Neurobiology of fear and specific phobias

Association between resting-state connectivity patterns in the defensive system network and treatment response in spider phobia-a replication approach

Although highly effective on average, exposure-based treatments do not work equally well for all patients with anxiety disorders. The identification of pre-treatment response-predicting patient characteristics may enable patient stratification. Preliminary research highlights the relevance of inhibitory fronto-limbic networks as such. We aimed to identify pre-treatment neural signatures differing between exposure treatment responders and non-responders in spider phobia and to validate results through rigorous replication. Data of a bi-centric intervention study comprised clinical phenotyping and pre-treatment resting-state functional connectivity (rsFC) data of n = 79 patients with spider phobia (discovery sample) and n = 69 patients (replication sample). RsFC data analyses were accomplished using the Matlab-based CONN-toolbox with harmonized analyses protocols at both sites. Treatment response was defined by a reduction of >30% symptom severity from pre- to post-treatment (Spider Phobia Questionnaire Score, primary outcome). Secondary outcome was defined by a reduction of >50% in a Behavioral Avoidance Test (BAT). Mean within-session fear reduction functioned as a process measure for exposure. Compared to non-responders and pre-treatment, results in the discovery sample seemed to indicate that responders exhibited stronger negative connectivity between frontal and limbic structures and were characterized by heightened connectivity between the amygdala and ventral visual pathway regions. Patients exhibiting high within-session fear reduction showed stronger excitatory connectivity within the prefrontal cortex than patients with low within-session fear reduction. Whereas these results could be replicated by another team using the same data (cross-team replication), cross-site replication of the discovery sample findings in the independent replication sample was unsuccessful. Results seem to support negative fronto-limbic connectivity as promising ingredient to enhance response rates in specific phobia but lack sufficient replication. Further research is needed to obtain a valid basis for clinical decision-making and the development of individually tailored treatment options. Notably, future studies should regularly include replication approaches in their protocols.

A Smartphone-Gamified Virtual Reality Exposure Therapy Augmented With Biofeedback for Ailurophobia: Development and Evaluation Study

BACKGROUND

To the best of our knowledge, no specialized research has been conducted to address ailurophobia (fear of cats) in Iran or globally. This has driven our project, along with the prevalence of ailurophobia and the absence of a gamified virtual reality exposure therapy (VRET) that incorporates affordable and easily accessible biofeedback (BF) tools. We hypothesize that a gamified VRET augmented with BF will yield more positive effects than a similar device lacking BF.

OBJECTIVE

This study primarily focuses on the development and preliminary evaluation of a smartphone-gamified VRET integrated with BF, targeting animal phobia, with a specific case study on ailurophobia. The secondary objectives are using affordable and readily available BF found in devices such as smart bands and smartwatches and creating a mobile virtual reality gamified app to improve patients' adherence to treatments while simultaneously enhancing the app's accessibility, scalability, and outreach.

METHODS

Evaluations encompassed 3 methods. First, we identified the tool's potential positive effects on phobia interventions, exploring 4 effects: intrinsic motivation, simulation of fearful situations, management of stressful circumstances without therapists' presence and mitigation of catastrophic thoughts, and preliminary effects on ailurophobia treatment. Participants were divided into BF and non-BF groups. Second, we gathered user preferences and opinions about the treatment. Third, we conducted heuristic evaluations using 44 heuristics from existing system usability scales assessing user interfaces, virtual reality platforms, and video games' playability. To interpret the data, mean scores; ANOVA, single factor; and ANOVA, 2-factor with replication were used. A total of 29 individuals were identified, of which 10 met the eligibility criteria or were accessible.

RESULTS

The smartphone-gamified VRET augmented with BF exhibited better results on the identified effects compared with the non-BF version and contributed to normalizing encounters with cats. Moreover, 41 of the 44 heuristics achieved a percentage above 62%, indicating its potential as a therapeutic product and its ability to enhance patient adherence to treatments. Patient preferences on the treatment and its strengths and weaknesses were provided for further improvement.

CONCLUSIONS

The tool has the potential to evolve into a comprehensive solution by incorporating various types of cats and their behaviors, simulating environments in which they are commonly found, and enhancing its appeal through an increased sense of adventure without inducing unrealistic fears. By adapting fear elements, the game can be tailored to treat various animal phobias. Phobia-focused games should avoid action and combat scenarios to prevent reinforcement of fear responses. After rigorous evaluation, further exploration is required to provide remote use beyond clinical settings.

Evaluation of the relationship between the fear of COVID-19 and mental status of female employees during the COVID-19 pandemic

BACKGROUND

The stress due to the COVID-19 pandemic has influenced the physical, mental, and social well-being of humans worldwide.

OBJECTIVE

To evaluate the relationship between the fear of COVID-19 and mental state of female employees during the COVID-19 pandemic.

METHODS

A cross-sectional study was conducted involving 726 participants. Data was collected using the Personal Information Form, fear of COVID-19 scale, and brief symptom inventory.

RESULTS

The fear experienced by women during the social isolation and quarantine period was associated with depression, anxiety, somatization, obsessive-compulsive disorder, interpersonal sensitivity, hostility, phobic anxiety and paranoid experiences.

CONCLUSION

Women, young people, the elderly and single individuals were most likely affected psychologically during the pandemic. Thus, interventions and psychological evaluations are recommended at an early stage to minimize this effect. Such interventions must be implemented considering the strategic planning and coordination of risk groups.

The relationship of kinesiophobia in patients with lymphedema: a case-control investigation

Introduction

Kinesiophobia and lymphedema appear to be related conditions, and it is important to understand this relationship, as many of the symptoms and comorbidities presented by individuals with lower limb lymphedema are prevented and treated through movement, thus constituting kinesiophobia as a barrier to intervention. The objective of this study is, therefore, to evaluate and analyze the kinesiophobic beliefs reported by individuals with and without lower limb lymphedema, regarding the agreement, severity and differences found, and to establish levels of kinesiophobia.

Methods

A case-control study with a total sample of 80 participants (40 with lower limb lymphedema and 40 without) was performed. Both groups (with and without lymphedema) were characterized anthropologically, sociodemographically, and clinically. In the case group, lymphedema was evaluated. Participants in both groups completed the Tampa Scale for Kinesiophobia - 13 items (TSK-13).

Results

Individuals with lower limb lymphedema had higher TSK-13 scores than their matched group without lymphedema. The items belonging to the activity avoidance subscale had the highest agreement and score in both groups. Differences between groups were mainly established for items belonging to the somatic focus subscale, showing that individuals with lower limb lymphedema have kinesiophobic beliefs related to the perceived severity of their lymphedema. The prevalence of kinesiophobia was increased in both groups, but the severity was mild.

Conclusions

Considering the apparent tendency of people with lower limb lymphedema to present kinesiophobia and movement-limiting beliefs regarding the condition, greater attention should be paid to its assessment, prevention and treatment from a multidisciplinary and multimodal perspective, which takes into account the multiplicity of factors inherent to kinesiophobia and lymphedema and thus reduce their impact on the management of lymphedema.

An animal model of trait anxiety: Carioca high freezing rats as a model of generalized anxiety disorder

Despite being one of the main components of anxiety and playing a pivotal role in how an individual perceives and copes with anxiogenic situations or responds to a given treatment, trait anxiety is paradoxically omitted in most animal models of anxiety. This is problematic and particularly more concerning in models that are used to screen drugs and other treatments for specific anxiety disorders and to investigate their neurobiological mechanisms. Our group has been engaged in the search for specific anxiety-related traits in animal models of anxiety. We developed two new lines of rats with strong phenotypic divergence for high (Carioca High-conditioned Freezing [CHF]) and low (Carioca Low-conditioned Freezing [CLF]) trait anxiety as expressed in the contextual fear conditioning paradigm. Here, we summarize key behavioral, pharmacological, physiological, and neurobiological differences in one these lines, the CHF rat line, relative to randomized-cross controls and discuss how far they represent a valid and reliable animal model of generalized anxiety disorder and so high trait anxiety.

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.

Paternal Prenatal and Lactation Exposure to a High-Calorie Diet Shapes Transgenerational Brain Macro- and Microstructure Defects, Impacting Anxiety-Like Behavior in Male Offspring Rats

Prenatal exposure to high-energy diets (HED) increases the susceptibility to behavioral alterations in the male offspring. We addressed whether prenatal HED primes the transgenerational inheritance of structural brain changes impacting anxiety/depression-like behavior in the offspring. For this, we used female Wistar rats exposed to a HED [cafeteria (CAF) diet, n = 6] or chow [control (CON) n = 6] during development. Anxiety and depression-like behavior were evaluated in filial 1 (F1), filial 2 (F2), and filial 3 (F3) male offspring using the open field (OFT), elevated plus maze, novelty suppressed feeding (NSFT), tail suspension (TST), and forced swimming tests. Structural brain changes were identified by deformation-based morphometry (DBM) and diffusion tensor imaging using ex vivo MRI. We found that the F1, F2, and F3 offspring exposed to CAF diet displayed higher anxious scores including longer feeding latency during the NSFT, and in the closed arms, only F1 offspring showed longer stay on edges during the OFT versus control offspring. DBM analysis revealed that CAF offspring exhibited altered volume in the cerebellum, hypothalamus, amygdala, and hippocampus preserved up to the F3 generation of anxious individuals. Also, F3 CAF anxious exhibited greater fractional anisotropy and axial diffusivity (AD) in the amygdala, greater apparent diffusion coefficient in the corpus callosum, and greater AD in the hippocampus with respect to the control. Our results suggest that prenatal and lactation exposure to HED programs the transgenerational inheritance of structural brain changes related to anxiety-like behavior in the male offspring.

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.

Spouses' coping with stress during the COVID-19 pandemic: is there a difference between male and female attitudes?

This descriptive study was conducted to determine the stress-coping status of spouses and the difference between male and female attitudes during the pandemic period. We collected data with the Personal Information Form and the Scale for Coping with Family Stressors from 533 participants. The mean age of women and men was 36.04 ± 10.04 and 37.13 ± 11.56, respectively. A significant difference in verbalizing with others, work - family segmentation, cognitive restructuring, changing behaviors, emotional disclosure, exercise, and spending more time with family was found between women and men (p < .05). A significant difference was also observed in coping mechanisms with family stressors between women and men, and thus, gender affects their coping attitudes. During crises such as pandemics, the community should be aware of the availability of mental health professionals, and spouses should also use effective coping methods with family stress at regular intervals.

Distinct Circuits From the Central Lateral Amygdala to the Ventral Part of the Bed Nucleus of Stria Terminalis Regulate Different Fear Memory

BACKGROUND

The ability to differentiate stimuli that predict fear is critical for survival; however, the underlying molecular and circuit mechanisms remain poorly understood.

METHODS

We combined transgenic mice, in vivo transsynaptic circuit-dissecting anatomical approaches, optogenetics, pharmacological methods, and electrophysiological recording to investigate the involvement of specific extended amygdala circuits in different fear memory.

RESULTS

We identified the projections from central lateral amygdala (CeL) protein kinase C δ (PKCδ)-positive neurons and somatostatin (SST)-positive neurons to GABAergic (gamma-aminobutyric acidergic) and glutamatergic neurons in the ventral part of the bed nucleus of stria terminalis (vBNST). Prolonged optogenetic activation or inhibition of the PKCδCeL-vBNST pathway specifically reduced context fear memory, whereas the SSTCeL-vBNST pathway mainly reduced tone fear memory. Intriguingly, optogenetic manipulation of vBNST neurons that received the projection from PKCδCeL neurons exerted bidirectional regulation of context fear, whereas manipulation of vBNST neurons that received the projection from SSTCeL neurons could bidirectionally regulate both context and tone fear memory. We subsequently demonstrated the presence of δ and κ opioid receptor protein expression within the CeL-vBNST circuits, potentially accounting for the discrepancy between prolonged activation of GABAergic circuits and inhibition of downstream vBNST neurons. Finally, administration of an opioid receptor antagonist cocktail on the PKCδCeL-vBNST or SSTCeL-vBNST pathway successfully restored context or tone fear memory reduction induced by prolonged activation of the circuits.

CONCLUSIONS

Together, these findings establish a functional role for distinct CeL-vBNST circuits in the differential regulation and appropriate maintenance of fear.

Copenhagen Psychosocial "Work Organization and Job Content" as a Higher-Order Construct in Relation to Workers' Health: The Moderating Role of Leadership Quality

Originality/Purpose

The current study aims to investigate the novel approach of utilizing work organization and job content (WOJC) as a higher-order construct that is one of the domains of the Copenhagen Psychosocial Questionnaire (COPSOQ), examining its relationship with sleeping troubles and somatic stress, while also exploring the moderating effect of leadership quality.

Sample/methods

Snowball sampling technique was used to collect the data in this study, with a population consisting of 360 workers employed in hazardous work environments at poultry feed mills. The structural equation modelling technique was applied to achieve the range of outcomes.

Results

The results reveal that WOJC has a significant negative impact on both psychological (sleeping troubles) and physiological (somatic stress) health factors among poultry workers. Although leadership quality did not moderate the relationship between WOJC and physiological health factors, it did moderate the relationship between WOJC and psychological health factors.

Conclusion/Implications

This study has significant implications for researchers, poultry feed mill owners, policymakers, and regulatory bodies. Additionally, the methodological contribution of utilizing WOJC as a higher-order construct provides unique insights for researchers.

Limitations

Due to COVID-19 restrictions, the data was collected online from one province only; future studies should spread the sampling framework to all provinces with different domains of COPSOQ.

The relationship between anxiety and internet gaming disorder in children during COVID-19 lockdown: a network analysis

Background

Internet gaming disorder (IGD) has become a social problem in children. Evidence from previous studies has proven that anxiety is associated with IGD. However, IGD was always assessed as a whole based on total scores, and the fine-grained relationship between anxiety and IGD was hidden.

Objective

The present study aims to investigate the fine-grained relationship between anxiety and IGD in elementary school students during the COVID-19 lockdown, and to identify potential targets for psychological interventions.

Methods

During the lockdown caused by the COVID-19 pandemic, 667 children from a primary school in China were investigated by the Spence Children's Anxiety Scale-Short Version and Internet Gaming Disorder Scale. R4.1.1 software was used to construct a network model, assess bridge centrality, and test the robustness of the network and conduct a network.

Results

There were 23 cross-community edges (weight ranged from -0.03 to 0.12), and each node of anxiety was connected to different nodes of IGD. The nodes with the top 80th percentile bridge expected influence were A2 "social phobia" (0.20), A3 "panic disorder" (0.21) and IGD5 "escape" (0.22). The robustness of the network was acceptable.

Conclusion

From the perspective of network analysis, the present study explored the correlation pathways between anxiety and IGD in children and identified social phobia and panic disorder as the best targets for intervention to reduce IGD.

Overcoming Fear of Flying: A Combined Approach of Psychopharmacology and Gradual Exposure Therapy

Aviophobia, the fear of flying, is a prevalent type of situational-specific phobia categorized under anxiety disorders in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Patients with aviophobia experience intense, irrational fear when traveling by air. Active avoidance of the phobic stimulus is a diagnostic feature that affects one's quality of life and commonly leads to significant functional limitations. Virtual reality based gradual exposure therapy is a treatment option for aviophobia due to its easy accessibility and low cost, but it may not be very effective. This case reports the effectiveness of using psychopharmacologic treatment in combination with real-life gradual exposure therapy to successfully treat a patient with aviophobia. Written consent from the patient was obtained prior to the writing and submission of this case report.

Examining the Relationships Between Fear of Coronavirus, State Anxiety, and Relationship Happiness Among Married Turkish Individuals During COVID-19

The present study aimed to investigate the mediating role of state anxiety in the relationship between the fear of COVID-19 and relationship happiness among married individuals. An additional aim of the study also tested the moderating role of joint family activities between state anxiety and relationship happiness. The study sample consisted of 1713 married individuals (1031 women and 682 men). The study findings showed both the significant direct associations among the studied variables and the mediating role of state anxiety in the relationship between fear of COVID-19 and relationship happiness. It also found that the path of state anxiety to relationship happiness among married individuals having family activities was significantly lower than those who did not. Directions for future research and application were discussed.

Angiotensin II Regulates the Neural Expression of Subjective Fear in Humans: A Precision Pharmaco-Neuroimaging Approach

BACKGROUND

Rodent models and pharmacological neuroimaging studies in humans have been used to test novel pharmacological agents to reduce fear. However, these strategies are limited with respect to determining process-specific effects on the actual subjective experience of fear, which represents the key symptom that motivates patients to seek treatment. In this study, we used a novel precision pharmacological functional magnetic resonance imaging approach based on process-specific neuroaffective signatures to determine effects of the selective angiotensin II type 1 receptor (AT1R) antagonist losartan on the subjective experience of fear.

METHODS

In a double-blind, placebo-controlled, randomized pharmacological functional magnetic resonance imaging design, healthy participants (N = 87) were administered 50 mg losartan or placebo before they underwent an oddball paradigm that included neutral, novel, and fear oddballs. Effects of losartan on brain activity and connectivity as well as on process-specific multivariate neural signatures were examined.

RESULTS

AT1R blockade selectively reduced neurofunctional reactivity to fear-inducing visual oddballs in terms of attenuating dorsolateral prefrontal activity and amygdala-ventral anterior cingulate communication. Neurofunctional decoding further demonstrated fear-specific effects in that AT1R blockade reduced the neural expression of subjective fear but not of threat or nonspecific negative affect and did not influence reactivity to novel oddballs.

CONCLUSIONS

These results show a specific role of the AT1R in regulating the subjective fear experience and demonstrate the feasibility of a precision pharmacological functional magnetic resonance imaging approach to the affective characterization of novel receptor targets for fear in humans.

Fear of clowns: An investigation into the aetiology of coulrophobia

Introduction

Fear of clowns or coulrophobia is a little understood phenomenon despite studies indicating that it has a high prevalence in the general population. There have been no previous investigations into the aetiology of this fear, although several plausible hypotheses from the wider literature can be generated; the fear stems from media portrayals of scary clowns, from the unusual physical appearance or the unpredictable behaviour displayed, or it derives from an unpleasant personal experience.

Methods

The current study reviews the literature in this area and also pilots a new questionnaire (Origin of Fear of Clowns Questionnaire; OFCQ) to explore the causes of the fear of clowns in a sample of 528 participants who reported such a fear.

Results

Our findings suggest that uncertainty of harmful intent, media influences and unpredictability of behaviour play an important role in the origins of coulrophobia. There are also multiple features of clown appearance which produce a negative experiential state and a sense of a direct threat.

Discussion

We conclude that the origins of clown fear are multi-factorial and primarily relate to aspects of their facial appearance, their behaviour, and how they have been portrayed in the media. Surprisingly, fear derived from personal experience was not one of our main findings. Further research is focused on looking at associations between the level of fear and each aetiological category.

New insights into fever phobia: a pilot qualitative study with caregivers and their healthcare providers

Despite the availability of clinical guidelines on the correct symptomatic management of fever in children, several studies have reported inaccurate knowledge about this symptom and inappropriate management behaviours among caregivers. There is evidence that caregivers' management of fever is largely influenced by unrealistic and unwarranted concerns about the potential harm that elevated body temperature can cause, a phenomenon commonly referred to as fever phobia. Research on fever phobia has predominantly focused on the role of fever misconceptions in triggering anxiety and impeding a proper fever management, in terms of both concept and operationalization, with little attention to the influence of the relationship between caregivers and the healthcare team. The aim of this pilot study was to explore and describe fever-related knowledge, experience and behaviour among a sample of caregivers, paediatricians and their medical assistants in the Canton of Ticino, Switzerland. We used a qualitative study design with semi-structured, one-to-one interviews with paediatricians employed in private healthcare facilities, their medical assistants and caregivers with at least one child between the ages of 0 and 3 years. We conducted individual interviews either in person or by phone, according to participants' preferences, between October 2020 and February 2021. We performed an inductive-deductive analysis of the transcripts to identify the most meaningful themes from participants' reports. The analysis of the transcripts yielded three main themes. The first theme refers to participants' awareness of the emotional component in managing the child's fever and the challenges this component presents. The second theme refers to the risk of overtreating when the child's right to be sick is not recognized and respected. The third theme refers to the importance of the relational component, showing how a solid therapeutic alliance with the healthcare team helps caregivers develop self-confidence in managing the child's fever. This study contributes to advance our understanding of fever phobia and to a better conceptualization and operationalization of this phenomenon.

CONCLUSION

Our results point out to the importance of going beyond a knowledge gap paradigm and recognizing both the emotional and the relational component of fever phobia, the former being entrenched in latter, that is, the unique relationship caregivers establish with their child's paediatrician and the medical assistant.

WHAT IS KNOWN

• Research on fever phobia has predominantly focused on the role of fever misconceptions in triggering anxiety and impeding a proper fever management, in terms of both concept and operationalization, with little attention to the relational component of this phenomenon.

WHAT IS NEW

• Our results point out to the importance of recognizing the emotional component of fever phobia, beyond its declarative and procedural knowledge dimensions. They also suggest that overtreating is not necessarily and not only the result of a phobia but also of a particular conception of health and the relational component of this phenomenon, which is entrenched in the unique relationship caregivers establish with their child's paediatrician and the medical assistant.

Development of the COVID-19-Specific Obsessive Compulsive Symptoms Scale with Various Validity and Reliability Proofs

The COVID-19 epidemic, which spread rapidly around the world, has had a significant negative impact on mental health. Obsessive-compulsive disorder (OCD) issues are among the main mental health effects of COVID-19. The purpose of this study is to develop a brief measurement tool that reliably and validly measures obsessive-compulsive (OC) symptoms in people with COVID-19. A total of 483 people took part in the research online. Individuals with aberrant item scores were excluded, and a series of validity and reliability analyses were performed to determine the psychometric properties of the COVID-19-specific obsessive compulsive symptoms scale (C19-OCS). C19-OCS was found to be a valid and reliable measure for assessing OC symptoms in relation to COVID-19. Mental health professionals could use C19-OCS to develop evidence-based intervention strategies and programs.

Partner relationship quality, social support and maternal stress during pregnancy and the first COVID-19 lockdown

Introduction: Pregnancy has been associated with diminished maternal mental health and a deterioration in partner relationship quality. The recent COVID-19 quarantine measures have created additional stressors for pregnant women due to isolation and a surge in partner conflict.Objective: The purpose of this study was to assess how partner relationship conflict and social support may mediate mental health outcomes during the COVID-19 lockdown.Methods: A cross-sectional study with a sample of 152 pregnant women using psychological measures, (i.e. Prenatal Distress Questionnaire, Symptom Checklist-90-R, Duke-UNC-11 Functional Social Support Questionnaire, Perceived Stress Scale). Demographic characteristics, obstetrics history, and partner relationship conflict were assessed using questionnaires.Results: While there were few reports of physical violence in this sample, between 18% and 59% of women reported partner relationship conflict on the psychological subscale (e.g. afraid of one's partner or screamed at by one's partner). Further, the psychological subscale was significantly associated with symptoms of psychopathology. There was a significant negative association between social support and pregnancy-specific stress (p = .005), and perceived stress (p= .038).Conclusions: These findings suggest that partner relationship conflict and social support may act as important buffers for prenatal mental health in childbearing women during vulnerable situations, such as the COVID-19 pandemic.

Time is a great healer: Peak-end memory bias in anxiety - Induced by threat of shock

Recently, we demonstrated that the peak-end memory bias, which is well established in the context of pain, can also be observed in anxiety: Retrospective evaluations of a frightening experience are worse when peak anxiety is experienced at the end of an episode. Here, we set out to conceptually replicate and extend this finding with rigorous experimental control in a threat of shock paradigm. We induced two intensity levels of anxiety by presenting visual cues that indicated different strengths of electric stimuli. Each of the 59 participants went through one of two conditions that only differed in the order of moderate and high threat phases. As a manipulation check, orbicularis-EMG to auditory startle probes, electrodermal activity, and state anxiety confirmed the effects of the specific threat exposure. Critically, after some time had passed, participants for whom exposure had ended with high threat reported more anxiety for the entire episode than those for whom it ended with moderate threat. Moreover, they ranked their experience as more aversive when compared to other unpleasant everyday experiences. This study overcomes several previous limitations and speaks to the generalizability of the peak-end bias. Most notably, the findings bear implications for exposure therapy in clinical anxiety.

Factors associated with COVID-19 fear among healthcare professionals in Bangladesh

To determine the factors associated with the COVID-19 fear, we conducted an online survey among healthcare professionals in Bangladesh. The "fear of COVID-19 scale" was used to measure the fear. The predicting factors were identified by deploying a multiple linear regression model. Structural equation modelling was used to explore the relationship between mental health symptoms and COVID-19 fear. The overall fear score was 19.39 ± 5.26 (M ± SD) out of 28. Multiple linear regression identified financial constraints, self-employment, and general duties as the independent predictors of COVID-19 fear. However, structural equation modelling found a strong positive relationship between anxiety, insomnia, and fear. Results might be helpful for the policymakers and mental healthcare professionals to identify and manage maladaptive levels of fear and worry because of the coronavirus outbreak.

Footshock-induced activation of the claustrum-entorhinal cortical pathway in freely moving mice

Footshock is frequently used as an unconditioned stimulus in fear conditioning behavior studies. The medial entorhinal cortex (MEC) contributes to fear learning and receives neuronal inputs from the claustrum. However, whether footshocks can induce a neuronal response in claustrum-MEC (CLA-MEC) projection remains unknown. Here, we combined fiber-based Ca2+ recordings with a retrograde AAV labeling method to investigate neuronal responses of MEC-projecting claustral neurons to footshock stimulation in freely moving mice. We achieved successful Ca2+ recordings in both anesthetized and freely exploring mice. We found that footshock stimulation reliably induced neuronal responses to MEC-projecting claustral neurons. Therefore, the footshock-induced response detected in the CLA-MEC projection suggests its potential role in fear processin.

The Mediating Role of Psychological Resilience in the Relationship between Emotional Reactivity, Intolerance of Uncertainty and Psychological Maladjustment in Children Receiving Orthodontic Treatment

The aim of this research was to examine the various psychological characteristics that affect psychological maladjustment in children undergoing orthodontic treatment. In this context, the predictive and mediating relationships between emotional reactivity, intolerance of uncertainty, psychological resilience and psychological maladjustment were considered. The study was conducted cross-sectionally with 543 children and adolescents aged 10−18 years, who were being treated at a state university orthodontic clinic in Turkey. Standardized measurement tools (The Emotional Reactivity Scale, Intolerance of Uncertainty Scale, Brief Resilience Scale and Depression Anxiety Stress Scale) and online data collection processes were used in the data collection process. The findings show that emotional reactivity and intolerance of uncertainty pose a risk for psychological maladjustment in children and adolescents receiving orthodontic treatment, but psychological resilience has a protective function against this risk (p < 0.001). It is suggested that these findings may contribute to the expansion of pediatric dentists’ perspectives on the secondary outcomes of orthodontic treatment practices.

Oxytocin: An Old Hormone, A Novel Psychotropic Drug And Possible Use In Treating Psychiatric Disorders

BACKGROUND

Oxytocin is a nonapeptide synthesized in the paraventricular and supraoptic nuclei of the hypothalamus. Historically, this molecule has been involved as a key factor in the formation of infant attachment, maternal behavior and pair bonding and, more generally, in linking social signals with cognition, behaviors and reward. In the last decades, the whole oxytocin system has gained a growing interest as it was proposed to be implicated in etiopathogenesis of several neurodevelopmental and neuropsychiatric disorders.

METHODS

With the main goal of an in-depth understanding of the oxytocin role in the regulation of different functions and complex behaviors as well as its intriguing implications in different neuropsychiatric disorders, we performed a critical review of the current state of art. We carried out this work through PubMed database up to June 2021 with the search terms: 1) "oxytocin and neuropsychiatric disorders"; 2) "oxytocin and neurodevelopmental disorders"; 3) "oxytocin and anorexia"; 4) "oxytocin and eating disorders"; 5) "oxytocin and obsessive-compulsive disorder"; 6) "oxytocin and schizophrenia"; 7) "oxytocin and depression"; 8) "oxytocin and bipolar disorder"; 9) "oxytocin and psychosis"; 10) "oxytocin and anxiety"; 11) "oxytocin and personality disorder"; 12) "oxytocin and PTSD".

RESULTS

Biological, genetic, and epigenetic studies highlighted quality and quantity modifications in the expression of oxytocin peptide or in oxytocin receptor isoforms. These alterations would seem to be correlated with a higher risk of presenting several neuropsychiatric disorders belonging to different psychopathological spectra. Collaterally, the exogenous oxytocin administration has shown to ameliorate many neuropsychiatric clinical conditions.

CONCLUSION

Finally, we briefly analyzed the potential pharmacological use of oxytocin in patient with severe symptomatic SARS-CoV-2 infection due to its anti-inflammatory, anti-oxidative and immunoregulatory properties.

Avoidance behaviour modulates but does not condition phonophobia in migraine

Background

Past studies do not account for avoidance behaviour in migraine as a potential confounder of phonophobia.

Objective

To analyse whether phonophobia is partially driven by avoidance behaviour when using the classic methodology (method of limits).

Methods

This is a case-control study where we tested phonophobia in a cohort of high-frequency/chronic migraine patients (15.5 ± 0.74 headache days/month) and non-headache controls. Auditory stimuli, delivered in both ears, were presented using three different paradigms: the method of limits, the method of constant stimuli, and the adaptive method. Participants were asked to report how bothersome each tone was until a sound aversion threshold was estimated for each method.

Results

In this study, we successfully replicate previously reported reduction in sound aversion threshold using three different methods in a group of 35 patients and 25 controls (p < 0.0001). Avoidance behaviour in migraine reduced sound aversion threshold in the method of limits (p = 0.0002) and the adaptive method (p < 0.0001) when compared to the method of constant stimuli. While thresholds in controls remained the same across methods (method of limits, p = 0.9877 and adaptive method, p = 1).

Conclusion

Avoidance behaviour can exacerbate phonophobia. The current methodology to measure phonophobia needs to be revised.

Fear of COVID-19, stress and depression: A meta-analytic test of the mediating role of anxiety

OBJECTIVES

The COVID-19 pandemic has negatively affected the lives of millions of individuals physiologically, behaviorally, socially, and/or psychologically. Moreover, there is now much empirical evidence that mental health problems have increased during the pandemic period and these problems have various consequences. The changes in the mood states of individuals due to the pandemic underpins the rationale of the present study. The aim of the study was to identify the cross-sectional associations between fear of COVID-19, stress, anxiety, and depression by using two stage-meta-analytic structural equation modeling (TS-MASEM).

DESIGN

This is a meta-analytic structural equation modelling study.

METHOD

A systematic literature review initially identified 4840 studies. As a result of applying inclusion and exclusion criteria, 25 studies comprising 28 samples (reporting 120 effect sizes) were eligible for inclusion in the current TS-MASEM (N = 16,452).

RESULTS

The results showed significant associations between fear of COVID-19, stress, anxiety, and depression. Additionally, the mediation role of anxiety in the association between depression and fear of COVID-19 and stress was explored.

CONCLUSIONS

Although the results did not allow for causal inferences regarding depression, they provide insight into the possible consequences of fear of COVID-19 and comorbid problems for clinicians and researchers.

Comparative Proteomic Analysis Reveals the Effect of Selenoprotein W Deficiency on Oligodendrogenesis in Fear Memory

The essential trace element selenium plays an important role in maintaining brain function. Selenoprotein W (SELENOW), the smallest selenoprotein that has been identified in mammals, is sensitive to selenium levels and abundantly expressed in the brain. However, its biological role in the brain remains to be clarified. Here, we studied the morphological and functional changes in the brain caused by SELENOW deficiency using its gene knockout (KO) mouse models. Histomorphological alterations of the amygdala and hippocampus, specifically in the female SELENOW KO mice, were observed, ultimately resulting in less anxiety-like behavior and impaired contextual fear memory. Fear conditioning (FC) provokes rapidly intricate responses involving neuroplasticity and oligodendrogenesis. During this process, the females generally show stronger contextual FC than males. To characterize the effect of SELENOW deletion on FC, specifically in the female mice, a Tandem mass tag (TMT)-based comparative proteomic approach was applied. Notably, compared to the wildtype (WT) no shock (NS) mice, the female SELENOW KO NS mice shared lots of common differentially expressed proteins (DEPs) with the WT FC mice in the hippocampus, enriched in the biological process of ensheathment and oligodendrocyte differentiation. Immunostaining and Western blotting analyses further confirmed the proteomic results. Our work may provide a holistic perspective of gender-specific SELENOW function in the brain and highlighted its role in oligodendrogenesis during fear memory.

Involvement of nitric oxide in the neurobiology of fear-like behavior

Fear is an emotional reaction that arises in dangerous situations, inducing the adaptation to an existing condition. This behavior was conserved in all vertebrates throughout evolution and is observed in mammals, birds, fish, amphibians, and reptiles. The neurocircuitry of fear involves areas of the limbic system, cortical regions, midbrain, and brainstem. These areas communicate with each other so that there is an expression of fear and memory formation to deal with the same situation at another time. The effect of nitric oxide (NO) on fear modulation has been explored. NO is a gaseous compound that easily diffuses through the cell membrane and is produced through the oxidation reaction of l-Arginine to l-citrulline catalyzed by nitric oxide synthase (NOS). Activating the intracellular NO receptor (soluble guanylyl cyclase enzyme - sGC) triggers an enzymatic cascade that can culminate in plastic events in the neuron. NOS inhibitors induce anxiolytic-like responses in fear modulation, whereas NO donors promote fear- and anxiety-like behaviors. This review describes the neurobiology of fear in mammals and non-mammals, how NO is produced in the central nervous system, and how NO acts in fear-like behavior.

The hidden stigma of aging and COVID-19: aggravating factors and strategies to mitigate the impact of the pandemic in older adults, a text mining analysis

OBJECTIVE

To identify factors associated with mental health of older adults during the pandemic and to provide strategies to mitigate their psychosocial impact in the elderly.

METHOD

An integrative text mining analysis in Medline was performed to identify studies on the mental health of older adults during the pandemic. Subsequently, statistical topic modeling was performed to identify the most prevalent terms and topics discussed in included studies.

RESULTS

A total of 29 studies were retrieved until July 1st 2020, including a majority of letters (12 studies) and commentaries (8 studies). The most frequent terms overall were: loneliness (n = 137), support (n = 132), home (n = 102), suicide (n = 96) and help (n = 94). The most prevalent terms were then divided in five topics: home (33%), suicide (32%), apps (15%), loneliness (12%) and physical activity (9%). Additionally, a section focused on low- and middle-income countries was included. A summary of strategies to mitigate the effects of pandemic in mental health of older adults was also provided.

CONCLUSION

These factors demonstrate the importance of developing strategies for psychosocial support that take into consideration the particularities of the elderly. Different levels of care are immediately necessary to diminish the devastating impact of the pandemic in the mental health of older adults.

Suicidal ideation and its related factors among older adults: a population-based study in Southwestern Iran

Objectives

Suicidal ideation is a major risk factor for suicide and can negatively affect self-care and health behaviors among the older adults. There are limited data on the prevalence and risk factors of suicidal ideation among the older population during the COVID-19 pandemic. The aim of the present study was to examine the prevalence and risk factors of suicidal ideations among Iranian older adults during the COVID-19 pandemic.

Methods

A total of 803 older community adults in Shiraz (Southwestern Iran) were surveyed to determine potential factors influencing suicidal ideation, including demographic factors, physical health status, access to healthcare, current depression status, fear of COVID-19, perceived social support, and social engagement. Data were collected utilizing face-to-face interviews between November and December 2020. Multivariate logistic regression analysis was used to identify independent variables associated with suicidal ideations.

Results

Among the 803 participants, 69 reported suicidal ideations (8.6%). Individuals with suicidal ideations were more likely to have greater fear of COVID-19. However, based on the results of multivariate logistic regression analysis, current depression (OR: 2.07, CI 95%: 1.18–3.65), not being married (OR: 1.82, CI 95%: 1.06–3.13), inability to pay for medical bills (OR: 2.16, CI 95%: 1.23–3.79), low perceived social support (OR: 2.03, CI95%: 1.11–3.71), and having limited social network (OR:1.77, CI 95%: 1.02–3.10) appeared to be more powerful influencing factors.

Conclusion

Suicidal ideation appears to be relatively common among Iranian older adults during the COVID-19 pandemic. A lack of longitudinal data makes it difficult to establish an association between suicidal ideations and the COVID-19 pandemic. Systematic monitoring of suicidal ideation is recommended among high-risk groups, particularly the older population.

Aesthetic Science of Rhinoplasty: Three Principles

Aesthetic science is a rapidly growing discipline that involves plastic surgery as much or more than other disciplines of science. Fortunately, how and why the human brain responds to the visual world is better understood now than ever before. Of necessity plastic surgery is a part of that aesthetic science movement because it deals directly with the application of aesthetic principles. Therefore, it behooves the surgeon to be familiar with the principles of aesthetic science so as to both delineate and attain the aesthetic goal at the same time any functional goal is part of the operation. There are three important principles for rhinoplasty: (1) symmetry, (2) continuity and (3) persistence. This study provides examples of how they apply in the preop, intraop and postop phase of performing aesthetic rhinoplasty. A firm understanding of these principles can then guide the surgeon through the difficult maze of decision making, operative planning and surgical execution that arguably makes aesthetic rhinoplasty the most difficult aesthetic operation in plastic surgery. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Kinesiophobia and Fear Avoidance in Older Adults: A Scoping Review on the State of Research Activity

A scoping review was performed to examine the extent and nature of research activity on kinesiophobia and fear avoidance in older adults and summarize research findings. Four databases were searched from January 2006 to May 2021. Eleven papers were selected for inclusion, with a predominance of cross-sectional design (54.5%; n = 6). Most of the studies were associated with chronic pain (n = 9; 81.8%). Higher levels of kinesiophobia were found among frailer and older people, predominantly living in care homes. Kinesiophobia and fear avoidance have been related to other constructs of the fear avoidance model, and the conclusions partially support the assumptions derived from it in older adults. Nevertheless, kinesiophobia proved to be a more dominant factor in determining the level of physical activity than pain in this population. None of the studies aimed to test the effectiveness of interventions directly targeting kinesiophobia or fear avoidance.

Hallucinogenic drugs and their potential for treating fear-related disorders: Through the lens of fear extinction

Fear-related disorders, mainly phobias and post-traumatic stress disorder, are highly prevalent, debilitating disorders that pose a significant public health problem. They are characterized by aberrant processing of aversive experiences and dysregulated fear extinction, leading to excessive expression of fear and diminished quality of life. The gold standard for treating fear-related disorders is extinction-based exposure therapy (ET), shown to be ineffective for up to 35% of subjects. Moreover, ET combined with traditional pharmacological treatments for fear-related disorders, such as selective serotonin reuptake inhibitors, offers no further advantage to patients. This prompted the search for ways to improve ET outcomes, with current research focused on pharmacological agents that can augment ET by strengthening fear extinction learning. Hallucinogenic drugs promote reprocessing of fear-imbued memories and induce positive mood and openness, relieving anxiety and enabling the necessary emotional engagement during psychotherapeutic interventions. Mechanistically, hallucinogens induce dynamic structural and functional neuroplastic changes across the fear extinction circuitry and temper amygdala's hyperreactivity to threat-related stimuli, effectively mitigating one of the hallmarks of fear-related disorders. This paper provides the first comprehensive review of hallucinogens' potential to alleviate symptoms of fear-related disorders by focusing on their effects on fear extinction and the underlying molecular mechanisms. We overview both preclinical and clinical studies and emphasize the advantages of hallucinogenic drugs over current first-line treatments. We highlight 3,4-methylenedioxymethamphetamine and ketamine as the most effective therapeutics for fear-related disorders and discuss the potential molecular mechanisms responsible for their potency with implications for improving hallucinogen-assisted psychotherapy.

Mental health distress during the COVID-19 pandemic in Nigeria: Need for psychological intervention

Background

Aim

Setting

Methods

Results

Conclusion

COVID-19 pandemic fears and obsessive-compulsive symptoms in adolescents with pre-existing mental disorders: An exploratory cross-sectional study

BACKGROUND

Previous research has established an association between pandemic fears and the development of obsessive-compulsive symptoms mainly in the general population.

AIM

To explore whether COVID-19 pandemic fears are associated with obsessive-compulsive symptoms and vice versa in adolescents with preexisting mental and behavioural disorders.

METHODS

A questionnaire-based cross-sectional study among adolescents with pre-existing mental disorders. The extent of worrying related to the COVID-19 pandemic was measured using the COVID-19 inventory whereas obsessive-compulsive symptoms were assessed using the obsessive-compulsive inventory-revised (OCI-R). Pearson correlation coefficient (r) was used to explore the relationship between COVID-19 pandemic fears and the development of obsessive-compulsive symptoms.

RESULTS

A total of 57 patients out of 63 participants (90.4%) had a COVID-19 inventory score of 12 or higher suggesting that a vast majority of young people with mental disorders had significant pandemic-related worries. Out of these 57 patients, over half (31) had an OCI-R modified score of 17 or higher indicating significant obsessive-compulsive symptoms. A positive correlation was found between the means of the two scores. This relationship was statistically significant - {r = 0.405, Sig. (two-tailed) = 0.001}.

CONCLUSION

Adolescents with mental disorders can exhibit significant pandemic fears and this is likely to be associated with obsessive-compulsive symptoms.

The effect of passion for activities on fear of COVID-19 and mental health among the Japanese population

As the ongoing pandemic limited the lives of the general population, people engaged in their favorite activities; either in alternative ways or while disregarding the restrictions. These activities and people's engagement in such activities are considered to have a significant impact on mental health. Thus, this study aimed to examine the relationship between two types of passion (harmonious passion and obsessive passion), fear of COVID-19, and mental distress. Thus, a total of 322 Japanese participants completed an online questionnaire. The results showed that harmonious passion (HP) was negatively related to mental distress. Conversely, obsessive passion (OP) was positively related to fear of COVID-19 and mental distress. The fear of COVID-19 had a positive relationship with mental distress. This study evidenced that HP is a protective factor against pandemics as it improves mental health during a pandemic. However, OP is a risk factor as it amplifies fear of COVID-19. Focusing on distinct types of passion may prove effective in improving mental health amidst the pandemic.

Fear of COVID-19 and Life Satisfaction: The Role of the Health-Related Hardiness and Sense of Coherence

Introduction: The COVID-19 pandemic is contributing to increased fear and anxiety throughout society, which may affect life satisfaction. Health-related hardiness and sense of coherence (SOC) are personal resources that help people adapt to difficult circumstances. The purpose of this study was to investigate the relationship between fear of COVID-19, SOC, health-related hardiness, and life satisfaction. Methods: A total of 907 Polish people (522 women and 385 men) participated in this study. The Fear of COVID-19 Scale (FOC-6), the Health-Related Hardiness Scale, the Sense of Coherence Scale (SOC-29), and the Satisfaction with Life Scale were used. Results: Correlation showed that fear of COVID-19 was negatively related to health-related hardiness, SOC, and life satisfaction. Health-related hardiness and SOC were positively related to life satisfaction. Both SOC and hardiness were mediators between fear of COVID-19 and life satisfaction during the current pandemic. Conclusion: SOC and health-related hardiness are personal resources that are important for dealing with the effects of the COVID-19 pandemic. According to our study, SOC and hardiness can mediate between fear of COVID-19 and life satisfaction. Presented cross-sectional results have to be verified in future longitudinal studies in order to strengthen the conclusions presented in this manuscript. This study verified the role of only two personal resources, so more research is needed on the role of other personal resources during COVID-19 pandemic.

Portuguese Version of COVID-19 Perceived Risk Scale and COVID-19 Phobia Scale: Psychometric Properties

The COVID-19 pandemic scenario has a psychological impact on individuals and society. A higher level of perceived risk concerning COVID-19 has been found when compared to other potential health threats. A misperception of risk in contrast with the real risk may lead people to develop disruptive cognitive, affective, or behavioral responses to the COVID-19 pandemic, namely, coronaphobia. Validated instruments are needed to evaluate such responses. This work aims to validate the COVID-19 Perceived Risk Scale (C19PRS) and the COVID-19 Phobia Scale (C19PS) in the Portuguese population. The two scales were translated from English to Portuguese using the back-translation technique. The cultural adaptation was framed in the context of establishing the validity and reliability of the instruments. In two studies, C19PRS and C19PS were validated for the adult Portuguese population (N = 1122; women = 725 (64.6%); mean age of 31.91 years old) through exploratory factorial analysis, followed by a confirmatory factorial analysis. Convergent validity was calculated by composite reliability (CR) and average variance extracted (AVE) values. Discriminant validity was assessed by square roots of the AVE values and their comparison with the C19PRS and C19PS dimensions’ cross-correlations. Both C19PRS and C19PS present a good adjustment model and solid reliability and validity and have significant correlations with fear of COVID-19 and COVID-19 anxiety scales.

Psychometric Validation of the Arabic Fear of Illness and Virus Evaluation

Global infectious pandemics can affect the psychology and behavior of human beings. Several tools were developed to evaluate the psychological impact of such outbreaks. The present study aimed to examine the psychometric properties of the Arabic translated version of Fear of Illness and Virus Evaluation scale (FIVE). FIVE is a 35-item tool consisting of four subscales that measure Fears about Contamination and Illness, Fears about Social Distancing, Behaviors Related to Illness and Virus Fears and Impact of Illness and Virus Fears. The tool was translated into Arabic by using a forward-backward translation. The online questionnaire contained the following sections: demographics, FIVE, Fear of COVID-19 Scale (FCV-19S) and face validity questions. Non-probability convenient sampling technique was used to recruit participants via a mobile instant messaging application. Reliability, concurrent validity, face validity and factor analysis were examined. The data consisted of 509 adult participants who reside in Saudi Arabia. The internal consistency of the Arabic FIVE subscales was high (0.84-0.91) with strong concurrent validity indicated by positive correlations of FIVE subscales with FCV-19S. Factor analysis suggested slightly different factor structures (Fears of Getting Sick, Fears that Others Get Sick, Fears of the Impact on Social Life and Behaviors Related to Illness and Virus Fears). Our data showed a better fit using the proposed structures. The Arabic version of the FIVE showed robust validity and reliability qualities to assess fear of COVID-19 on Arabic adult population.

Relationship of fear of COVID-19 and pregnancy-related quality of life during the COVID-19 pandemic

AIM

The aim of this study was to determine the relationship between fear of COVID-19 and quality of life in Iranian pregnant women during the COVID-19 pandemic.

METHODS

This cross-sectional study was carried out on 250 Iranian pregnant women. Data was collected through questionnaires including demographic and obstetric characteristics, fear of COVID-19 and quality of life. An adjusted general linear model was used to determine the relationship between variables.

RESULTS

There was a negatively significant relationship between fear of COVID-19 and quality of life (P < 0.001). Based on the adjusted general linear model, it was expected that if COVID-19 fear score increased, the quality of life score would decrease significantly (B = -0.21, 95%CI: -0.34 to -0.09, P = 0.001).

CONCLUSION

This study indicated a reverse correlation between fears of COVID-19 and quality of life. Therefore, developing appropriate interventions in order to overcome the fear caused by COVID-19 are recommended to improve pregnant women's quality of life.

The Psychological Impact of Coronavirus Pandemic Restrictions in Italy. The Mediating Role of the Fear of COVID-19 in the Relationship between Positive and Negative Affect with Positive and Negative Outcomes

Italy was quickly hit hard by the coronavirus. 'Lockdown' has significantly impacted the psychological health, personal wellbeing and quality of life of the people. The study aims to explore the relationship between positive and negative affect, as well as positive (spiritual well-being and flourishing) and negative outcomes (psychological distress caused by a traumatic life event in terms of perception of PTSD symptoms) on Italian adults during the lockdown period. Data was collected between April and May 2020. The participants were 281 Italian adults aged between 18 and 73 years. The survey was composed of the following measures: Flourishing Scale, Jarel Spiritual Well-Being scale, Positive and Negative Affect Schedule, Impact of Event Scale-Revised, Fear of COVID-19. The mediational analysis shows that fear of COVID-19 fully mediates the relationship between negative affect and spiritual well-being and flourishing; fear of COVID-19 partially mediates the relationship between negative affect and PTSD symptoms; the positive affect shows only direct effects on positive outcomes. Therefore, fear of COVID-19 does not play any mediation role. Implications for psychological interventions and future research will be discussed.

The Nighttime Fears Scale: Development and psychometric evidence of a standardized self-report scale to assess nighttime fears in children

Nighttime fears are highly prevalent in children and are linked to children's distress and internalizing problems, especially childhood anxiety. Although its assessment may be critical, there is a lack of available standardized self-reports. This study aimed to describe the development and psychometric evaluation of the Nighttime Fears Scale (NFS), a new standardized self-report for assessing nighttime fears in school-aged children. The construction of the scale was based on prior relevant research and involvement of researchers and clinicians, experts in childhood anxiety, and fears. A total of 794 Spanish-speaking children (51.1 % girls) aged 8-12 years completed the NFS along with measures of anxiety, sleep problems, internalizing and externalizing problems, and positive behaviors. Exploratory and confirmatory factor analyses supported a four-factor structure of the NFS, consisting of 21 items measuring a range of potentially fear-provoking stimuli at nighttime. Strong internal consistency (alphas ranging from .87 to .94), adequate test-retest reliability, and evidence of convergent, divergent and incremental validity was found. This study provides initial support for the use of the NFS by clinicians and researchers, suggesting that it is a promising tool for a rapid and easily-administered assessment to identify the presence and intensity levels of a set of common children's nighttime fears.

A Fear of COVID-19 and PTSD Symptoms in Pathological Personality: The Mediating Effect of Dissociation and Emotion Dysregulation

Background: The 2019 coronavirus disease (COVID-19) outbreak is currently putting a strain on the mental health resilience of the world's population. Specifically, it is likely to elicit an intense response to fear and to act as a risk factor for the onset of posttraumatic stress disorder (PTSD). Some individuals may be more at risk than others, with pathological personality variables being a potential candidate as a central vulnerability factor. In addition, the pathways that lead the pathological personality to PTSD and intense fear responses to COVID-19 are likely to be explained by poor emotion regulation capacities, as well as by dissociative mechanisms. Aims: This study aimed to shed light on vulnerability factors that may account for the onset of PTSD and intense responses of fear in response to COVID-19 outbreak and to test the mediating role of emotion dysregulation and dissociation proneness in these pathways. Methods: We used a longitudinal design of research administered to a sample of community individuals (N = 308; meanage = 35.31, SD = 13.91; 22.7% were male). Moreover, we used self-report questionnaires to measure pathological personality, emotion regulation capacities, dissociative proneness at the beginning of the lockdown, and PTSD symptoms and fear of COVID-19 at the end of the Italian lockdown (from March 9 to May 18, 2020). Structural equation modeling was used to test the hypotheses. Results: We found that pathological personality levels longitudinally predicted PTSD and fear of COVID-19 levels. Moreover, the associations between emotion dysregulation and dissociation were shown to significantly and totally mediate the relationship between pathological personality and PTSD, whereas no significant mediation effects were observed in relation to fear of COVID-19. Conclusions: Individuals with pathological personality traits may be more vulnerable to the onset of negative psychological consequences related to COVID-19 outbreak, such as PTSD symptomatology and fear levels. Emotion regulation capacities appear to be relevant targets of interventions for PTSD symptomatology. Future research should explore the mediating variables linking pathological personality to intense fear responses to COVID-19.

Associations Between Fear of COVID-19, Affective Symptoms and Risk Perception Among Community-Dwelling Older Adults During a COVID-19 Lockdown

Fear is a common and potentially distressful psychological response to the current COVID-19 pandemic. The factors associated with such fear remains relatively unstudied among older adults. We investigated if fear of COVID-19 could be associated with a combination of psychological factors such as anxiety and depressive symptoms, and risk perception of COVID-19, and demographic factors in a community sample of older adults. Older adults (N = 413, M age = 69.09 years, SD = 5.45) completed measures of fear of COVID-19, anxiety and depressive symptoms, and risk perception of COVID-19, during a COVID-19 lockdown. These variables, together with demographics, were fitted to a structural equation model. Anxiety and depressive symptoms were highly correlated with each other and were combined into the higher order latent variable of affective symptoms for analyses. The final model revealed that fear of COVID-19 was positively associated with psychological factors of affective symptoms and risk perception. Older age was associated with greater fear of COVID-19. Our findings showed that fear of COVID-19 can be a projection of pre-existing affective symptoms and inflated risk perceptions and highlighted the need to address the incorrect risk perceptions of COVID-19 and socio-affective issues among older adults in the community.

Coping with COVID-19: social representations underlying blaming processes and fear

Objective. This study examines how people socially represent the COVID-19 pandemic in the early stage of the health crisis in Europe. Specifically, this research analyses the days before and immediately after the declaration of the state of emergency in Spain, which resulted in the entire population being placed in lockdown. Design. For this purpose, we used the Grid Elaboration Method for free association elicited by the word "coronavirus". This exercise was completed by 1037 people from Spain. Main Outcome Measures. Responses were analysed using Iramuteq software for lexical analysis. Results. Before the state of emergency and lockdown, there was a repeat of many of the emotional and cognitive patterns seen in previous pandemics such us upward and downward blaming or feelings of anger and emotional fatigue. However, outward blaming patterns towards peers also emerged. Moreover, in the period following lockdown, we noted the emergence of new representations and emotions such as paralyzing distrust or resilience. Similarity analysis revealed that the "fear of pandemic" hides a wide variety of emotions. Conclusion. Understanding the blaming and fear processes that are linked to the emergence of the COVID-19 pandemic in Spain offers us practical implications for coping with the challenge of this new crisis.

An Emotion Care Model using Multimodal Textual Analysis on COVID-19

At the dawn of the year 2020, the world was hit by a significant pandemic COVID-19, that traumatized the entire planet. The infectious spread grew in leaps and bounds and forced the policymakers and governments to move towards lockdown. The lockdown further compelled people to stay under house arrest, which further resulted in an outbreak of emotions on social media platforms. Perceiving people's emotional state during these times becomes critically and strategically important for the government and the policymakers. In this regard, a novel emotion care scheme has been proposed in this paper to analyze multimodal textual data contained in real-time tweets related to COVID-19. Moreover, this paper studies 8-scale emotions (Anger, Anticipation, Disgust, Fear, Joy, Sadness, Surprise, and Trust) over multiple categories such as nature, lockdown, health, education, market, and politics. This is the first of its kind linguistic analysis on multiple modes pertaining to the pandemic to the best of our understanding. Taking India as a case study, we inferred from this textual analysis that 'joy' has been lesser towards everything (~9-15%) but nature (~17%) due to the apparent fact of lessened pollution. The education system entailed more trust (~29%) due to teachers' fraternity's consistent efforts. The health sector witnessed sadness (~16%) and fear (~18%) as the dominant emotions among the masses as human lives were at stake. Additionally, the state-wise and emotion-wise depiction is also provided. An interactive internet application has also been developed for the same.

Percepção do medo de ser contaminado pelo novo coronavírus

RESUMO Objetivo: Avaliar a prevalência e os fatores associados à percepção do medo de ser contaminado pelo novo coronavírus. Métodos: Estudo transversal realizado em Passo Fundo, Rio Grande do Sul, com indivíduos de ambos os sexos e 18 ou mais anos de idade. Coleta on-line de dados sociodemográficos, de saúde, de comportamento e de conhecimento acerca do vírus. Análise estatística descritiva e cálculo de prevalência e de razões de prevalência (RP) brutas e ajustadas. Resultados: Amostrados 920 participantes, com 64% de prevalência de medo de contaminação, sendo maior em indivíduos que trabalham (RP = 1,10; IC95 1,02-1,20), com idosos no domicílio (RP = 1,18; IC95 1,17-1,19), percepção negativa da saúde (RP = 1,15; IC95 1,02-1,31), avaliação de elevado risco de contaminação (RP = 1,30; IC95 1,23-1,38), com no mínimo um dos principais sinais/sintomas na semana anterior (RP = 1,12; IC95 1,11-1,13), que realizam maior número de medidas preventivas (RP = 1,27; IC95 1,15-1,40), vacinados contra a gripe (RP = 1,08; IC95 1,07-1,10) e que sabem que pertencem ao grupo de risco (RP = 1,17; IC95 1,14-1,19). Menor probabilidade do desfecho observada em idosos (RP = 0,74; IC95 0,60-0,91), profissionais ou estudantes da saúde (RP = 0,82; IC95 0,81-0,83) e em não fumantes (RP = 0,86; IC95 0,79-0,94). Conclusões: Observou-se elevada proporção de medo entre os participantes, especialmente entre aqueles que se percebem sob maior risco. Considerando o importante papel do medo na saúde mental das pessoas, os achados indicam a importância de intensificar ações educativas e informativas, visando ampliar o esclarecimento da população e reduzir os impactos da pandemia nesse aspecto.