, while trajectories of stress-related growth were predicted by optimism. Subsequent network analyses, including individual intercepts and slopes from LGMM, showed that RFs had small to moderate associations with intercepts but were unrelated to slopes. Our findings provide evidence for SOC playing an important role in mental distress and suggest further examining SOC's incremental validity. However, our results also propose that RFs might be more important for stable levels of mental health than for adaptation processes over time. The differential associations for negative and positive outcomes support the use of multidimensional outcomes in resilience research.

The Relationship Between Fear and Anxiety Among Chinese Uninfected Residents During the Pandemic: A Conditional Process Analysis

Background

This study aimed to explore the relationship between residents' COVID-19 fear and anxiety, consider whether this relationship is mediated through obsessions and the moderating role of self-efficacy on this mediating pathway.

Methods

This study used an online questionnaire to obtain and assess fear, obsession, anxiety and self-efficacy in 1589 Chinese COVID-19 uninfected residents. A conditional process model was used to examine the relationships between variables.

Results

Higher levels of fear were positively associated with obsession and anxiety. In addition, obsession was positively associated with anxiety, while self-efficacy attenuated the effect of fear on obsession and further mitigated the indirect effect of fear on anxiety through obsession.

Conclusion

During the COVID-19 outbreak, uninfected residents suffered varying degrees of psychological distress. COVID-19 fear may have an effect on anxiety in COVID survivors through obsession, and self-efficacy as a protective factor for individual mental health partially attenuates the effect of COVID-19 fear on obsession and the indirect effect of fear on anxiety.

Prevalence of COVID-19 fear and its association with quality of life among fire service recruits after ceasing the dynamic zero-COVID policy in China

Background

In December 2022, China terminated its dynamic zero-COVID policy. To date, however, no research has been conducted upon mental health issues and their relationship with quality of life (hereafter QoL) among fire service recruits since the dynamic zero-COVID policy ended. This study explored fear of COVID-19 (FOC) prevalence and correlates as well as its network structure and interconnections with QoL among fire service recruits.

Methods

A cross-sectional survey design was used to assess fire service recruits in Beijing and Sichuan, Guangxi and Guizhou provinces of China between February 13 and 16, 2023. Fear of COVID-19 was measured using the Fear of COVID-19 Scale, depression was assessed with the Patient Health Questionnaire, anxiety was examined using the Generalized Anxiety Disorder scale, and QOL was evaluated with the World Health Organization Quality of Life-brief version. Univariate and multivariate analyses were used to explore correlates of COVID-19 fear. Network analysis assessed the structure of fear of COVID-19 and its associations with QoL.

Results

A total of 1,560 participants were included in this study. The overall prevalence of fear of COVID-19 was 38.85% (n = 606; 95% CI = 36.42-41.32%). Being afraid of COVID-19 was significantly related to depression (OR = 1.084; p < O.OO1) and physical fatigue (OR = 1.063; p = 0.026). Fire service recruits with more fear of COVID-19 had lower QOL (F = 18.061 p < 0.001) than those with less fear of COVID-19 did. The most central symptoms included FOC6 ("Sleep difficulties caused by worry about COVID-19"), FOC7 ("Palpitations when thinking about COVID-19") and FOC2 ("Uncomfortable to think about COVID-19"). The top three symptoms negatively associated with QoL were FOC4 ("Afraid of losing life because of COVID-19"), FOC6 ("Sleep difficulties caused by worry about COVID-19") and FOC2 ("Uncomfortable to think about COVID-19").

Conclusion

Over one-third of fire service recruits reported fear of COVID-19 after China's dynamic zero-COVID policy had terminated. Poorer QoL was related to fear of COVID-19. Targeting core symptoms of the fear network structure could help improve the physical and mental health of fire service recruits during public health crises.

Impact of social isolation caused by the COVID-19 pandemic on the mood profile of active and sedentary older adults: physical activity as a protective factor

Background

The COVID-19 pandemic has changed our habits and lifestyle due to social isolation and mobility restrictions. This new scenario, together with the fear of contracting the coronavirus, influenced mental health, especially among older adults, who presented reductions in social contact and physical activity (PA). Thus, the objective of the study was to analyze the impact caused by social isolation during the COVID-19 pandemic on the mood states of active and sedentary older adults.

Methods

This is an observational study conducted during the COVID-19 pandemic. Older adults aged over 60 years, who were registered in the database of the Secretariat for the Promotion of Citizenship from a city in southern Brazil, participated in the research. An online questionnaire was applied with questions about sociodemographic characteristics, level of PA, confinement, and mood states in two periods: May 2020 and June 2021. The Mann-Whitney U test was used to compare the mood states of active and inactive individuals during the pandemic.

Results

One hundred and fifty participants answered the questionnaire, of which 80 (53.3%) reported practicing PA. More active older adults suffered fewer changes in mood when compared to inactive older adults, with lower levels of confusion (p = 0.035), depression (p = 0.002), and fatigue (p = 0.000). Older adults confined for more than 50 days were more likely to develop depression. In addition, the mood state correlated with the variable fear of contracting the coronavirus; the greater the fear, the greater the mental confusion, depression, fatigue, and tension, and the lower the vigor in the older adults. The practice of PA is also correlated with the mood state; the greater the number of hours dedicated to PA, the lower the confusion, depression, fatigue, and tension of the older adults.

Conclusion

The practice of PA positively influenced the mental health of older adults during periods of isolation and social restrictions. PA has a protective factor for the development of mental health problems and improves mood states, with greater time performing PA leading to more benefits.

Anxiety symptoms before and during the COVID-19 pandemic: A longitudinal examination of Canadian young adults

The COVID-19 pandemic has resulted in many changes that may impact anxiety symptoms (i.e., general anxiety and somatization), particularly for young adults who were at higher risk for anxiety than older adults. We examined anxiety symptoms before (age 19, 20, 21, and 22) and during the pandemic (age 23 and 24) in a cohort of Canadian young adults (n = 396). Latent growth curve models were performed for general anxiety and somatization and the pandemic time points were estimated as structured residuals to quantify the change from participants' expected trajectories. We also examined whether fear of COVID-19 predicted the changes in anxiety symptoms during the pandemic. Results indicated that a history of general anxiety and somatization positively predicted fear of COVID-19 during the pandemic and negatively predicted pandemic change from predicted values for both general anxiety and somatization. Increased COVID-19 fear was related within time to increases in general anxiety at ages 23 and 24 and increases in somatization at age 24. We also found that the proportion of individuals in the subclinical/clinical range of somatization was higher from age 23-24, but not from age 22-23 and there were no differences for general anxiety. Results highlight the need to consider within-person change and development in evaluating anxiety symptom changes and predictors of changes in anxiety symptoms.

Prevalence of fear of COVID-19, depression, and anxiety among undergraduate students during remote classes

BACKGROUND

During the coronavirus disease 2019 (COVID-19) pandemic, undergraduate students were exposed to symptoms of psychological suffering during remote classes. Therefore, it is important to investigate the factors that may be generated and be related to such outcomes.

OBJECTIVE

To investigate the association between fear of COVID-19, depression, anxiety, and related factors in undergraduate students during remote classes.

METHODS

This cross-sectional study included 218 undergraduate students (60.6% women and 39.4% men). Students answered a self-administered online questionnaire designed to gather personal information, pandemic exposure, physical activity level, fear of COVID-19 using the 'Fear of COVID-19 Scale', symptoms of depression using the Patient Health Questionnaire-9, and anxiety using General Anxiety Disorder-7.

RESULTS

Undergraduate students had a high prevalence of depression and anxiety (83.0% and 76.1%, respectively) but a low prevalence of fear of COVID-19 (28.9%) during remote classes. Multivariate analysis revealed that women who reported health status as neither good nor bad and who had lost a family member from COVID-19 had the highest levels of fear. For depression and anxiety, the main related factors found were female gender, bad health status, insufficiently active, and complete adherence to the restriction measures.

CONCLUSION

These findings may be used to develop actions to manage symptoms of anxiety and depression among students, with interventions through physical activity programmes to improve mental health.

Emotions, COVID-19 related thoughts and satisfaction with life during the critical period from control to relaxation

Introduction

In the context of declining mortality rates and increasing infectivity, it has become unavoidable for the majority of individuals to experience a COVID-19 infection at some point. This study aimed to investigate the psychological well-being of the general population during China's transition period from strict control measures to relaxed policies in COVID-19 prevention and control, as well as the impact of COVID-19 related thoughts on emotion and life satisfaction during widespread infections.

Methods

A cross-sectional study was conducted involving a sample size of 1578 participants. Participants completed self-report questionnaires assessing positive and negative emotions, thoughts about COVID-19, and satisfaction with life. Demographic characteristics such as sex, age, and education level were controlled for in the analysis.

Results

The findings revealed that individuals who had been infected with COVID-19 (specifically the Omicron variant BA.5.2 or BF.7) reported lower levels of positive emotions compared to those who were uninfected or had recovered from the infection. There was a significant relationship between COVID-19-related thoughts, emotions, and life satisfaction. Positive COVID-19 related thoughts were found to mediate the relationship between negative emotions and satisfaction with life.

Discussion

This study represents a comprehensive examination conducted in China, focusing on assessing the impact of the COVID-19 pandemic on the general population during the critical transition period from control to relaxation. Throughout this period, the number of infections experienced fluctuations, initially rising but eventually declining over a one-month span. In such a momentous historical period, maintaining a positive perspective on COVID-19 and its management becomes paramount in enhancing the emotional well-being, life satisfaction and overall well-being of individuals.

Trajectories of quality of life and mental health during the Covid-19 lockdown and six months after in Italy. A longitudinal exploration

Aim

Covid-19 pandemic and its relative containment measures have affected populations' quality of life and psychological well-being worldwide. The fear related to the pandemic and the imposed containment measures has acted as a trigger causing a global increase in negative mental health states. Thus, we aimed to explore the relationship between fear of covid-19 and mental health via QoL (the first and the second lockdown in Italy, 2020).

Subject and methods

Through a quantitative cross-lagged path model research design, the study investigates people's fear of Covid-19, quality of life, and negative mental states in a population of 444 Italian adults (Mean=40.7; Standard Deviation=16.9; 80% women), in the period between the first and the second waves of the pandemic.

Results

Results show that participants' Covid-19 fear decreased between waves, contributing to a decrease in negative mental states (stress, anxiety and depression), thus improving the perceived quality of life. Furthermore, quality of life emerged as able to buffer the impact of fear of Covid on people's psychological distress in short and medium terms, confirming its central role in regulating mental distress.

Conclusion

The study suggests important guidelines for developing interventions to support the populations' well-being and mental health.

Investigating the psychological effects of home quarantine during the early peaks of the COVID-19 pandemic: a survey from Iran

We assessed psychological symptoms among individuals who were quarantined during early coronavirus disease 2019 (COVID-19) peaks. This cross-sectional study was performed during April-October 2020 in Iran. We surveyed 100 individuals with COVID-19 patients in their families and 100 others with health conditions associated with a higher risk of developing critical forms of COVID-19 infection, who have completed at least 14 days of home quarantine. Validated Persian versions of the 21-item Depression, Anxiety, and Stress and 22-item Impact of Event Scale-Revised were used to measure the symptoms of depression, anxiety, stress and distress. The rates of stress, anxiety, depression and quarantine-related distress were 46.5, 48.5, 57.0 and 80.5%, respectively; however, they were not significantly different between the contact and no-contact groups. Female sex and being unemployed were significantly associated with quarantine-related distress, P  = 0.007 and P  = 0.018, respectively. Independent risk factors for anxiety were a history of medical comorbidity ( P  = 0.025) and contact with COVID-19 patients ( P  = 0.007). Findings show high prevalence rates of psychological symptoms among quarantined individuals, regardless of whether they had contact with COVID-19 patients or not. Female sex and unemployment were risk factors for quarantine-related distress.

Psychosocial and behavioral outcomes in the adult workforce during the COVID-19 pandemic: a 1-Year longitudinal survey

BACKGROUND

Efforts to limit the spread of COVID-19 have included public space closures, mask usage, and quarantining. Studies regarding the impact of these measures on the psychosocial and behavioral health outcomes of the workforce have focused frequently on healthcare employees. To expand the literature base, we deployed a one-year longitudinal survey among mostly non-healthcare employees assessing changes in select psychosocial outcomes, health behaviors, and COVID-19-related transmission prevention behaviors and perceptions.

METHODS

We deployed the CAPTURE baseline survey across eight companies from November 20, 2020-February 8, 2021. The baseline survey included questions on psychosocial outcomes, health behaviors, and COVID-19 transmission prevention behaviors, with several questions containing a retrospective component to cover the time period prior to the pandemic. Additional questions on vaccination status and social support were subsequently added, and the updated survey deployed to the same baseline participants at three, six, and 12 months after baseline survey deployment. We analyzed data descriptively and performed Friedman's and subsequent Wilcoxon-signed rank tests, as appropriate, to compare data within and between time points.

RESULTS

A total of 3607, 1788, 1545, and 1687 employees completed the baseline, 3-month, 6-month, and 12-month CAPTURE surveys, respectively, with 816 employees completing all four time points. Employees reported higher stress, anxiety, fatigue, and feelings of being unsafe across all time points compared to pre-pandemic. Time spent sleeping increased initially but returned to pre-pandemic levels at follow-up. Lower rates of physical activity and higher rates of non-work screen time and alcohol consumption relative to pre-pandemic were also reported. Over 90% of employees perceived wearing a mask, physical distancing, and receiving the COVID-19 vaccine as 'moderately' or 'very important' in preventing the spread of COVID-19 across all time points.

CONCLUSIONS

Relative to pre-pandemic, poorer psychosocial outcomes and worsened health behaviors were observed across all time points, with values worse at the baseline and 12-month time points when COVID-19 surges were highest. While COVID-19 prevention behaviors were consistently deemed to be important by employees, the psychosocial outcome and health behavior data suggest the potential for harmful long-term effects of the pandemic on the well-being of non-healthcare employees.