Increased generalized anxiety, depression and distress during the COVID-19 pandemic: a cross-sectional study in Germany

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Transitions in mental health care utilisation at GHU Paris between 2019 and 2024: A post-pandemic perspective

OBJECTIVE

This study aimed to analyse the long-term evolution of mental health services use following the COVID-19 pandemic.

DESIGN

This was a retrospective study, conducted from 2019 to 2024, using the Groupe Hospitalier Universitaire Paris Psychiatry and Neurosciences (GHU Paris) databases.

METHODS

We considered the number of patients consulting at GHU Paris clinics, number of patients presenting at the emergency department (ED), and number of hospital admissions per week, by sex and age group. We performed a piecewise linear regression, using a threshold approach to identify time patterns between 2019 and 2024: pre-pandemic period (T1), short-term (T2) and long-term post-pandemic period (T3). Temporal changes in mental healthcare service use were then analysed.

RESULTS

No significant overall changes were observed in the number of outpatients after the COVID-19 pandemic, except for a slight increase among patients aged 15-24 years. The number of hospital admissions remained lower in 2024 compared with 2019, with a decreasing trend in T3 for all subgroups. In contrast, the number of ED visits increased over time, with higher use of emergency services by women and young people in 2024 compared with 2019. The overall long-term trend (T3) continued to show an increasing pattern. Additionally, a reduction in schizophrenia presentations was observed, while there was an overall increase in patients with substance use or neurotic disorders.

CONCLUSIONS

Our results described transitions in mental health service use at GHU Paris between 2019 and 2024, highlighting reduced hospital admissions, increased psychiatric emergencies, and changes in the reasons for seeking care.

Divergent psychological stress response patterns to the COVID-19 pandemic in psychiatric patients with vs. without PTSD: A real-world exploratory study

The COVID-19 pandemic has been shown to increase psychological burden and requires efficient coping strategies to maintain mental health. In particular, it remains unclear which pandemic-related stress response pattern occurs in pre-existing posttraumatic stress disorder (PTSD) during the pandemic - at the same time these patients potentially exhibit dysfunctional coping of artificially generated psychosocial stressors. To analyze this so far widely unconsidered pandemic-related stress response in PTSD, this study longitudinally measured psychosocial burden and adjustment disorder (AD) symptom load in 14 patients with a primary or secondary diagnosis of PTSD vs. a cohort of 145 psychiatric patients without PTSD. The previously established Goettingen psychosocial Burden and Symptom Inventory (Goe-BSI) was used. Patients were interviewed at the end of the first (April/May 2020) and the second nationwide lockdown in Germany (November/December 2020). In our convenience sample, psychiatric disorders were diagnosed by patients' treating clinicians prior to study inclusion. Psychosocial burden and AD symptom load were significantly higher in patients with PTSD than in patients without PTSD over the course of the pandemic (both p = .005). Moreover, explorative analysis of Goe-BSI-assessed general psychiatric symptoms did not reveal changes during the pandemic in patients with PTSD. In sum, we provide preliminary evidence that, in relation to psychiatric patients without PTSD, those with PTSD might experience a higher pandemic-related burden and might thus cope less efficiently with this enduring real-world stressor. This study is limited inter alia by the small sample size and by the underrepresentation of some psychiatric diagnoses.

Long‑term physical and mental Health-Related Quality of Life in Italian patients post COVID-19 hospitalisation

PURPOSE

Prior evidence suggests that patients' Health Related Quality of Life (HRQoL) worsens after COVID-19. This study aimed to investigate HRQoL in Italian patients post-hospitalization for COVID-19, focusing on changes in physical and mental HRQoL over time since COVID-19 diagnosis.

METHODS

A cohort of patients hospitalized for COVID-19 at Molinette Hospital in Turin, Italy, was contacted post-discharge to assess HRQoL using the SF-36 questionnaire. Patients completed the questionnaire only once at a different time since diagnosis. This design allowed for the analysis of responses up to three years after diagnosis. Measured scores were compared with normative data from the Italian population using z-scores. HRQoL differences by gender, comorbidities, and self-perception of health status before and after COVID-19 were tested. The effect of time since diagnosis on physical (PCS) and mental (MCS) SF-36 scores was analysed using multiple linear models and stratified analyses.

RESULTS

A total of 601 patients completed the questionnaire. HRQoL was significantly lower compared to the normative Italian population. Men and individuals without comorbidities had better HRQoL, and self-perceptions of health status before and after COVID-19 influenced HRQoL. Time since diagnosis was associated with improved PCS, but MCS remained unaffected. Mental health declined in patients using anxiolytics post-COVID-19, and increasing age negatively affected physical health.

CONCLUSION

Our findings highlight the impact of time since diagnosis on HRQoL post-COVID-19 in an Italian population and suggest the need for further investigation into the pandemic's effects on HRQoL. Physicians should implement measures to improve mental HRQoL post-COVID-19.

Predictors of quality of life and resilience in patients with ovarian cancer during the COVID-19 pandemic: a cross-sectional study

PURPOSE

The aim of this cross-sectional study was to investigate the psychosocial burdens of patients with ovarian cancer during the COVID-19 pandemic.

METHODS

Ovarian cancer patients answered a quantitative survey assessing their resilience (BRS) and quality of life (FACT-G7) as well as clinical (first- vs. ≥ second-line treatment), demographic (age < 65 vs. ≥ 65 years) and COVID-19 pandemic-related psychosocial impairment, i.e. anxiety (GAD7); depression (PHQ2); global physical, mental, and social health (PROMIS items). Analyses of variance were applied to compare psychological impairment between patients on first- vs. ≥ second-line treatment and between patients aged < vs. ≥ 65 years at start of treatment. Multiple linear regression analyses were performed to evaluate predictors of patients' resilience and quality of life based on demographic, clinical, and psychosocial variables.

RESULTS

Most of the 93 patients rated their physical and mental health, and satisfaction with social activities as good. Eighty-seven (91.4%) were somewhat or very concerned about the pandemic. Patients on first-line therapy reported a better quality of life (p = 0.03) and better general health (p = 0.014) than those on at least second-line therapy. Patients < 65 years old reported significantly more concern about the pandemic than older patients (p = 0.008). Predictors of resilience were severity of anxiety (GAD-7) and mental health. Predictors of quality of life were general health, severity of depression (PHQ-2), and type of therapy.

CONCLUSIONS

Patients in first line of treatment and younger patients could benefit from support in coping with pandemic-related burdens, meaning that attention should be paid to potential psychological distress, which should be treated alongside the cancer.

Psychometric evaluation and community norms of the GAD-7, based on a representative German sample

Introduction

The Generalized Anxiety Disorder-7 (GAD-7) scale is widely used to assess generalized anxiety symptoms in both clinical and general populations. However, updated psychometric evaluations and population norms for the German adult population are lacking. This study aims to examine the psychometric properties of the GAD-7 and provide representative population norms.

Methods

A representative sample of the adult population in Germany (N = 2,519) was assessed. Item characteristics (means, standard deviations, inter-item correlations) were examined. Construct validity was evaluated through correlations with the PHQ-9 and BSI-18. Internal consistency was assessed using coefficient omega. Confirmatory factor analysis (CFA) was conducted to test the one-factor model, and measurement invariance across gender and age was examined using multi-group CFA.

Results

The GAD-7 demonstrated strong internal consistency and construct validity. CFA supported the assumed one-factor model. Measurement invariance analyses indicated that the GAD-7 provides comparable measurements across gender and age groups. Updated population-based norms were established for the total sample and specific age groups.

Discussion

Findings confirm the GAD-7 as a psychometrically sound measure for generalized anxiety in the general population. The updated norms enhance its applicability in clinical and epidemiological research, supporting its use for screening and assessment across diverse demographic groups.

Predictors of post-traumatic stress disorder among healthcare workers during the COVID-19 pandemic in Poland

The COVID-19 pandemic has significantly impacted the mental health of healthcare workers globally. Given the critical role these professionals play, understanding the prevalence and predictors of post-traumatic stress disorder (PTSD) among healthcare workers is crucial for developing targeted interventions. Comprehensive data on the predictors of PTSD symptoms within this population remain limited. This cross-sectional study surveyed 852 healthcare workers across 4 Polish regions between 2021 and 2022. Data were collected using the Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C), which was culturally adapted and validated for Polish respondents. To identify key predictors of PTSD symptoms, researchers employed various statistical methods: Descriptive Statistics summarized key variables (e.g. age, job tenure) to provide an overview of data distribution and sample characteristics. Pearson Correlations examined linear relationships among variables like age, work experience, and PTSD severity, ensuring no multicollinearity through variance inflation factor checks. t-Tests and Mann-Whitney U tests compared PTSD symptom severity across demographic and professional subgroups, accounting for normality using the Kolmogorov-Smirnov test. And Hierarchical Regression Analysis identified significant predictors, incorporating demographic factors first and work-related variables (e.g. fear for personal health) in a second step. A total of 88.1% of participants were female, and 82.6% were nurses. The overall prevalence of PTSD symptoms was high, with a mean total PTSD score of 37.87. Gender differences were significant, with women reporting higher scores across the PTSD subscales, including avoidance and hyperarousal. Nurses had significantly higher intrusion symptoms compared to other professionals. Fear for personal health was the strongest predictor of PTSD symptoms (β = 0.15, P < .001), explaining 11% of the variance in the final regression model (R2 = 0.11, P < .001). The findings underscore the urgent need for targeted mental health interventions, particularly for women and nurses, who are disproportionately affected by PTSD during the pandemic. Predictive models should guide the development of support programs to mitigate the long-term psychological impact of COVID-19 and ensure better preparedness for future pandemics. The significant influence of fear for personal health on PTSD outcomes highlights the importance of protective measures and psychological support for frontline healthcare workers.

"It was simply disturbing" - evaluation of the stress factors of nursing staff on special COVID-19 wards during the pandemic: a qualitative study

BACKGROUND

The COVID-19 pandemic has posed enormous challenges for healthcare systems worldwide. The strain on nursing staff working in special COVID-19 wards during the pandemic increased dramatically. To support nursing staff more effectively in similar situations in the future, it is important to identify specific stress factors to design effective support measures.

OBJECTIVE

To collect the experiences and lessons learned from nursing staff who have been affected by COVID-19 pandemic on a special COVID-19 ward that were perceived as stressful. The findings should contribute to the development of specific support measures for healthcare professionals.

DESIGN

Qualitative interview study.

SETTING

We interviewed 14 members of nursing staff who worked on COVID-19 wards at two University Hospitals about their working experiences during the pandemic.

RESULTS

We were able to identify 10 key stress factors. These included an increased workload, communication deficits, a difficult personnel situation, subjective pressure, the establishment of a new ward, a shortage of material resources, inadequate hygiene conditions, a lack of opportunities to cope with the situation, the absence of relatives and decision making.

CONCLUSION

The identification of various stress factors highlights the urgent need for comprehensive support measures. These measures could include concepts for dealing with physical and psychosocial stress, the provision of resources and sufficient personnel support. It remains crucial to proactively take preventive and supportive measures to reduce the burden and moral distress of nursing staff and protect their health in the long term. Despite the pandemic, the implications of our findings remain relevant for the future.

Move, connect and go outside! A randomized controlled trial of two online interventions and analysis of helpful coping strategies in COVID-19 "homestayers"

The COVID-19 pandemic has led to a global health crisis and a significant increase in psychological distress and psychopathological symptoms. We conducted a randomized controlled trial with two online interventions derived from positive psychology (PP) and acceptance and commitment therapy (ACT) in N = 138 "homestayers" during the first lock-down period in Germany. PP exercises had a positive impact on anxiety scores, which decreased significantly during the intervention, particularly in participants without access to a garden. Direct or indirect social contact, movement/exercise, and exposure to nature were the most frequently reported helpful coping strategies. We conclude that low-threshold online interventions with a focus on positive aspects of people's lives may be helpful to support mental health during pandemic crises. From a mental health perspective, the results also reinforce the approach of countries that allow their citizens to, for example, still go for walks during periods of contact restrictions, compared to full lock-down conditions.

Pandemic policies and sleeping problems in older adults

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

Considerations and experiences with healthcare-seeking during the first COVID-19 lockdown in Denmark

AIM

To (1) examine considerations before and experiences with GP contact during the first COronaVIrus Disease 2019 (COVID-19) lockdown among Danish citizens; (2) analyse the associations with sex, age, chronic disease, and socioeconomic factors; and (3) explore changes in healthcare-seeking behaviour post-pandemic.

METHOD

A total of 100,000 Danes aged 20 years or older, randomly selected in the general population, were invited to participate in a survey examining considerations and experiences with healthcare seeking during the first COVID-19 lockdown. Data were collected in spring 2022 and linked to register data on socioeconomic factors. Descriptive statistics and multivariable logistic regression models were applied.

RESULTS

Of the 27,369 eligible individuals, 18% reported a need to contact their GP. Being worried about burdening the healthcare system was most frequently reported (45%), followed by being in doubt about acceptable contact reasons (33%), and concern about infection (24%). Although 44% of those who needed to contact their GP found the digital solutions advantageous, individuals frequently found it difficult to discuss symptoms by telehealth (29%) and that they were examined less thoroughly. Generally, women, younger people, and individuals with lower socioeconomic status were more likely to be worried and report difficulties with contact to general practice. Some 86% of the respondents reported no changes in healthcare-seeking behaviour post-pandemic.

CONCLUSION

The results may assist in the organisation of healthcare in case of future lockdowns. Yet, the COVID-19 pandemic has only slightly affected the healthcare-seeking behaviour in the Danish general population.

App-Based Psychotherapy of Panic Disorder With Self-Guided Exposure in Virtual Reality—A Randomized Controlled Trial

BACKGROUND

Patients with panic disorder often suffer from tempo rary unavailability of care. The smartphone app Invirto (IVT) provides digital treatment for panic disorder comprising self-guided exposure in virtual reality. The aim of this trial was to assess the efficacy of Invirto.

METHODS

In a randomized, controlled, non-blinded trial, IVT was compared with care as usual (CAU) in patients with panic disorder (preregistration: DRKS00027585). The endpoints were assessed online before treatment (t0) and at 3 months (t1). The primary endpoint was the change in symptoms of anxiety, as measured with the Beck Anxiety Inventory (BAI), between the groups. The secondary endpoints were the patients' scores on the following assessment instruments, all in their German versions: the Panic and Agoraphobia Scale (PAS), the Beck Depression Inventory (BDI-II), a questionnaire on patient satisfaction (Client Satisfaction Questionnaire, CSQ-8), the Acceptance and Action Questionnaire (AAQ-II), and quality of life as a global item in the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF).

RESULTS

One hundred twenty-four participants were included. The intention-to-treat analysis revealed greater improvement with IVT than with CAU with respect to both the primary endpoint (BAI, d = -0.46; 95% confidence interval [-0.87; -0.04]) and the secondary endpoints (PAS, d = -0.63 [-1.05; -0.22]; BDI-II, d = -0.44 [-0.86; -0.02]; AAQ-II, d = -0.42 [-0.84; -0.01]), except for WHOQOL-BREF (p = 0.216).

CONCLUSION

A digital treatment with virtual exposure can lessen anxiety, panic, and depressive symptoms and improve mental flexibility. In further studies, IVT should be compared with an active control group.

Mental health in Germany before, during and after the COVID-19 pandemic

Based on nationally representative panel data (N person-years = 40,020; N persons = 18,704; Panel Labour Market and Social Security; PASS) from 2018 to 2022, we investigate how mental health changed during and after the COVID-19 pandemic. We employ time-distributed fixed effects regressions to show that mental health (Mental Health Component Summary Score of the SF-12) decreased from the first COVID-19 wave in 2020 onward, leading to the most pronounced mental health decreases during the Delta wave, which began in August 2021. In the summer of 2022, mental health had not returned to baseline levels. An analysis of the subdomains of the mental health measure indicates that long-term negative mental health changes are mainly driven by declines in psychological well-being and calmness. Furthermore, our results indicate no clear patterns of heterogeneity between age groups, sex, income, education, migrant status, childcare responsibilities or pre-COVID-19 health status. Thus, the COVID-19 pandemic appears to have had a uniform effect on mental health in the German adult population and did not lead to a widening of health inequalities in the long run.

Resident perspectives on the impact of program leadership communication on well-being during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic introduced a myriad of changes that negatively impacted resident physicians' well-being. Communication from program leadership may mitigate resident stress during times of crisis, yet literature supporting this premise is scant, and best communication practices remain uncertain. This qualitative study aimed to identify stressors to residents and explore the influence of residency program leadership's communication on emotional stress during the COVID-19 pandemic.

METHODS

Informed by Kotter's 8-step management model to support resident well-being, this qualitative study used grounded theory methods to interview 25 residents from three training programs (Pediatrics, Internal Medicine, and Medicine-Pediatrics) on a single academic medical campus from May-September 2020. Four investigators coded the data using the constant comparative analysis. Sampling continued until reaching thematic saturation. Codes were built using an iterative approach and organized into themes. Discrepancies were resolved by consensus discussion among investigators.

RESULTS

Residents described increased stress levels, the all-consuming nature of COVID-19, mixed emotions about their role as healthcare providers, new coping mechanisms, and changes to their education and work environment that impacted stress. Communication from leadership to residents during the pandemic varied. Effective communication helped mitigate stress; perceived suboptimal communication exacerbated stress. Who was communicating, methods of communication, and content of communication influenced resident stress.

CONCLUSIONS

The COVID-19 pandemic introduced new stressors and challenges to residents. The perception of leadership communication played a critical role in mitigating or exacerbating resident stress. We propose a communication framework ("Who? What? Where? When? How?") that residency leadership can utilize during times of crisis.

The SARS-CoV-2 pandemic causes a dysfunctional dietary behavior: A German cross-sectional study

Background: Since the COVID-19 pandemic has been affected our daily lives, the global population has been exposed to permanent concerns and thus might suffer from the psychological burden. It is well known that psychological burdens can affect dietary behavior. Aim: The impact of a psychological burden on people, and in particular on their dietary patterns was investigated in this nationawide cross-sectional study. Methods: 7525 participants responded to the questionnaire regarding the psychological burden concerning the COVID-19 pandemic and their current dietary structure with changes in the pattern and food amount (between November 2020 and March 2021). Results: A pandemic-related dysfunction of dietary behavior was found. Some participants reported restrictive (conscious) food intake and as well impulsive food intake, which can be described as dysfunctional eating behaviors. In particular, younger persons and individuals who claimed an increased psychological burden reported dysfunctional dietary behavior. Data clearly show that psychological burdens affect an individual's dietary behavior. Conclusion: Public health strategies have to be developed to support individuals at risk to improve coping strategies. The long-term aim should be avoiding the maintenance of dysfunctional dietary behavior.

COVID-19 and speeding: Results of population-based survey of ontario drivers

INTRODUCTION

During COVID-19, increased speeding was observed in many jurisdictions. Yet, evidence is limited on what factors predicted increased speeding during the pandemic. This study's purpose was to examine speeding, and person and situation factors associated with increased speeding since the start of the pandemic.

METHODS

An online panel survey sampled 1,595 drivers using sex, age, and region quota sampling and weighting to approximate the Ontario, Canada adult population. Measures included: (1) person factors: socio-demographics (age, sex, region); psychological trait of risk propensity (Competitive Attitudes Toward Driving Scale (CATDS)); psychological states (distress - general and COVID-19-related); and behaviors (kilometers driven, alcohol use, police stops and collisions); and (2) COVID-19-related situation factors: perceived changes in (traffic volume, police enforcement).

RESULTS

67.2% of respondents reported speeding; 7.2% reported increased speeding since the start of the pandemic. Bivariate analyses indicated that person factors of younger age, male sex, higher CATDS, higher distress, more alcohol use, more kilometers traveled, police stops, and collisions since the start of the pandemic were associated with increased speeding. Situation factor of perceived less traffic volume since the start of the pandemic was associated with increased speeding. Logistic regression analysis identified odds of reported increased speeding during the pandemic was significantly higher for drivers with higher scores on the CATDS, higher kilometers traveled, and more alcohol use during the pandemic.

CONCLUSIONS

These findings suggest that higher risk propensity as well as the more kilometers driven and increased alcohol consumption were risk factors for increased speeding.

PRACTICAL APPLICATIONS

COVID-19-related factors of lower traffic volume and enforcement are less predictive of increased speeding than driver personality and pandemic-related behaviors of more driving and drinking. Interventions to reduce speeding still need to focus on these person factors through education, enforcement, and strong sanctions for speeding.

Mood, Quality of Life, and Immune Fitness During the COVID-19 Pandemic of Young Adults in Germany

Background: The COVID-19 pandemic has profoundly affected young adults' lives globally, including those in Germany. This study investigated mental health and quality of life during the pandemic, with a particular focus on mood. Immune fitness, the body's capacity to respond to health challenges (such as infections) by activating an appropriate immune response, was assessed as a physical health indicator. Methods: Data were collected from 317 participants, aged 18 to 35, via an online survey conducted between November 2021 and March 2022. Participants included 103 men (32.5%) and 214 women (67.5%), with a mean age of 25.5 years (SD = 4.1). Results: Compared to pre-pandemic levels, significant declines in mood, quality of life, immune fitness, and sleep quality were observed during the lockdown periods of the COVID-19 pandemic (p < 0.0125). The most pronounced effects were observed during the second lockdown, with declines extending into the second no-lockdown period for fatigue, depression, happiness, optimism, and immune fitness (p < 0.0125). Significant sex differences were found for the magnitude of mood effects (anxiety, depression, stress). No significant differences were found according to age or occupational status (student vs. work). Conclusions: The COVID-19 pandemic and associated lockdown periods had a significant negative effect on the mood, immune fitness, and well-being of young adults living in Germany.

Changes in Stress, Depression, and Anxiety Symptoms in a Brazilian Sample During Quarantine Across the Early Phases of the COVID-19 Crisis

OBJECTIVE

We aimed to estimate prevalence and incidence of stress, depression, and anxiety symptoms in Brazilians during the COVID-19 pandemic.

METHOD

We assessed 103 (54 women, 49 men) participants online in three periods of the pandemic: March 2020 (T1), April 2020 (T2), and June 2020 (T3). Estimates of prevalence and incidence were identified when mental health scores were two standard deviations above the mean compared to normative data. Mental health indicators were measured using the Perceived Stress Scale, the Filgueiras Depression Index, and the State-Trait Anxiety Inventory - State Subscale.

RESULTS

At T1, 89% of individuals were below cut-off scores for stress, anxiety, and depression, which dropped to 35% by T3. Estimated stress prevalence was 1.9% at T1, 7.8% at T2, and 28.2% at T3. Estimated depression prevalence was 0% at T1, 23.3% at T2, and 25.2% at T3. Estimated state anxiety prevalence was 10.7% at T1, 11.7% at T2, and 45.6% at T3. Stress incidence increased by 7.8% from T1 to T2, and 23.3% from T2 to T3. Depression incidence increased by 23.3% from T1 to T2, and 15.5% from T2 to T3. Anxiety incidence increased by 9.7% from T1 to T2, and 39.8% from T2 to T3. Stress severity scores significantly increased from 16.1 ± 8.7 at T1 to 23.5 ± 8.4 at T2, and 30.3 ± 6.0 at T3. Depression severity scores significantly increased from 48.5 ± 20.5 at T1 to 64.7 ± 30.2 at T2, and 75.9 ± 26.1 at T3. Anxiety increased from 49.0 ± 13.4 at T1 to 53.5 ± 12.5 at T2 and 62.3 ± 13.4 at T3. Females had significantly higher anxiety scores than males by T3 (66.7 ± 11.8 vs. 57.4 ± 13.5).

CONCLUSION

Prevalence and incidence of stress, depression, and anxiety significantly increased throughout the pandemic. The largest increase in stress and anxiety occurred between T2 and T3, and between T1 and T2 for depression. Severity of stress, depression, and anxiety increased throughout the study.

Determining the acceptance of e-mental health interventions in elite athletes using the unified theory of acceptance and use of technology

Background

Elite athletes are exposed to many different sport-specific stressors that may put them at particular risk for mental health symptoms and disorders. E-mental health interventions could be a feasible option to support elite athletes in need. The aim of the present study was to assess the acceptance of e-mental health interventions among elite athletes and explore its underlying drivers and barriers.

Materials and methods

A cross-sectional study was conducted with N = 382 elite athletes. Of these, N = 275 (71.99%, 167 females) were included in the statistical analyses. The impact of various sociodemographic, sport-related and medical characteristics on acceptance was assessed. EHealth-related data and acceptance of e-mental health interventions were examined using a modified assessment based on the Unified Theory of Acceptance and Use of Technology (UTAUT).

Results

Overall, the acceptance of e-mental health interventions in elite athletes can be classified as high (M = 3.69 SD = 0.97). In the UTAUT regression model sex, financial situation, depression symptoms, digital confidence, digital overload as well as the UTAUT predictors performance expectancy, effort expectancy, and social influence predicted acceptance significantly.

Conclusions

The UTAUT model has proven to be a valuable instrument in predicting of acceptance of e-mental health interventions in elite athletes. Given the strong association between acceptance and future use, new interventions should focus on the explored factors to establish effective e-mental health interventions for elite athletes.

Positive Humor/Affection and Age Advantages in Affective Responses During the COVID-19 Pandemic. A Three-Wave Longitudinal Study

The COVID-19 pandemic has disrupted the lives of people worldwide. However, even in times of prolonged exposure to extreme and new realities such as this pandemic, people are also able to experience positive emotions. To understand how people's emotional responses have changed over the course of the pandemic and what helps people to be positively engaged in perceiving negative situations as an opportunity to experience positive emotions, we conducted a three-wave longitudinal study in Spain. A total of 396 participants (Mage = 40.11, SD 12.66, 74% women) completed three waves of a web-based survey during the lockdown. Descriptive and correlational analyses, a repeated measures General Lineal Model, and 4 mixed effects models with a random effect on individuals were conducted to test hypotheses. Growth models revealed that positive and negative affect increased over time. Older people show more positive and less negative affectivity. Positive humor and affection coping strategies bolster positive emotions and buffer negative emotions over time in older participants. Older people who use more positive humor and affection experienced more positive emotions and decreased their levels of negative emotions over time. The different trajectories in positive and negative affect suggest age benefits in emotional regulation and a positive effect in older ages during the lockdown. Positive psychological interventions that boost a person's coping repertoire by helping them increase the experience of positive emotions may hold great promise aiding people to bolster their mental health in highly stressful and unexpected future crises.

Changes in the Success and Characteristics of Tobacco Dependence Treatment before and during the COVID-19 Pandemic: Clinical Sample Comparisons

Background and Objectives: There is little information on changes in the process and outcomes of intensive tobacco dependence treatment during the COVID-19 pandemic. The following characteristics were evaluated: interest in treatment, the number of face-to-face or telephone follow-ups, the duration of pharmacotherapy use, and the success rate. The aim of our study was to compare the number of patients who entered tobacco dependence treatment programmes and evaluate the one-year success rate in patients three years before and three years after the COVID-19 pandemic. Materials and Methods: A single-site retrospective cohort study using data from patients treated at the Centre for Tobacco Dependence in Prague, Czech Republic, between 2017 and 2022 (n = 2039) was performed. The one-year abstinence rate was validated by measuring carbon monoxide in exhaled air (6 ppm cut-off). Patients were divided into two groups: the group for which treatment was initiated in 2017-2019 (i.e., before the COVID-19 pandemic, BC; n= 1221) and the group for which treatment was initiated in 2020-2022 (i.e., during the COVID-19 pandemic, DC; n = 818). Results: No significant differences in the success rate of tobacco dependence treatment were found between the two groups (BC group, 40.5% (494/1221) vs. DC group, 42.2% (345/818)) (χ2 (1, N = 2.039) = 0.6, p = 0.440). Furthermore, differences were not found in sex, education level, age at first cigarette, the duration of pharmacotherapy use, or the number of in-person visits. In contrast, there was an increase in the number of telephone contacts between the groups (18.7% (SD = 17.5%) vs. 32.9% (SD = 18.2%), p < 0.001). Conclusions: The number of patients who started treatment during the COVID-19 pandemic decreased by one-third compared to that during the 3-year period before the pandemic. The overall treatment success rate did not change significantly even with the increase in the number of telephone visits with the therapist.

Wastewater-based epidemiology to monitor 68 NPS/conventional drug use in Taipei metropolitan area in Taiwan during and after COVID-19 pandemic

Amidst far-reaching COVID-19 effects and social constraints, this study leveraged wastewater-based epidemiology to track 38 conventional drugs and 30 new psychoactive substances (NPS) in northern Taiwan. Analyzing daily samples from four Taipei wastewater plants between September 2021 and January 2024-encompassing club reopenings, holidays, Lunar New Year, an outbreak, and regular periods-thirty-one drugs were detected, including 5 NPS. Tramadol, zolpidem tartrate, CMA, and MDPV were newly detected in Taiwanese sewage with frequency of 1.4 %- 89.0 %. Conventional drug use typically increased post-pandemic, aside from benzodiazepines and methadone. Methamphetamine showed 100 % frequency, indicating ongoing daily consumption despite COVID-19 measures. Methamphetamine and morphine's consumption dipped then rose around club reopening, hinting at limited access. The consumption trend of methadone appeared to compensate for the use of morphine. Ketamine and NPS demonstrated similar patterns throughout the entire period. NPS as party drugs seemed influenced by an unstable supply chain and complexities in implementation. Benzodiazepines, commonly abused alongside synthetic cathinones in Taiwan exhibited an opposing trend to NPS while aligned with acetaminophen, suggesting elevated stress and anxiety levels during the pandemic. No significant differences were observed in drug consumption between weekdays and weekends, potentially indicating that COVID-19 measures blurred the traditional distinctions between these timeframes. ENVIRONMENTAL IMPLICATION: New psychoactive substances refer to chemically modified variants of controlled drugs designed to mimic the effects of the original drugs while evading modern detection methods, categorizing them as hazardous materials. The study presents a sewage monitoring project conducted from 2021 to 2024, collecting samples from four WWTPs to analyze NPS and conventional drug trends during and after the COVID-19 pandemic. The findings uncovered connections between drug consumption patterns and pandemic-related policies. In light of the persistent drug abuse and their environmental presence, the results bear critical importance for both environmental and public health. We provide a thorough assessment of these relationships and prioritize areas for future research.

Association between COVID-19 and subsequent depression diagnoses-A retrospective cohort study

BACKGROUND

The present study aimed to investigate the association between COVID-19 and the cumulative incidence of depression and the potential role of sick leave in a large representative sample of German adults.

METHODS

This retrospective cohort study was based on the Disease Analyzer database (IQVIA) data. This study included individuals aged ≥16 years with a COVID-19 diagnosis in 1284 general practices in Germany between March 2020 and December 2021, and the propensity score matched cohort without COVID-19. Univariable Cox regression analysis assessed the association between COVID-19 and depression.

RESULTS

The present study included 61,736 individuals with and 61,736 without COVID-19 (mean age 46.1 years; 49 % women). Patients visited their physicians about 4.3 times per year during the follow-up period. About 25.5 % of patients were diagnosed with COVID-19 in 2020 and 74.5 % in 2021. In this representative sample of German adults, COVID-19 infection was associated with a higher cumulative incidence of depression, and this cumulative incidence was greater in women than men. As compared with non-COVID-19, COVID-19 with ≤2 weeks sick leave duration was associated with 17 % higher depression risk (HR: 1.17; 95 % CI: 1.09-2.16), COVID-19 with >2-4 weeks sick leave duration with 37 % higher depression risk (HR: 1.37; 95 % CI: 1.11-1.69), and COVID-19 with >4 weeks sick leave duration with 2 times higher depression risk (HR: 2.00; 95 % CI: 1.45-2.76).

CONCLUSION

COVID-19 sick leave was positively associated with a risk for depression, and the longer the duration of sick leave, the higher the cumulative incidence of depression.

The Effect of COVID-19 on Mood Disorders in Urban and Suburban Detroit

Introduction

The COVID-19 pandemic has increased the global experience of anxiety and depression owing to social isolation and government-mandated quarantine for transmission reduction. To date, literature surrounding the mental health effects of COVID-19 for the U.S. population is limited.

Methods

This is a retrospective study from a large metropolitan Detroit health system. Patient encounters between December 23, 2018 and June 22, 2021, with March 23, 2020 being the start of Michigan state-wide lockdown, were used to define pre- and post-COVID-19 encounters, respectively. The data were divided into Detroit and non-Detroit on the basis of patient ZIP code. All patients aged ≥13 years with a visit with a family medicine provider were included. Outcome variables included Patient Health Questionnaires-2 and -9 and General Anxiety Disorder-7 scores; diagnoses of depression, anxiety, adjustment, and grief disorders; antidepressant prescriptions; and behavioral health referrals. Logistic regression was used to determine the incidence of composite mood disorder, depression, and anxiety.

Results

A total of 20,970 individuals were included in this study: 10,613 in the Detroit subgroup and 10,357 in the non-Detroit subgroup. A total of 88.2% of the Detroit population were Black, and 70% were female. Logistic regression shows that the incidence of composite mood disorder decreased with increasing age (OR=0.787, 0.608, 0.422, and 0.392; p<0.001). Male sex is a protective factor (OR=0.646, p<0.001). Federal insurance is the only factor presenting a statistically significant increased risk (OR=1.395, p<0.001). There was no statistical difference between residing in urban and suburban areas in the incidence of composite mood disorder (OR=0.996, p=0.953).

Conclusions

This research demonstrates that residing in an urban setting did not increase the risk of developing a mental health disorder during the COVID-19 period.

Empathy and redemption: Exploring the narrative transformation of online support for mental health across communities before and after Covid-19

This study examines the impact of the COVID-19 pandemic on individuals' mental health and their online interactions, particularly within Reddit's mental health communities. By analyzing data from 15 subreddits categorized into mental health and control groups from 2018 to 2022, we observed that forums dedicated to mental health exhibited higher levels of user engagement and received more supportive responses than those in other categories. However, as the pandemic evolved, a significant decrease in online support was noted, especially within these mental health groups. This decline hints at a risk of emotional burnout among users, which poses a particularly acute challenge for individuals grappling with mental health issues. Intimate relationships have also an impact on online expression of mental health. The research underscores the pandemic's effect on online support and interaction dynamics, signaling the necessity for a deeper understanding and the development of strategies to maintain support within online communities during times of crisis.

Dentists' stress level during the COVID-19 pandemic and their opinion on the oral health status of their patients

Background and aims

"Severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2) is the name of the etiological agent of the pandemic Corona Virus Disease (COVID-19) which was declared on March 11, 2020 by the WHO and which affected all countries of the world, including Romania. Our study aimed to evaluate the psycho-affective implications and economic consequences for dentists in Romania during the COVID-19 (Corona Virus Disease) pandemic state of emergency and their opinion on the patients' oral health impact.

Methods

A cross-sectional observational and analytical study based on a questionnaire was conducted. Dentists who work in Romania affiliated in 2020 to the Romanian College of Dental Practitioners was the target population.

Results

Three hundred and seventy-three dentists participated in this survey. The age of the respondents ranged from 24 to 70. Men and women have the same expectation regarding the lockdown effect of worsening the oral health of the general population (worst, 79.5% of women and 81.3% of men, P=0.8842).

Conclusions

The anxiety regarding the bank rates, supplementary investments, risk of COVID-19 infection and exposure to COVID-19 related mass-media information proved to be significantly higher among young dentists.

Changes in experienced quality of oncological cancer care during the COVID-19 pandemic based on patient reported outcomes - a cross-sectional study

AIM

The study aims to investigate the impact of the COVID-19 pandemic on cancer patients' perceptions of the quality of their oncological treatment and care.

BACKGROUND

The COVID-19 pandemic disrupted healthcare delivery and oncological resources were repurposed, potentially leading to prolonged treatment and reduced access to innovative therapies and clinical trials. Still, little is known about how patients perceived the quality of their treatment.

METHODS

A cross-sectional study was conducted in the spring of 2020 among cancer patients at the Department of Oncology, Aarhus University Hospital and Rigshospitalet, Denmark. Patients were invited to complete an online questionnaire on clinical, socioeconomic, emotional, behavioural, and quality-related aspects of oncological cancer care. Patients who experienced reduced treatment quality and those who reported no or slight reductions were compared using multiple logistic regression, exploring the associations with patient characteristics, behaviours, and fear of cancer progression or recurrence.

RESULTS

A total of 2,040/5,372 patients experienced changes in their treatment plans during the pandemic, and 1,570/5,372 patients experienced reduced treatment quality, with 236 reporting a high degree of reduction. Patients with breast, head and neck, and upper gastrointestinal cancers were more likely to experience reduced treatment quality. Altered interactions with healthcare providers, along with isolation, lack of social support, and heightened fear of cancer progression, were significant risk factors for experiencing reduced cancer care quality.

INTERPRETATION

We identified subgroups of cancer patients needing targeted communication and care during health crises affecting cancer treatment. The findings underscore the importance of safeguarding the needs of vulnerable patient populations in future healthcare emergencies.

Physical activity, anxiety, depression, and coping in Turkish men and women during the first wave of COVID-19

A need exists to better understand the relationships between COVID-19, coping behaviors, physical activity and stress, and COVID-19's impact on way of life. A cross-sectional study design was used to examine adult physical activity, hope, depression, anxiety, and coping status by gender during the COVID-19 pandemic, and to determine the impact of these variables on the coping process. The study also examined the effect of gender on the relation between physical activity and dependent variables. A global survey instrument was used in this study, including 1,400 Turkish adults. This study identified significant gender-based differences regarding physical activity, hope, depression, anxiety, and coping status of adults, although no significant gender-based difference was found regarding hope scores. Furthermore, physical activity directly influenced coping (β = 0.10), hope (β = 0.12), and anxiety (β = -0.08). Hope directly and positively influenced coping (β = 0.45) and directly and negatively influenced anxiety (β = -0.25) and depression (β = -0.28). Moreover, gender did not directly affect physical activity, but it was associated with decreased coping and increased depression and anxiety. Finally, gender had no effect on the relation between physical activity and hope, coping, depression, and anxiety (p > 0.01). These outcomes support the critical importance of physical activity and hope when coping with COVID-19 regardless of gender.

COVID-19-related fear and anxiety in a sample of patients with type 2 diabetes: a cross-sectional study in Iran after several peaks of the pandemic

Purpose

The aim of this study was to assess COVID-19-related anxiety, and fear burden in diabetic patients, as a risk group for severe COVID-19.

Methods

A cross-sectional online survey conducted on 111 type 2 diabetes mellitus (T2DM) patients referred to a Diabetes clinics of Royan institute, and 155 healthy controls recruited from normal population using a snowball sampling technique. Fear of COVID-19 Scale (FCV-19 S) and Coronavirus anxiety scale (CAS) were used.

Results

The total score of coronavirus fear in T2DM patients was 15.79 (6.39) and in healthy controls 15.48 (5.97) (p = 0.696). The total score of coronavirus fear in T2DM patients was 15.79 (6.39) and in healthy controls 15.48 (5.97) (p = 0.696). Correlation matrix between coronavirus anxiety and fear scores in these samples confirmed that in T2DM participants CAS was significantly positively associated with FCV-19 (r = 0.407, p = 0.000). There was also statistically and positively significant correlation between CAS and FCV-19 in healthy subjects (r = 0.495, p = 0.000).

Conclusion

The present study revealed that the level of fear and anxiety from COVID-19 was almost the same in a sample of Iranian T2DM patients and healthy controls. The pandemic with several peaks in the country cannot cause an increased anxiety and fear from COVID-19, especially in patients with diabetes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01353-8.

The impact of positive psychology counseling on sexual and marital satisfaction and anxiety among reproductive-aged women during the COVID-19 pandemic: a randomized controlled clinical trial

BACKGROUND

Sexual and marital satisfaction is considered one of the important factors in happiness and life satisfaction of couples. COVID-19 pandemic results in psychological effects, such as increased anxiety levels which can affect sexual and marital satisfaction. This study aimed to investigate the impact of positive psychology on women's sexual and marital satisfaction.

METHODS

A randomized controlled trial was conducted on 72 married women of reproductive age in Tabriz, Iran between February 2021 and May 2022. The participants were randomly divided into the intervention and control groups. There was no significant difference between the control and intervention groups in terms of the socio-demographic characteristics (p < 0.05). The mean age of the participants in the intervention and control groups was 31.8 ± 6.92 and 30.97 ± 5.09 years, respectively. The intervention group attended seven 60-90 min counseling sessions at weekly intervals. The Spielberger anxiety, sexual satisfaction and marital satisfaction questionnaires were completed before and four weeks after the intervention.

RESULTS

The results of this study indicated that after counseling, the average overall score of marital satisfaction [MD: 15.46, 95% CI: 7.47 to 23.41, p = 0.034] and sexual satisfaction [MD: 7.83, 95% CI: 6.25 to 9.41, p = 0.001] significantly increased in the intervention group compared to the control group. Also, the mean score of state anxiety [MD: -2.50, 95% CI: -4.19 to -0.80, p = 0.001] and trait anxiety [MD: -1.03, 95% CI: -2.46 to -0.09, p = 0.032] significantly decreased after counseling in the intervention group compared to the control group.

CONCLUSIONS

Using counseling based on a positive psychology approach can improve anxiety, sexual and marital satisfaction, and anxiety of women of reproductive age during the COVID-19 pandemic. However, further randomized clinical trials are needed before making a definitive conclusion.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT): IRCT20171007036615N8. Date of registration: 11/28/21. Date of first registration: 11/28/21. URL: https://www.irct.ir/user/trial/58680/view ; Date of recruitment start date: 12/01/21.

Development of audio-guided deep breathing and auditory Go/No-Go task on evaluating its impact on the wellness of young adults: a pilot study

OBJECTIVES

Numerous studies indicate that deep breathing (DB) enhances wellbeing. Multiple deep breathing methods exist, but few employ audio to reach similar results. This study developed audio-guided DB and evaluated its immediate impacts on healthy population via self-created auditory Go/No-Go task, tidal volume changes, and psychological measures.

METHODS

Audio-guided DB with natural sounds to guide the DB was developed. Meanwhile, audio-based Go/No-Go paradigm with Arduino was built to measure the attention level. Thirty-two healthy young adults (n=32) were recruited. Psychological questionnaires (Rosenberg's Self-Esteem Scale (RSES), Cognitive and Affective Mindfulness Scale-Revised (CAMS-R), Perceived Stress Scale (PSS)), objective measurements with tidal volume and attention level with auditory Go/No-Go task were conducted before and after 5 min of DB.

RESULTS

Results showed a significant increment in tidal volume and task reaction time from baseline (p=0.003 and p=0.033, respectively). Significant correlations were acquired between (1) task accuracy with commission error (r=-0.905), (2) CAMS-R with task accuracy (r=-0.425), commission error (r=0.53), omission error (r=0.395) and PSS (r=-0.477), and (3) RSES with task reaction time (r=-0.47), task accuracy (r=-0.362), PSS (r=-0.552) and CAMS-R (r=0.591).

CONCLUSIONS

This pilot study suggests a link between it and young adults' wellbeing and proposes auditory Go/No-Go task for assessing attention across various groups while maintaining physical and mental wellness.

Self-Control, Openness, Personal Need for Structure and Compensatory Control Change: A Serial Mediation Investigation

In the aftermath of the COVID-19 pandemic, numerous studies have indicated that individuals are confronting a diminished sense of control. Compensatory control theory suggests that individuals strive to mitigate this loss by modifying their behavior. The present study aims to investigate the relationship between self-control and compensatory control change during the COVID-19 pandemic, as well as the mediating effects of openness and the personal need for structure. Participants completed an online questionnaire consisting of Personal Need for Structure Scale, Self-Control Scale, Openness Scale and Compensatory Control Change Scale. The results showed that the compensatory control change increased after the outbreak. Moreover, a serial mediation was found: openness and the personal need for structure partially mediated the relationship between self-control and compensatory control change. The results indicate that the COVID-19 pandemic has led to an increase in compensatory control behaviors, especially among those with pronounced self-control. High self-control individuals are found to exhibit greater openness, reducing their personal need for structure, in effect enhancing their compensatory control change. These findings highlight the critical role of self-control in sustaining a sense of control, which is vital for understanding psychological health management in the context of public health events.

Association between Changes in Daily Life Due to COVID-19 and Depressive Symptoms in South Korea

We aimed to examine changes in daily life due to coronavirus disease 2019 (COVID-19) among younger (≤64 years) and older (≥65 years) individuals and to analyze their association with depressive symptoms. Raw data from the 2020 Korean Community Health Survey were used to analyze 228,485 individuals. Changes in daily life due to COVID-19 were measured using a questionnaire that evaluated changes in physical activity, sleep duration, instant food intake, and drinking and smoking status. Depressive symptoms were assessed using the Patient Health Questionnaire 9 scale, and logistic regression analysis was performed to explore the association between the two variables. This study confirmed a significant association between the two variables and found that the intake of instant food showed the largest difference in odds ratios between the younger (OR: 1.851; 95% CI: 1.720-1.992) and older groups (OR: 1.239; 95% CI: 1.060-1.447). A major finding of this study is that the analysis of the association between the two variables revealed a stronger correlation in more variables in the younger population compared to the older population. To address COVID-19-related depression and prepare for potential mental health crises, countries should expand response measures.

Relationship between interprofessional collaboration and psychological distress experienced by healthcare professionals during COVID-19: a monocentric cross-sectional study

Background

Since the onset of the COVID-19 pandemic, global healthcare systems have faced unprecedented challenges, leading to significant psychological distress among healthcare professionals. Recognizing the importance of enhanced interprofessional collaboration in alleviating this burden, as emphasized by the World Health Organization in 2020, we investigated whether such collaboration could mitigate staff psychological distress during crises. To our knowledge, no study has yet explored the role of interprofessional collaboration as a resilience factor in crises.

Methods

For this monocentric cross-sectional study at a German university hospital, we examined the relationship between the quality of interprofessional collaboration and the psychological distress of healthcare professionals during the initial pandemic wave. We employed validated mental health instruments, such as the GAD-7 and PHQ-2, to assess anxiety and depressive symptoms. Additionally, custom-designed questionnaires evaluated "Pandemic-Associated Burden and Anxiety (PAB; PAA)" and interprofessional crisis management experiences. A novel "Interprofessional collaboration and communication (IPC)" assessment tool was developed based on international competency frameworks, demonstrating strong reliability.

Results

The study involved 299 healthcare professionals (78.6% in direct contact with COVID-19 patients). Moderate levels of PAB/PAA were reported. However, a significant proportion experienced clinically relevant anxiety, as indicated by GAD-7. Negative IPC perceptions correlated with higher levels of psychological distress. Linear regression analysis showed associations between interprofessional collaboration and anxious and depressive symptoms, and pandemic-related burden.

Conclusion

Our findings highlight the vital role of enhanced interprofessional collaboration in strengthening the psychological well-being of healthcare professionals during crises. The study underscores the need to foster a collaborative environment and integrate interprofessional education for resilience.

COVID-19 pandemic impacts on the elderly: the relationship between PPPD and prefrontal alpha rhythm

BACKGROUND

In the COVID-19 epidemic more patients presented with persistent postural-perceptual dizziness (PPPD), but it has received little attention by the doctors in China and many patients reject psychological measurements or scales. Therefore, there is an urgent need for an objective method to diagnose and evaluate PPPD.

OBJECTIVE

To investigate the effect of the COVID-19 epidemic on elderly PPPD patients and define the relationship between prefrontal alpha rhythm asymmetry (FAA) by Electroencephalography (EEG) and PPPD.

METHODS

This case-control study was conducted to discuss the differences of elderly outpatients (>60 years) with PPPD during the peak period of COVID-19 in 2020 and the corresponding period in 2019, and collect the prefrontal FAA value in PPPD during COVID-19 outbreak, which were compared to its FAA in healthy control.

RESULTS

Compared with the same period in 2019, the number of elderly PPPD patients during the epidemic period in 2020 increased significantly (16.4%, p = 0.000, x2 =31.802) . The left alpha wave signal power (F3) was significantly higher than the right alpha wave signal power (F4) (Z= -3.073, p = 0.002). In PPPD patients FAA were significantly lower in patients compared to control group (Z = -11.535, p = 0.000). There was a negative correlation between FAA and HAMA scores (R2 =0.906, p < 0.05) and a negative correlation between FAA and HAMD scores (R2 =0.859, p < 0.05), too.

CONCLUSIONS

The increase in cases of elderly PPPD patients is most likely attributed to the mental health in older adults during the COVID-19 pandemic. Less left frontal brain activity in EEG may be related to elderly PPPD.

Psychological distress among individuals with a suicide attempt or suicidal ideation and suicide attempts patterns: first two years of the pandemic

BACKGROUND

The COVID-19 pandemic and related restrictions may have led to increased stress, particularly in people with mental health problems. Since stress factors play important role in the emergence of suicide attempts (SA) and suicidal ideation (SI), they may have been exacerbated by the pandemic, which could have led to an increased number of suicide attempts. Thus, we first investigated whether the pandemic affected personal stress experiences and appraisal of coping potential in individuals with and without SA and SI. In a second step, we analyzed the frequency and dynamics of SAs by patients admitted to a psychiatric university clinic over a period of four years.

METHODS

We examined stress experiences and appraisal of coping resources of inpatients recruited between March 2021 and February 2022 with SA (n=38), SI (n=27), and with mood disorder without SA or SI (n=45). In the second study, we investigated the time course of prospectively recorded patients with a suicide attempt (n=399) between January 1st 2018 and December 31st 2021 using interrupted time-series Poisson regression models.

RESULTS

There was a significant main effect of group (F[2,107]=6.58, p=0.002) regarding psychological stress levels, which was significantly higher in the SA and SI groups than in the psychiatric control group. No significant differences were found in the appraisal of coping resources or in the frequency of SAs before and during pandemic. However, the pandemic had a significant impact on the seasonal pattern of SAs.

CONCLUSIONS

The pandemic increased psychological stress levels in individuals with SA and SI, which may be related to SI and do not necessarily result in SA. The pandemic did not affect the overall frequency of SA between March 2020 and December 2021, but interfered with the seasonal pattern of SA occurrence. Effective intervention strategies during a pandemic should include programs to strengthen the psychological resilience of people who are susceptible to mental health problems.

Efficacy of eHealth interventions to reduce depression symptoms in individuals with obesity: a systematic review of randomized controlled trials

Introduction

Obesity and depression are inter-related health concerns, demanding a high level of treatment and costs in the health care system. The development of eHealth interventions that simultaneously address obesity and mental health can be supportive in this regard. However, evidence of the efficacy of eHealth interventions in the treatment of depression symptoms in individuals with obesity is lacking. The aim of this systematic literature review is to evaluate the efficacy of existing eHealth interventions for individuals with obesity that target depression symptoms.

Methods

We systematically searched electronic databases (Cochrane Library, PubMed, Scopus) to identify studies published in English between January 2016 and January 2023, that focused on eHealth interventions, targeting depression symptoms in individuals with obesity people. Exclusion criteria were study objectives that (1) focused specifically on one or more metabolic comorbidities of individuals with obesity, e.g., hypertension, hyperlipidemia, diabetes; (2) focused specifically on eating disorders comorbidities e.g., binge eating disorder, and (3) focused specifically on patients before or after bariatric surgery.

Results

The database search identified 214 records. Six articles were included in this review. Sample sizes ranged from 70 to 1267 participants of ages 18-60 years. All included studies were randomized controlled trials. Two of the six included studies were web-based interventions guided either by medical doctors or psychologists. All interventions included video, printed materials, and interactive parts of which two studies integrated elements of Cognitive Behavioural Therapy and Social Cognitive Therapy. The findings showed that eHealth treatment services, supported and guided throughout the intervention had high acceptance and efficacy in the reduction of depression symptoms among individuals with obesity.

Conclusion

EHealth interventions that address and target both mental and physical health with interactive strategies calls for better efficacy in the reduction of depression symptoms. Future eHealth interventions that target depression symptoms in individuals with obesity should integrate digital strategies that address both mental and physical health through interactive modules.

Interactive changes in depression and loneliness symptoms prior to and during the COVID-19 pandemic: A longitudinal network analysis

OBJECTIVES

Depression and loneliness co-occur frequently. This study examined interactive changes between depression and loneliness among older adults prior to and during the COVID-19 pandemic from a longitudinal network perspective.

METHODS

This network study was based on data from three waves (2016-2017, 2018-2019, and 2020) of the English Longitudinal Study of Ageing (ELSA). Depression and loneliness were measured with the eight-item version of the Center for Epidemiologic Studies Depression Scale (CESD-8) and three item version of the University of California Los Angeles (UCLA) Loneliness Scale, respectively. A network model was constructed using an Ising Model while network differences were assessed using a Network Comparison Test. Central symptoms were identified via Expected Influence (EI).

RESULTS

A total of 4,293 older adults were included in this study. The prevalence and network of depression and loneliness did not change significantly between the baseline and pre-pandemic assessments but increased significantly from the pre-pandemic assessment to during COVID-19 assessment. The central symptom with the strongest increase from pre-pandemic to pandemic assessments was "Inability to get going" (CESD8) and the edge with the highest increase across depression-loneliness symptom communities was "Lack companionship" (UCLA1) - "Inability to get going" (CESD8). Finally, "Feeling depressed" (CESD1) and "Everything was an effort" (CESD2) were the most central symptoms over the three assessment periods.

CONCLUSIONS

The COVID-19 pandemic was associated with significant changes in the depression-loneliness network model. The most changed symptoms and edges could be treatment targets for reducing the risk of depression and loneliness in older adults.

SARS-CoV-2 infection is associated with physical but not mental fatigue - Findings from a longitudinal controlled population-based study

OBJECTIVE

Fatigue has been identified as the core symptom of long-Covid, however, putative pandemic-related influences remain largely unclear. We investigated trajectories of total, physical and mental fatigue and the factors associated with it in previously infected and non-infected individuals up to one year post- infection.

METHODS

We used data from a longitudinal cohort study of German adults with two samples: A representative probability sample and a sample of individuals with proven SARS-CoV-2 infection. Surveys were conducted in spring 2020(T1), autumn 2020(T2) and summer 2021(T3). Fatigue was assessed using the FAS, distinguishes between physical and mental fatigue. Depression, anxiety and stress were assessed using PHQ-4 and PSQ.

RESULTS

1990 participants [mean age 47.2 (SD = 17.0), 30.5% previously infected] were included in the survey at T1 (n = 1118 at T2, n = 692 at T3). Total and physical fatigue, but not mental fatigue were significantly higher in the previously infected compared to the non-infected sample at T2, but this group difference disappeared at T3. We identified Covid-infection as a factor associated with transient total and physical fatigue at T2. Depression, anxiety and stress at T1 were associated with total, physical and mental fatigue at both follow-ups.

CONCLUSIONS

Our results highlight the importance of considering physical and mental fatigue as separate entities, while suggesting a greater relevance of the physical signs of fatigue in understanding long-Covid. The results further showed that baseline mental health symptoms were the most strongly associated with fatigue trajectories.

The flashbulb-like nature of memory for the first COVID-19 case and the impact of the emergency. A cross-national survey

Flashbulb memories (FBMs) refer to vivid and long-lasting autobiographical memories for the circumstances in which people learned of a shocking and consequential public event. A cross-national study across eleven countries aimed to investigate FBM formation following the first COVID-19 case news in each country and test the effect of pandemic-related variables on FBM. Participants had detailed memories of the date and others present when they heard the news, and had partially detailed memories of the place, activity, and news source. China had the highest FBM specificity. All countries considered the COVID-19 emergency as highly significant at both the individual and global level. The Classification and Regression Tree Analysis revealed that FBM specificity might be influenced by participants' age, subjective severity (assessment of COVID-19 impact in each country and relative to others), residing in an area with stringent COVID-19 protection measures, and expecting the pandemic effects. Hierarchical regression models demonstrated that age and subjective severity negatively predicted FBM specificity, whereas sex, pandemic impact expectedness, and rehearsal showed positive associations in the total sample. Subjective severity negatively affected FBM specificity in Turkey, whereas pandemic impact expectedness positively influenced FBM specificity in China and negatively in Denmark.

[Influence of the Corona pandemic on cardiovascular risk factors - Data from 1775 participants of the ELITE study before and during the Corona pandemic]

BACKGROUND

 The COVID-19 pandemic and its interventions have led to a deficit in medical care and changes in people's lifestyles, which has consequently changed cardio- and cerebrovascular primary and secondary prevention. The existing data are mainly based on surveys. In addition to the problem of the accuracy of self-assessments, the pandemic per se and the massive public reporting may have biased the data.Only a few publications have compared data collected before the pandemic with results during the pandemic. The ELITE study has regularly monitored risk factors (RF) and psychosocial parameters (stress, depression, well-being, diet, brain performance, exercise) in over 5000 participants for years. From this study, data were analyzed from 1775 individuals collected before the onset and again during the pandemic (06/05/2020-25/01/2022). Thus, baseline values were unaffected by the pandemic.

RESULTS

 As expected, both improvements and worsening of the collected parameters were found. Blood pressure and depressive symptoms worsened significantly more often, with women more frequently affected. Weight and stress levels also increased more often than they improved. Only physical activity showed a slight increase. 24.1 % showed only deteriorations and no improvements in these parameters. In contrast, 19.6 % showed improvements exclusively. In the group with only worsening, there was a significant increase in individuals with the risk factors (RF) hypertension, obesity, elevated LDL cholesterol, nicotine, and diabetes mellitus. This resulted in an increase in individuals with 2 or more RF. In contrast, the number of individuals with 2 and more RF decreased in the group with only improvements. Strikingly, individuals with risk factors improved more frequently.

CONCLUSION

 A not insignificant part of the population experienced significant worsening of RF during the pandemic. This particularly affected blood pressure and depressive symptoms, and more often women.

Conventional weight loss therapy in morbid obesity during COVID-19 pandemic: degree of burdens at baseline and treatment efficacy

Introduction

COVID-19 affected global physical and psychological health. The purpose of this study was to explore the pandemics impact on health-related quality of life (HRQoL), mental health (anxiety, depression, and perceived stress) and eating behavior in people with severe obesity participating in a multimodal conservative behavioral weight loss (BWL) program conducted via videoconferencing. Additionally, the efficacy of the six-month BWL program in a virtual video-based setting during the pandemic was examined.

Methods

297 participants of a face-to-face multimodal behavioral weight loss program prior to the pandemic (PrePAN, May 2014-September 2019) and 146 participants of the in terms of content same intervention in a videoconference-based setting during the pandemic (PAN, July 2020-April 2022) were questioned and compared using standardized questionnaires for HRQoL, symptoms of depressive and anxiety disorders, perceived stress, and eating behavior at baseline and at the end of treatment.

Results

Symptoms for anxiety, depression and perceived stress were similar between PrePAN and PAN at baseline. In addition, PAN tended to show lower disinhibition of eating behavior and feelings of hunger than PrePAN. During the pandemic, the BWL intervention resulted in body weight loss (67%) or stabilization (16%) in most of the participants. It also contributed by improving physical HRQoL, lower worries, and improved eating behaviors compared to baseline.

Conclusion

During the COVID-19 pandemic, baseline mental health of people with morbid obesity was not worse than before the pandemic. Additionally, the BWL intervention in the virtual video-based setting stabilized and improved physical and mental health during the COVID-19 pandemic.

Healthcare provider perceptions and reported practices regarding opioid prescription for patients with chronic cancer pain

PURPOSE

Data indicates that clinicians might be under-prescribing opioids for patients with chronic cancer pain, and this could impact adequate pain management. Few studies have sought to understand healthcare provider (HCP) perceptions and practices regarding the prescription of opioids for chronic cancer pain. We assessed HCP perceptions and practices regarding opioid prescription for patients with chronic cancer pain since the onset of the COVID-19 pandemic.

METHODS

An anonymous cross-sectional survey was conducted among 186 HCPs who attended an opioid educational event in April 2021 and 2022.

RESULTS

Sixty-one out of 143 (44%) opioid prescribers reported reluctance to prescribe opioids for chronic cancer pain. In a multivariate logistic model, younger participants (log OR - 0.04, 95% CI - 0.085, - 0.004; p = 0.033) and pain medicine clinicians (log OR - 1.89, CI - 3.931, - 0.286; p = 0.034) were less reluctant, whereas providers who worry about non-medical opioid use were more reluctant to prescribe opioids (log OR 1.58 95% CI 0.77-2.43; p < 0.001). Fifty-three out of 143 (37%) prescribers had experienced increased challenges regarding opioid dispensing at pharmacies, and 84/179 (47%) of all respondents reported similar experience by their patients. Fifty-four out of 178(30%) were aware of opioid-related harmful incidents to patients or their families, including incidents attributed to opioid misuse by a household or family member.

CONCLUSION

A considerable number of opioid prescribers were reluctant to prescribe opioids for patients with chronic cancer pain. Many reported challenges regarding dispensing of opioids at the pharmacies. These may be unintended consequences of policies to address the opioid crisis. Future measures should focus on addressing regulatory barriers without undermining the gains already made to combat the opioid crisis.

Unlocking the power of physical activity in easing psychological distress

The severity of the current global mental health situation and the importance of maintaining psychological well-being call for more powerful, convenient, and efficient solutions for addressing psychological issues and relieving mental stress. Physical activity not only effectively improves physical fitness and reduces negative emotions such as anxiety and depression but also increases the improvement of psychological health and sense of well-being. At the same time, physical activity interventions for mental health have unique advantages, including reducing the side effects of psychological interventions and increasing necessity, convenience, and cost-effectiveness, as well as flexible adaptability across multiple methods, groups, and age ranges, providing stronger support for relieving psychological stress and addressing psychological issues. Although physical activity is an important intervention measure in relieving psychological stress, its value and role in mental health care seem to have not yet received sufficient attention, and its potential remains to be further revealed. Given the significant advantages and effectiveness of physical activity in mental health intervention practices, it is necessary to stimulate its potential in relieving psychological stress through various means in future studies to better safeguard the public's physical and mental health. Developing guidelines for physical activity for improved mental health, enhancing organic integration with other inter-vention measures, and providing necessary respect, encouragement, and support are important directions to consider.

Just as Essential: The Mental Health of Educators During the COVID-19 Pandemic

OBJECTIVE

The coronavirus disease 2019 (COVID-19) pandemic deleteriously impacted physical and mental health. In the summer of 2020, return-to-learn plans were enacted, including virtual, hybrid, and in-person plans, impacting educators and students. We examined (1) how return-to-learn plan was related to depressive and social anxiety symptoms among educators and (2) how psychological flexibility related to symptoms.

METHODS

Educators (N = 853) completed a survey via Qualtrics that assessed internalizing symptoms, psychological flexibility, and occupational characteristics. Two one-way analyses of variance (ANOVAs) examined between-group differences in return-to-learn plans across depression and social anxiety. Two hierarchical linear regressions examined the relation between psychological flexibility components and depressive and social anxiety symptoms.

RESULTS

Median T-scores were well above the national normative means for General Depression (median T-score: 81) and Social Anxiety (median T-score: 67). There were no significant differences between reopening plans in general depression nor social anxiety T-scores. Psychological flexibility accounted for 33% of the variance in depressive symptoms and 24% of the variance in social anxiety symptoms.

CONCLUSIONS

Results indicated high levels of psychiatric symptoms among educators during COVID-19, and psychological flexibility was associated with lower symptoms. Addressing educator mental health is of utmost importance in future research.

Effects of the COVID-19 pandemic on the mental health of medical students and young physicians in Germany: Gender-specific results of an online survey

Background

Healthcare workers and medical students faced new challenges during the COVID-19 pandemic. Processes within many hospitals were completely disrupted. In addition, the face to face teaching of medical students was drastically reduced. Those at risk of developing mental health problems appear to be younger health care workers and women.

Objective

To investigate potential COVID-19 pandemic-related gender differences in psychological distress among medical students and physicians in their first years of practice.

Design and setting

An anonymous survey was carried out online between December 1, 2021, and March 31, 2022, at the Mannheim Medical Faculty and the Würzburg Medical Faculty, Germany, after obtaining informed consent. Primary outcome measures were changes in anxiety and depression symptoms using the Hospital Anxiety and Depression Scale (HADS), and changes in participants' current quality of life using the WHO Quality of Life BREF.

Results

The results show wave-like courses for perceived anxiety and burden overlapping with the course of the COVID-19 incidence. In comparison to men, women showed a significant higher increase in HADS (p = 0.005) and a reduced life quality (p = 0.007) after COVID-19. Both sexes showed different frequencies of the factors influencing quality of life, with the presence of a previous mental illness and mean anxiety having a significant higher negative impact in women.

Conclusion

Future and young female physicians reported a disproportionate higher burden during COVID-19 compared to their male colleges. These observations suggest an increased need for support and prevention efforts especially in this vulnerable population.

Impact of COVID-19 containment measures on perceived health and health-protective behavior: a longitudinal study

This longitudinal study aimed to assess the impact of COVID-19 containment measures on perceived health, health protective behavior and risk perception, and investigate whether chronic disease status and urbanicity of the residential area modify these effects. Participants (n = 5420) were followed for up to 14 months (September 2020-October 2021) by monthly questionnaires. Chronic disease status was obtained at baseline. Urbanicity of residential areas was assessed based on postal codes or neighborhoods. Exposure to containment measures was assessed using the Containment and Health Index (CHI). Bayesian multilevel-models were used to assess effect modification of chronic disease status and urbanicity by CHI. CHI was associated with higher odds for worse physical health in people with chronic disease (OR = 1.09, 95% credibility interval (CrI) = 1.01, 1.17), but not in those without (OR = 1.01, Crl = 0.95, 1.06). Similarly, the association of CHI with higher odds for worse mental health in urban dwellers (OR = 1.31, Crl = 1.23, 1.40) was less pronounced in rural residents (OR = 1.20, Crl = 1.13, 1.28). Associations with behavior and risk perception also differed between groups. Our study suggests that individuals with chronic disease and those living in urban areas are differentially affected by government measures put in place to manage the COVID-19 pandemic. This highlights the importance of considering vulnerable subgroups in decision making regarding containment measures.

Factors Associated with Psychological Distress, Fear, and Coping Strategies during the COVID-19 Pandemic in Thailand: A Cross-Sectional Study

Introduction

Despite being initially perceived as a local infectious disease, COVID-19 has emerged as one of the most perilous global health threats, significantly impacting the psychological well-being of individuals worldwide.

Objective

This cross-sectional descriptive study investigates the psychological distress, fear, and coping mechanisms among Thai people residing in Thailand during the COVID-19 pandemic.

Methods

This online cross-sectional survey targeted Thai individuals during the first and third waves of the COVID-19 pandemic. Participants aged 18 and above who provided consent self-reported their responses to the Kessler Psychological Distress Scale, Fear of COVID-19 Scale, and Brief Resilient Coping Scale. Data collection occurred between November 2020 and January 2021 across four regions of Thailand. Univariate and multivariate logistic regression analyses explored associations between contextual factors and the variables of interest.

Results

Out of 498 survey respondents, with an average age of 43.07 (SD = 13.69) years, 81.9% were female, and 61.6% self-identified as healthcare workers, with 47.59% identified as frontline healthcare workers. Findings revealed that 46% of participants experienced moderate-to-very high levels of psychological distress, 14.3% reported high levels of fear of COVID-19, and 35.1% exhibited low resilient coping. Factors such as changes in employment status or financial situations, comorbidities, contact with known or suspected COVID-19 cases, recent healthcare utilization for COVID-19-related stress, and elevated fear of COVID-19 were associated with higher levels of psychological distress. Conversely, being nurses and perceived better mental health status were linked to more effective coping strategies.

Conclusion

These results emphasize the critical importance of government interventions to safeguard the psychological well-being of healthcare workers and the broader Thai population. Urgent measures to bolster resilience among these groups during and after the pandemic are imperative.

Anxiety, Depression and Quality of Life in Relation to SARS-CoV-2 Antibodies in Individuals Living with Diabetes During the Second Wave of COVID-19

Aims

The objective was to compare anxiety, depression, and quality of life (QoL) in individuals living with type 1 (T1D) and type 2 (T2D) diabetes with matched controls during the second wave of the COVID-19 pandemic.

Methods

Via randomization, individuals living with diabetes T1D (n= 203) and T2D (n=413), were identified during February-July 2021 through health-care registers. Population controls (n=282) were matched for age, gender, and residential area. Questionnaires included self-assessment of anxiety, depression, QoL, and demographics in relation to SARS-CoV-2 exposure.Blood was collected through home-capillary sampling, and SARS-CoV-2 Nucleocapsid (NCP) and Spike antibodies (SC2_S1) were determined by multiplex Antibody Detection by Agglutination-PCR (ADAP) assays.

Results

Younger age and health issues were related to anxiety, depression, and QoL, with no differences between the study groups. Female gender was associated with anxiety, while obesity was associated with lower QoL.The SARS-CoV-2 NCP seroprevalence was higher in T1D (8.9%) compared to T2D (3.9%) and controls (4.0%), while the SARS-CoV-2 SC2_S1 seroprevalence was higher for controls (25.5%) compared to T1D (16.8%) and T2D (14.0%).

Conclusions

A higher SARS-CoV-2 infection rate in T1D may be explained by younger age and higher employment rate, and the associated increased risk for viral exposure.

Prevalence and factors of posttraumatic growth among Hubei residents during the COVID-19 pandemic: A cross-sectional study

The adverse impact of the COVID-19 pandemic on mental health has been widely concerned, but the research on positive psychological factors is insufficient, this study aims to investigate the prevalence and factors of posttraumatic growth (PTG) among residents in the worst-hit areas of China (Hubei Province). We were conducted in three disaster areas with different severity in Hubei Province three months after the outbreak, and the data were from 575 respondents. Instruments included the simplified Chinese version of the Posttraumatic Growth Inventory (C-PTGI) and the public health emergency psychological questionnaire. Nonparametric tests, Spearman correlation analyses, and multiple linear regression equations were used to analyze the data. The results showed that three months after the outbreak of COVID-19, the PTG of Hubei residents was at a low level, and their sense of fear was the most prominent, with a positive detection rate of 82.09%. According to the results of this study, high PTG levels were associated with high levels of fear, married and healthcare providers, while low levels of PTG were associated with serious chronic diseases, males, good economic status, and poor prevention and control measures. Government departments should strengthen social support for residents, carry out necessary stress management training to help them correctly deal with negative emotions and promote their personal growth.