Anxiety and depression in the Republic of Ireland during the COVID-19 pandemic

The impact of depressive and anxious symptoms on quality of life in adults on the autism spectrum

Quality of life (QoL) is lower in adults on the autism spectrum (AS) compared with typically developing (TD) adults. In this context, recent studies have examined the role of depression and anxiety in reducing QoL in AS adults. The aim of this study was to (1) replicate these findings of lower QoL and (2) assess the negative influence of depressive and anxious symptoms on QoL in an adult AS (N = 86) and TD (N = 87) German sample with a broad age range (18-70 years). For this, we used questionnaires that have been validated for the AS and TD population: the World Health Organization Quality of Life Brief Version, the Autism-Specific QoL items, and the Hospital Anxiety and Depression Scale. We replicated previous findings and extended them to autism-specific QoL. Our AS sample had lower QoL compared with the TD adults. However, depressive symptoms were the largest contributor to lower QoL in both samples, more so than group membership and anxious symptoms. We conclude that interventions to improve QoL in AS adults should specifically target depressive symptoms and for this, improvements to the diagnostic process and treatment of depression in AS are necessary.

A comparative analysis of stress, anxiety, and social well-being of working mothers and stay-at-home mothers during the covid pandemic

BACKGROUND

The role of mental health is crucial in maintaining the dynamism and productivity of any given society. In contemporary times, a significant proportion of the workforce is comprised of women and mothers. Working in healthcare facilities, where exposure to pathogenic agents is an everyday nuisance, can have detrimental effects on mothers' stress and anxiety levels. Furthermore, such exposure can also endanger the health of both the family and society. Conversely, the employment of mothers could positively impact their social well-being. The primary objective of this study is to assess and compare the stress, anxiety, and social well-being scores of mothers employed in healthcare facilities and stay-at-home mothers during the COVID pandemic.

MATERIALS AND METHODS

This study is a cross-sectional analysis of 246 mothers, equally divided into two groups: Mothers who work in health centers and stay-at-home mothers (123 individuals in each group). The study was conducted from 2021 to 2022, a multistage sampling method was utilized and two questionnaires were administered: The DASS 21 (21 questions) and the social well-being questionnaire (48 questions). The data were analyzed using SPSS 18, and descriptive and analytical tests (Independent Samples T-Test, Mann-Whitney) were employed.

RESULTS

The mean age was 35.7 ± 7.1 for working mothers and 34.3 ± 6.3 for stay-at-home mothers. The average stress score for employed mothers was 5.72 ± 4.7, and for stay-at-home mothers, it was 7.16 ± 4.3, which indicates a statistically significant difference in stress levels between the two groups (P = 0.04). However, the two groups had no significant difference in the mean anxiety score (P = 0.08). The mean score for social well-being was 165.5 ± 18.4 for working mothers and 162.17 ± 21.2 for stay-at-home mothers. This difference was not statistically significant (P = 0.18). Except for the social acceptance dimension (P = 0.003), no statistically significant differences were observed in the social well-being dimension between the two groups.

CONCLUSION

The social acceptance of working mothers appears to be greater than that of stay-at-home mothers. Higher social acceptance suggests that they hold a more positive outlook on people and are at ease in social situations, which may have helped to alleviate their stress and anxiety.

Perceptions of risk and coping strategies during the COVID-19 pandemic among women and older adults

The world's health, economic, and social systems have been adversely impacted by the COVID-19 pandemic. With lockdown measures being a common response strategy in most countries, many individuals were faced with financial and mental health challenges. The current study explored the effect of the COVID-19 pandemic on the psychological well-being, perception of risk factors and coping strategies of two vulnerable groups in Malaysia, namely women and older adults from low-income households (USD592). A purposive sample of 30 women and 30 older adults was interviewed via telephone during Malaysia's Movement Control Order (MCO) regarding the challenges they faced throughout the pandemic. Thematic analysis was subsequently conducted to identify key themes. The themes identified from the thematic analysis indicated a degree of overlap between both groups. For women, seven themes emerged: 1) Psychological challenges due to COVID-19 pandemic, 2) Family violence, 3) Finance and employment related stress and anxiety, 4) Women's inequality and prejudice, 5) Coping strategies, 6) Professional support, and 7) Women's empowerment. Similarly, there were six themes for the older adults: 1) Adverse emotional experiences from COVID-19, 2) Threats to health security, 3) Loss of social connections, 4) Government aid to improve older adults' psychological well-being, 5) Psychological support from family members and pets, and 6) Self-reliance, religion, and spirituality. The findings provide valuable information on the specific burdens faced by these groups, and support psychological interventions and mitigations that would be appropriate to improve well-being during the recovery phase.

There is no association between anxiety and lifestyle in older adults during the COVID-19 pandemic: A cross-sectional study

Introduction and objective

The COVID-19 pandemic has caused mental health problems worldwide. Older people have been particularly affected by the lockdown as their health conditions have changed, although they have been kept in isolation to avoid exposure to contagion. We sought to determine the association between lifestyles and anxiety in older adults during the COVID-19 pandemic.

Materials and methods

This study was cross-sectional. We enrolled 150 older adults of both sexes and with a history of chronic diseases from the municipality of El Agustino (Lima, Peru). The 20-item Geriatric Anxiety Scale and the 25-item Lifestyle Questionnaire on eating, physical activity, rest, and sleep were administered in Spanish during July-August 2021.

Results

The mean age was 70.8 ± 8.1 years, 54.7% were male, and 75.3% practiced exercise. During the COVID-19 pandemic, 99.3% of the elderly had healthy lifestyles and 40% presented anxiety (mild, moderate, and severe anxiety in 26.7%, 8.7%, and 4.7%, respectively). We found no association between anxiety and lifestyle (p = 0.189), physical exercise was a predictor of lifestyle (p < 0.001) and we did not find predictors of anxiety symptoms (p > 0.05).

Conclusions

Our results suggest that there was no link between anxiety symptoms and lifestyle in older adults during the lockdown. It is important to conduct in-depth research on factors associated with anxiety symptoms among older residents in other regions, focusing on population groups with the highest rates of infection and death from COVID-19.

How COVID-19 affects voting for incumbents: Evidence from local elections in France

How do voters react to an ongoing natural threat? Do voters sanction or reward incumbents even when incumbents cannot be held accountable because an unforeseeable natural disaster is unfolding? We address this question by investigating voters' reactions to the early spread of COVID-19 in the 2020 French municipal elections. Using a novel, fine-grained measure of the circulation of the virus based on excess-mortality data, we find that support for incumbents increased in areas that were particularly hard hit by the virus. Incumbents from both left and right gained votes in areas more strongly affected by COVID-19. We provide suggestive evidence for two mechanisms that can explain our findings: an emotional channel related to feelings of fear and anxiety, and a prospective-voting channel, related to the ability of incumbents to act more swiftly against the diffusion of the virus than challengers.

Risk factors associated with depression and anxiety among the Chinese general population after retracting the dynamic zero-COVID policy: A network analysis

BACKGROUND

Recent studies have evidenced the negative psychological consequences of the COVID-19 pandemic and sociodemographic vulnerability among the general population, while limited information was available on which factors make the greatest contribution to psychological distress when these factors were considered concurrently. Herein, we aimed to investigate the pathways that underlie psychological distress in the context of retracting dynamic zero-COVID policy.

METHODS

We employed the mixed graphical model to construct the network of depression (PHQ-9), anxiety (GAD-7), and pandemic-related factors in a general population sample (N = 1610). Then, we re-examined the network by adding sociodemographic variables to further explore the influence of sociodemographic factors. Additionally, we repeated the analyses in the second sample (N = 620) collected in the same period to assess the replicability.

RESULTS

The relationships between the pandemic factors and anxiety and depressive symptoms exhibited a tendency to decrease after adding demographic variables, and income became the most important node and shared edge weights with all anxiety and depressive symptoms. These findings were replicable with the second sample. No significant difference in the network properties was detected between the two samples.

LIMITATIONS

The cross-sectional design limits the ability to observe longitudinal changes in these risk factors and their relationship with psychological distress.

CONCLUSIONS

Income level, rather than the pandemic-related factors, acted as a vital role in the psychological distress of the general population, implying that livelihood issues may be the critical intervention targets for mental health during the post-pandemic period.

Associations Between Psychopathological Symptom Severity Amid the Pandemic and the Childhood Sociodemographic Environment

It is well-documented that childhood socioeconomic status (SES) is associated with various health conditions in adulthood. Here, we examine the extent to which childhood SES is associated with COVID-19 pandemic anxiety and depression. Participants (n = 212), recruited from Amazon Mechanical Turk, were assessed for depression and anxiety in February 2022 for both the current context and retrospective self-perceived early pandemic depression and anxiety (April 2020). Participants also reported childhood SES and current demographics. Consistent with predated findings, we show a strong, positive correlation between depression and anxiety under both conditions. Paternal unemployment in childhood was associated with increased anxiety, while maternal occupation was not. High household education in childhood was generally associated with greater anxiety and depression, similar to past studies examining education levels and depression. However, the shift from high school to post-secondary degrees (trade school and associate's) was associated with decreased anxiety and depression, which may reflect "essential work" careers, therefore indicating a dualism. Growing up in crowded, de-individualized spaces was associated with lower anxiety and depression, suggesting better conditioning for the imposition of COVID-19 quarantines. Pandemic-related unemployment was associated with an increase in anxiety and depression. Strong political views, regardless of ideology, were associated with increased anxiety. Finally, participants in our cohort perceived their mental health to be worse in the early pandemic for anxiety and depression, up 6.6% and 7.9%, respectively. Our work suggests a complex relationship between SES, demographics, and anxiety and depression during the pandemic. These findings emphasize the importance of exploring the dynamics between early SES and mental health in adulthood, particularly during extended societal stressors.

Mental health during the COVID-19 pandemic and first lockdown in Lebanon: Risk factors and daily life difficulties in a multiple-crises setting

INTRODUCTION

Research from around the world shows important differences in the impact of the COVID-19 pandemic and lockdowns on mental health. This study examined the extent of mental health challenges (depressive and anxiety symptoms and daily life difficulties) and their associations with pandemic- and response-related factors during the first lockdown in Lebanon, which happened amid a severe economic crisis and socio-political turmoil.

METHODS

Data come from a cross-sectional internet-based survey (May-June 2020). Association of depressive (Patient Health Questionnaire (PHQ-9)) and anxiety symptoms (Generalized Anxiety Disorder (GAD-7)) with outbreak-related worries and knowledge, information sources, and confidence and satisfaction in response measures were estimated using logistic regression adjusted for sociodemographic and socioeconomic indicators.

RESULTS

Among 510 participants (mean age 36.1±11.3; 69.4% women), 32.3% had elevated depressive and 27.3% had elevated anxiety symptoms; younger age, unemployment, loss of employment, and lower income were related to more mental health symptoms. Most prevalent daily life challenges were feelings of uncertainty (74.5%) and financial (52.2%) and emotional (42.2%) difficulties; these and all other daily life difficulties (work-related, caregiving, and online learning) were significantly higher among participants with higher depressive and anxiety symptoms. Higher outbreak-related worries were associated with higher depressive (OR = 1.36, 95% CI = 1.20,1.53) and anxiety symptoms (OR = 1.47, 95% CI = 1.30,1.67). Higher pandemic-related knowledge, reliance on and trust in local health agencies and professionals' information, and satisfaction and confidence regarding governmental and health institutions' response were all related to lower mental health symptoms.

CONCLUSION

Results show that mental health burden in Lebanon during the first lockdown (when the COVID-19 outbreak was still minimal) is among the highest reported worldwide and highlight elevated emotional and financial tolls and widespread impact on daily life. In this high-burden and multiple-challenges context, results suggest an important role for the healthcare body, knowledge, and trust in the institutions managing the response.

Trauma history predicts depression and posttraumatic stress symptoms better than a psychiatric diagnosis: Comparing wartime, routine time, and early COVID-19 in Israel

Individuals with a psychiatric diagnosis and those with a history of trauma are at high risk for depression and posttraumatic stress symptoms (PTSS) following exposure to new traumatic events. Nevertheless, research is scarce on how having both a psychiatric diagnosis and a trauma history affect reactions to new traumatic events, and how different trauma types may affect individuals with a psychiatric diagnosis. We thus examined whether different stressful contexts (War and COVID-19) affected individuals with and without a psychiatric diagnosis differentially and whether results might be explained by prior trauma exposure. In the same cohort, we assessed depression and PTSS during wartime (2014), routine time (2016), and during the COVID-19 pandemic (2020) in a sample with (n = 89) and without (n = 104) a self-reported psychiatric diagnosis. This cohort was recruited during the 2014 Israel-Gaza War using social media, snowballing and outreach to mental health rehabilitation centres. We used a linear mixed modelling approach on data from the entire sample, as well as on the two study groups separately. We found that trauma history predicted PTSS and depression whereas a history of psychiatric diagnosis did not. Regarding trauma types, we found that individuals in the psychiatric diagnosis group relative to themselves had more symptoms during COVID-19 compared to war and routine time, while those without diagnosis had more PTSS and depression symptoms during wartime compared to routine time and COVID-19. In conclusion, a traumatic past may have an important influence on reactions to different types of traumatic events. Distinct traumatic events may affect individuals with or without a psychiatric diagnosis differentially.

A comparison of rate and methods of probable suicide for 2 years pre and post the onset of the COVID-19 pandemic

OBJECTIVES

To examine and compare rates and methods of probable suicide in a Western region of Ireland during a 24 month period since the onset of the COVID-19 pandemic compared with a similar period immediately prior to the pandemic onset.

METHODS

Post-mortem reports between March 1st 2018 and February 29th 2020 were reviewed and compared with data from March 1st 2020 to February 28th 2022. Relevant demographic data, rates and methods of probable suicide and lifetime engagement with mental health services were compared across the two time points.

RESULTS

Identical rates of probable suicide (85 individuals at both time points) were demonstrated with no difference evident in the utilisation of violent compared to non-violent methods.

CONCLUSIONS

This study demonstrates that despite previous reports of increased rates of self-harm and some evidence of increased mental distress since the onset of the COVID-19 pandemic, no change in rates of or methods employed by individuals who died by probable suicide were evident in this geographical region.

Prevalence of COVID-19 anxiety, geriatric anxiety, and related factors among the elderly in Quchan, Iran during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

Anxiety is a prevalent mental disorder among the elderly, leading to discomfort, disability, increased expenses, reduced quality of life, and dysfunction. Consequently, this study was conducted to determine the prevalence of COVID-19 anxiety and geriatric anxiety, along with the factors influencing anxiety, in the elderly population served by urban healthcare centres in Quchan.

METHODS

This cross-sectional study involved 650 elderly individuals aged 60-95 years. The participants were selected using a two-stage cluster sampling method. Data were collected through three questionnaires: the Geriatric Anxiety Inventory (GAI), the Corona Disease Anxiety Scale (CDAS), and a questionnaire on factors contributing to anxiety. Data analysis was performed using simple and multiple regression with IBM SPSS 24.

RESULTS

The prevalence of geriatric anxiety among the elderly was 40.3%, while the prevalence of COVID-19 anxiety (moderate and severe) was 22.8%. Significant relationships were observed between geriatric anxiety and substance abuse, stressful life events, comorbidities, COVID-19 anxiety, financial support, loneliness, walking habits, and sleep patterns (P < 0.05).

CONCLUSION

COVID-19 anxiety and geriatric anxiety are prevalent concerns among the elderly. Factors like substance abuse, stressful life events, COVID-19-related anxiety, comorbidity, living alone, lack of financial support, and poor walking and sleeping habits, which affect anxiety in the elderly, it is essential to address these factors in life planning and provide services through relevant organisations, healthcare teams, and initiatives by the elderly themselves.

Implications for long COVID: A systematic review and meta-aggregation of experience of patients diagnosed with COVID-19

AIMS AND OBJECTIVES

This review aims to synthesize the available evidence of what patients experience when infected with COVID-19, both in hospital and post-discharge settings.

DESIGN

This review was conducted using the Joanna Briggs Institute (JBI) methodology for qualitative systematic reviews and evidence synthesis. Reporting of results was presented according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist.

BACKGROUND

Coronavirus disease 2019 (COVID-19) continues to be a public health crisis worldwide. Many patients diagnosed with COVID-19 have varied levels of persisting mental disorders. Previous studies have reported the degree, prevalence and outcome of psychological problems. Minimal research explored the experience of patients with long COVID. The real-life experience of patients with COVID-19 from diagnosis to post-discharge can deepen the understanding of nurses, physicians and policymakers.

METHODS

All studies describing the experience of patients were included. Two authors independently appraised the methodological quality of the included studies using the JBI Critical Appraisal Checklist for Qualitative Research 2020.

RESULTS

This systematic review aggregated patients' experience of being diagnosed with COVID-19 in both hospitalized and post-discharge settings. Finally, 17 studies met inclusion criteria and quality appraisal guidelines. The selected studies in the meta-synthesis resulted in 12 categories, and further were concluded as five synthesized findings: physical symptoms caused by the virus, positive and negative emotional responses to the virus, positive coping strategies as facilitators of epidemic prevention and control, negative coping strategies as obstacles of epidemic prevention and control, and unmet needs for medical resource.

CONCLUSIONS

The psychological burden of patients diagnosed with COVID-19 is heavy and persistent. Social support is essential in the control and prevention of the epidemic. Nurses and other staff should pay more attention to the mental health of the infected patients both in and after hospitalization.

RELEVANCE TO CLINICAL PRACTICE

Nurses should care about the persistent mental trauma of COVID-19 survivors and provide appropriate psychological interventions to mitigate the negative psychological consequences of them. Besides, nurses, as healthcare professionals who may have the most touch with patients, should evaluate the level of social support and deploy it for them. It is also needed for nurses to listen to patient's needs and treat them with carefulness and adequate patience in order to decrease the unmet needs of patients.

The combined impact of social networks and connectedness on anxiety, stress, and depression during COVID-19 quarantine: a retrospective observational study

Introduction

The COVID-19 pandemic and associated quarantine measures have precipitated a surge in mental health disorders, particularly depression and anxiety. Government policies and restrictions on physical activity have contributed to this phenomenon, as well as diminished subjective social connectedness and exacerbated objective social isolation. As two dimensions of social isolation, it is worth noting that subjectively perceived social connectedness serves as a protective factor for mental health, whereas the decline in the size of objectively evaluated social networks poses a significant risk. However, research investigating the combined influence of these two dimensions remains limited.

Methods

This study used an online survey to collect data to investigate the effects of objective social connectedness and objective social networks on anxiety, stress, and depression during COVID-19 quarantine. A total of 485 participants were analyzed using statistical methods, including paired t-test, Pearson correlation analysis, linear regression, cluster analysis, ANOVA, and moderated mediated.

Results

The study found that anxiety and depression scores increased during the quarantine, with age, education, and social connectedness scores associated with the increase. Pre-quarantine anxiety and depression levels were strongly correlated with mental health status during quarantine. Cluster analysis, respectively, revealed three clusters for those without increasing anxiety and depression scores. The study also found that objective social network influences the impact of subjective social connectedness on pre-quarantine mental health, which in turn affects anxiety and depression levels during quarantine.

Conclusion

The study identified that quarantine increased anxiety and depression, with age being protective, and education and subjective social connectedness as risk factors. The study also emphasizes the comprehensive impact of objective and subjective social isolation. Although individuals perceive the same degree of social connectedness, those with smaller social networks are more prone to developing symptoms of anxiety and depression, which are also more likely to worsen during quarantine.

Determination of anxiety, depression, avoidance and obsessions experienced by hemodialysis patients during the COVID-19

INTRODUCTION

The purpose of this study was to ascertain the levels of anxiety, despair, avoidance, and obsessions that hemodialysis patients dealt with during the pandemic.

METHODS

The study was conducted with 139 hemodialysis patients. Research data "Coronavirus Anxiety Scale (CAS)," "Hospital Anxiety and Depression Scale (HAD)," "COVID-19 Avoidance Scale" (AA-COVID-19) and "Coronavirus Obsession Scale (OCS)." The data obtained from the research were analyzed using the SPSS 21 package program.

RESULTS

The average score of the patients on the CAS scale was 0.73 ± 1.17, on the HAD-A scale was 5.94 ± 3.67, and on the HAD-D scale was 7.06 ± 3.89. The COVID-19 outbreak has consequently had a severe impact on hemodialysis patients' mental health.

CONCLUSION

Covid 19 epidemic, the health sector failed to protect the mental health of patients. However, new epidemics and disasters await the world in the future. In these results show that new strategies need to be developed.

The relationship between pain, anxiety and depression in patients with post-intensive care syndrome

PURPOSE

Survivors of critical illness frequently experience long-term symptoms including physical symptoms such as pain and emotional symptoms such as anxiety and depression. These symptoms frequently co-exist, however, at present there is limited understanding of these relationships. The aim of this study was to quantify the relationship between pain, anxiety and depression across the recovery trajectory.

METHODS

This study is a secondary analysis of data from a multi-centre, prospective, cohort study which followed-up patients recovering from critical illness. Data was available at multiple time points and for 3 distinct cohorts. Structural equation modelling was used to investigate the relationship between outcome measures of pain, anxiety and depression.

RESULTS

Data from 414 patients was analysed. Pain was significantly associated with both anxiety and depression in all cohorts and at all time points sampled. Path coefficients for the covariances between pain and depression ranged between 0.39 and 0.72 (p < 0.01). Path coefficients for the covariances between pain and anxiety ranged between 0.39 and 0.65 (p < 0.01).

CONCLUSIONS

Pain, anxiety and depression are highly correlated in survivors of critical illness. Pharmacological treatments for pain management may be ineffective alone and further research is required to assess interventions targeting these symptoms in combination.

Accuracy and precision of responses to visual analog scales: Inter- and intra-individual variability

Visual analog scales (VASs) are gaining popularity for collecting responses in computer administration of psychometric tests and surveys. The VAS format consists of a line marked at its endpoints with the minimum and maximum positions that it covers for respondents to place a mark at their selected location. Creating the line with intermediate marks along its length was discouraged, but no empirical evidence has ever been produced to show that their absence does any good. We report a study that asked respondents to place marks at pre-selected locations on a 100-unit VAS line, first when it only had numerical labels (0 and 100) at its endpoints and then when intermediate locations (from 0 to 100 in steps of 20) were also labeled. The results show that settings are more accurate and more precise when the VAS line has intermediate tick marks: The average absolute error decreased from 3.02 units without intermediate marks to 0.82 units with them. Provision of intermediate tick marks also reduced substantially inter- and intra-individual variability in accuracy and precision: The standard deviation of absolute error decreased from 0.87 units without tick marks to 0.25 units with them and the standard deviation of signed distance to target decreased from 1.16 units without tick marks to 0.24 units with them. These results prompt the recommendation that the design of VASs includes intermediate tick marks along the length of the line.

Anxiety among healthcare workers during the COVID-19 pandemic: a longitudinal study

Background

During the COVID-19 pandemic, many healthcare workers faced extreme working conditions and were at higher risk of infection with the coronavirus. These circumstances may have led to mental health problems, such as anxiety, among healthcare workers. Most studies that examined anxiety among healthcare workers during the COVID-19 pandemic were cross-sectional and focused on the first months of the pandemic only. Therefore, this study aimed to investigate the longitudinal association between working in healthcare and anxiety during a long-term period (i.e., 18 months) of the COVID-19 pandemic.

Methods

Data were used from online questionnaires of the Lifelines COVID-19 prospective cohort with 22 included time-points (March 2020-November 2021). In total, 2,750 healthcare workers and 9,335 non-healthcare workers were included. Anxiety was assessed with questions from the Mini-International Neuropsychiatric Interview, and an anxiety sum score (0-7) was calculated. Negative binomial generalized estimating equations (GEE), adjusted for demographic, work and health covariates, were used to examine the association between working in healthcare and anxiety.

Results

Anxiety sum scores over time during the COVID-19 pandemic were similar for healthcare workers and non-healthcare workers. No differences between the anxiety sum scores of healthcare workers and non-healthcare workers were found [incidence rate ratio (IRR) = 0.97, 95% CI = 0.91-1.04].

Conclusion

This study did not find differences between healthcare workers and non-healthcare in perceived anxiety during the COVID-19 pandemic.

Is a change in economic status associated with anxiety, depression and suicide ideation during the COVID-19 pandemic in South Korean adults?

BACKGROUND

Coronavirus disease 2019 (COVID-19) affected global economic changes and mental health outcomes. However, sex differences are unclear regarding the relationship between economic status change and mental health outcomes during the pandemic. Therefore, we investigated whether change in economic status is associated with depression, anxiety and suicidal ideation, based on sex.

METHODS

We used data from the COVID-19 National Mental Health Survey 2021 in South Korea. We used the Generalized Anxiety Disorder (GAD) 7-item scale for measuring anxiety, the Patient Health Questionnaire-9 scale for measuring depression and self-reported questionnaires for investigating suicidal ideation and COVID-19-related suicidal ideation.

RESULTS

Among 2000 participants, those with a worse economic status change had a 2.7-fold higher risk of GAD (prevalence ratio [PR], 2.70; 95% confidence interval [CI], 2.07-3.51); 2.5-fold higher depression risk (PR, 2.55; 95%CI, 2.05-3.18); 2.1-fold higher risk of suicidal ideation (PR, 2.09; 95%CI, 1.72-2.53); and 4.0-fold higher risk of COVID-19-related suicidal ideation (PR, 4.03; 95%CI, 2.78-5.83). Women whose economic status worsened had a 3.5-fold higher risk of COVID-19-related suicidal ideation (PR, 3.49; 95%CI, 2.01-6.06).

CONCLUSION

Worse economic change is associated with negative mental health outcomes during the COVID-19 pandemic; particularly, women experiencing financial hardships during the pandemic had a higher risk of COVID-19-related suicidal ideation.

The relationship between tolerance for uncertainty and academic adjustment: the mediating role of students' psychological flexibility during COVID-19

Introduction

University students are among the groups most adversely affected by COVID-19 in terms of their psychological and academic wellbeing, particularly given the pandemic's uncertainty. However, little is known about their psychological flexibility to deal with this uncertain nature of pandemic. This study aimed to examine the mediating role of psychological flexibility (PF) in the relationship between university students' intolerance of uncertainty (IU) and their academic adjustment to the online learning process during COVID-19.

Methods

Data was collected from 388 university students from Türkiye (18-34 (Mage = 21.43, SD = 2.04) who completed five questionnaires - Intolerance of Uncertainty Scale, Acceptance and Action Questionnaire II, Academic Self Efficacy Scale, Educational Stress Scale, and Online Self-Regulatory Learning Scale. Additionally, as indicators of students' academic adjustment, perceived academic performance - ranging 1 to 10, and their last academic grade point average before and during the pandemic were also collected.

Results

The results indicated that PF and IU had a significant effect on the academic adjustment of students during the pandemic. PF had a complete mediating role between the IU and academic adjustment. Results also revealed that online self-regulation, a sub-dimension of academic adjustment, did not show a significant relationship with any other variable in the model.

Discussion

Research findings showed that psychological flexibility is a very important strength for university students to maintain their academic adjustment in stressful times. The results were discussed in light of the relevant research, and recommendations for further research and implications were provided.

Predicting internalizing symptoms with machine learning: identifying individuals that need care

Objective The current project aims to identify individuals in urgent need of mental health care, using a machine learning algorithm (random forest). Comparison/contrast with conventional regression analyses is discussed. Participants: A total of 2,409 participants were recruited from an anonymous university, including undergraduate and graduate students, faculty, and staff. Methods: Answers to a COVID-19 impact survey, the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) were collected. The total scores of PHQ-9 and GAD-7 were regressed on six composites that were created from the questionnaire items, based on their topics. A random forest was trained and validated. Results: Results indicate that the random forest model was able to make accurate, prospective predictions (R2 = .429 on average) and we review variables that were deemed predictively relevant. Conclusions: Overall, the study suggests that predictive models can be clinically useful in identifying individuals with internalizing symptoms based on daily life disruption experiences.

The effect of the COVID-19 pandemic on the treated incidence of psychotic disorders in South London

Evidence on the impact of the COVID-19 pandemic on psychotic disorders is so far scarce. We conducted an incidence study to ascertain rates of first-episode psychosis (FEP) before and during the COVID-19 pandemic in South London. We screened clinical records of individuals living in the London boroughs of Southwark and Lambeth who were referred to the early intervention services before (from 1/3/2019 to 28/2/2020) and during (from 1/3/2020 to 28/2/2021) the COVID-19 pandemic. We used the Office for National Statistics to determine the population at risk. We computed crude and sex-age standardised FEP incidence per 100,000 person-years. We used Poisson regression to calculate the incidence rate ratio (IRR) across the COVID-19 pandemic. A total of 321 incident cases of FEP were identified during the COVID-19 pandemic, accounting for a crude rate of 69.8 (95% CI 62.1-77.4) per 100,000 person-years. The crude rate for the year before was 47.5 (95% CI 41.2-53.8). The incidence variation between the two years accounted for an adjusted IRR of 1.45 (95% CI 1.22-1.72). The pandemic was accompanied by a 45% spike in the rates of first-episode psychosis. This finding should inform public health research and demonstrate the need for adequate resources for secondary care.

Did healthy life awareness affect the behavioral or cognitive avoidance attitude from COVID-19? An observational study

Aim

This study purposed to evaluate the healthy life awareness (HLA) level versus the COVID-19 avoidance attitudes.

Materials and Methods

A single-centered observational study was conducted in the Family Medicine Clinics of a tertiary hospital between April 30, 2021 and July 30, 2021. The HLA scale was used to determine the participants' HLA levels. In addition, the avoidance attitudes from the COVID-19 scale score assessed attitudes toward avoiding COVID-19. Data were analyzed with E-Picos (MediCRES) Statistical Programme.

Results

Of the 311 participants aged 30.79 ± 8.37 years, 58.52% (n = 182) were female and 41.48% (n = 129) were male. A negative relationship between the HLA and cognitive avoidance scores (r = -0.255, P < 0.001) and a positive relationship between HLA and behavioral avoidance scores (r = 0.119, P = 0.036) have been indicated. The results of a binary logistic regression, taking the presence of a higher HLA score as the dependent variable, have shown that high awareness was observed in women, approximately 1.7 times more than in men [odds ratio (OR): 1.684, 95% confidence interval (CI) = 1.058-2.696; P = 0.030]. Participants with high HLA had 1.06 times higher behavioral avoidance scores than others (OR: 1.066, 95% CI = 1.012-1.455; P = 0.049). As the cognitive avoidance score increased, the presence of high HLA decreased by nearly 33%. (OR: 0.666, 95% CI = 0.512-0.867; P = 0.002).

Conclusion

This study emphasized that a higher HLA was associated with increased behavioral avoidance and decreased cognitive avoidance from COVID-19. HLA has led to doing what needed to be done without being affected by negative discourses.

Changes in anxiety and depression during the COVID-19 pandemic in the European population: A meta-analysis of changes and associations with restriction policies

BACKGROUND

Early studies of common mental disorders (CMDs) during the COVID-19 pandemic mainly report increases; however, more recent findings have been mixed. Also, studies assessing the effects of restriction measures on CMDs show varied results. The aim of this meta-analysis was to assess changes in levels of CMDs from pre-/early to during the pandemic and the effects of restriction policies in the European population.

METHODS

We searched for studies assessing both pre-pandemic and peri-pandemic self-reported emotional distress and symptoms of depression or anxiety among nationally/regionally representative samples in Europe and collected microdata from those studies. Estimates of corona containment index were related to changes in CMDs using random-effects meta-regression.

RESULTS

Our search strategy resulted in findings from 15 datasets drawn from 8 European countries being included in the meta-analysis. There was no evidence of change in the prevalence of emotional distress, anxiety, or depression from before to during the pandemic; but from early pandemic periods to later periods, there were significant decreases in emotional distress and anxiety. Increased school restrictions and social distancing were associated with small increases in self-reported emotional distress.

CONCLUSIONS

Despite initial concerns of increased emotional distress and mental illness due to the COVID-19 pandemic, the results from this meta-analysis indicate that there was a decrease in emotional distress and no change in anxiety or depression in the general population in Europe. Overall, our findings support the importance of strong governance when implementing periodic and robust restriction measures to combat the spread of COVID-19.

The compounding effects of income loss and change in living arrangement on emerging adult women's mental health during COVID's onset

Research suggests that young adult women were among those more susceptible to mental health declines in the initial months of COVID-19. Unfortunately, longitudinal data examining mental health before and after the pandemic's onset are extremely limited. In a sample of 240 women ages 18-29 who were surveyed online first in November-December 2019 and then again between May and July 2020, this study aimed to examine how major life changes associated with the pandemic (i.e. loss of income, loss of employment, change in relationship status, and change in living arrangement) impacted mental health (i.e. depression, anxiety, stress). Multivariate regression analyses were conducted on three models predicting stress, anxiety, and depression from the four life changes, controlling for the effects of mental health before the COVID-19 pandemic. Results showed that a change in living arrangement was uniformly associated with increased mental health problems among women who also experienced a decrease in income. Likewise, loss of income was uniformly related to increased mental health problems among women who also experienced a change in living arrangement. In contrast, job loss was associated with a decrease in stress, and changes in relationship status were not associated with mental health outcomes. These findings highlight the potential for COVID-19 to produce co-occurring and synergistic stressors. Meanwhile, the impact of job loss on mental health may have been attenuated by enhanced unemployment benefits. Mental health interventions that aim to support young women as the pandemic abates should be tailored to address the impact of multiple psychosocial stressors.

Does fear of infection affect people's dental attendance during COVID-19? A Chinese example to examine the association between COVID anxiety and dental anxiety

Introduction

Little is known about the psychological and behavioural effect of COVID-19 pandemic on patients and their reaction to dental visiting. Patients may delay attendance due to fears of contracting the corona virus at the dentist. The study aims to confirm the psychometric properties of the two COVID-19 scales and then use dental patient responses to assess the associations between the COVID-19 Anxiety Scale (CAS), dental anxiety (MDAS) and the clinical care COVID-19 Anxiety (CCAS).

Methods

A cross-sectional study was conducted among 503 patients visiting a polyclinic of a stomatological hospital in East China in 2020. Patients completed a survey consisting of demographical information, dental attendance, COVID-19 Anxiety Scale, Clinical Care COVID-19 Anxiety Scale and Modified Dental Anxiety Scale. Confirmatory factor analysis was conducted to determine the psychometric characteristics. A further structural model was tested with the combined measurement model and a path analysis was calculated.

Results

The sample (n = 503) consisted of more women than men (63% vs. 37%). A fifth of the sample (21%) claimed regular dental attendance and just over a third (35%) reported delaying their dental visit due to the pandemic. Our analysis showed that both CAS and CCAS possessed a unidimensional structure. The MDAS was divided into anticipatory and treatment components as separate latent variables. The anticipatory component (MDAS_A) had some association to CCAS through its expression on treatment dental anxiety (MDAS_T). General anxiety about COVID (CAS) had a direct effect on CCAS. The fit statistics were acceptable [Chi-square = 183.27, df = 68, p < .001; CFI = 0.973; RMSEA = 0.058 (95%CIs: 0.048-0.068)] and the Standardised Root Mean Square Residuals (SRMR) index was 0.041.

Discussion

The Clinical Care COVID-19 Anxiety has shown satisfactory psychometric properties. Both dental anxiety and general anxiety about the pandemic have strong associations to patients' fear of contracting corona virus when using dental facilities. Our study has practical implications to help healthcare providers better understand how environmental stressors influence patients' overall concerns on infection risks and appropriate dental treatments during the pandemic.

Symptoms of anxiety and depression in Denmark during the first year of the COVID-19 pandemic: A two-wave matched-control study

Subsequent to the restriction measures taken to curb the COVID-19 infection rate, researchers theorized these would have detrimental mental health consequences. This two-wave matched-control study investigates depression and anxiety symptoms during the first 12 months of the pandemic (March 2020-March 2021) in Denmark with data from the I-SHARE and Project SEXUS studies. The I-SHARE study includes 1,302 (Time period 1 only n = 914, Time period 2 only n = 304, both time periods 1 and2 n = 84) Danish participants, and the sex and birth year-matched control participants from the Project SEXUS study comprise 9,980 Danes. During the first year of the pandemic, the study populations' anxiety and depression symptom mean levels did not significantly differ from pre-pandemic matched controls. Younger age, female gender, fewer children in the same household (depression only), lower education level, and not being in a relationship (depression only) were associated with increased anxiety and depression symptom scores. The key COVID-19-related variable linked with significantly higher anxiety and depression symptom scores was COVID-19-related loss of income. Contrary to initial concerns, we did not find a significant effect of the pandemic on anxiety and depression symptom scores. However, the results underscore the importance of structural resources to prevent income loss to safeguard mental health during crises such as a pandemic.

Immunoglobulin Replacement Therapy During COVID-19 Pandemic: Practical and Psychological Impact in Patients with Antibody Deficiency

PURPOSE

The COVID-19 pandemic has impacted on how health services deliver care and the mental health of the population. Due to their clinical vulnerability, to reduce in-hospital attendances during the COVID-19 pandemic, modifications in immunoglobulin treatment regimens were made for patients with antibody deficiency. These patients were also likely to experience social isolation due to shielding measure that were advised. We aimed to investigate the impact of modifying immunoglobulin treatment regimen on infection and mental health burden during shielding restrictions.

METHOD

Patients on immunoglobulin replacement therapy (IGRT) responded to a standardised questionnaire examining self-reported infection frequency, anxiety (GAD-7), depression (PHQ-8), fatigue (FACIT), and quality of life during the pandemic. Infection frequency and immunoglobulin trough levels were compared to pre-pandemic levels.

RESULTS

Patients who did not change treatment modality or those who received immunoglobulin replacement at home during the pandemic reported fewer infections. In patients who received less frequent hospital infusions, there was no significant increase in infections whilst immunoglobulin trough levels remained stable. There was no significant difference in anxiety, or depression scores between the treatment modality groups. Patients reported higher fatigue scores compared to the pre-COVID general population and in those discharged following hospitalisation for COVID.

CONCLUSION

Changing immunoglobulin treatment regimen did not negatively impact infection rates or psychological wellbeing. However, psychological welfare should be prioritised for this group particularly given uncertainties around COVID-19 vaccination responsiveness and continued social isolation for many.

Psychological state and predictors of psychiatric morbidity in COVID-19 patients six weeks after discharge

To be able to detect possible psychological distress and long-term deterioration caused by COVID-19, following the patient, who has recovered, is crucial. Therefore, this study (i); aims to examine the ongoing fear-loss of control, the rate of anxiety, depression, and post-traumatic stress disorder levels following the 6th week after discharge; (ii) to examine the effect of post-traumatic stress disorder on anxiety, and depression and (iii) within the same context to reveal the developmental markers of psychiatric morbidity and the risk group. The study includes 180 patients who were hospitalized with COVID-19 diagnosis. Sociodemographic Data Form, the Hospital Anxiety Depression Scale and the Impact of Event Scale-Revised were used in the current study. High rates of symptoms of anxiety, depression, and PTSD were reported by the inpatients, as more than one-third scored above the anxiety and depression cut-off scores of borderline abnormal and abnormal. Also, 37.22 % of the participants reported the likely presence of PTSD symptoms. Anxiety and depression were significantly positively related to the symptoms of PTSD. The results suggest that there is psychiatric morbidity in anxiety, depression, and post-traumatic stress disorder and that especially posttraumatic stress poses a risk for other psychopathologies.

The impact of the COVID-19 pandemic on presentations of self-harm over an 18-month period to a tertiary hospital

OBJECTIVES

To examine and compare rates and methods of self-harm presenting to a tertiary referral hospital during an 18-month period since the onset of the COVID-19 pandemic with a similar period immediately prior to the pandemic onset.

METHODS

Data from an anonymized database compared rates of self-harm presentations and methods employed between 1st March 2020 and 31st August 2021 to a similar time-frame prior to the onset of the COVID-19 pandemic.

RESULTS

A 9.1% increase in presentations with self-harm was noted since the onset of the COVID-19 pandemic. Periods of more stringent restrictions were associated with higher levels of self-harm (daily rate of 2.10 v 0.77). A higher lethality of attempt was demonstrated post-COVID-19 onset (χ2 = 15.38, p < 0.001). Fewer individuals presenting with self-harm were diagnosed with an adjustment disorder since the onset of the COVID-19 pandemic (n = 84, 11.1%, v. n = 112, 16.2%, χ2 = 7.898, p = 0.005), with no other differences pertaining to psychiatric diagnosis noted. More patients actively engaged with mental health services (MHS) presented with self-harm (n = 239 (31.7%) v. n = 137, (19.8%), χ2 = 40.798, p ≤ 0.001) since the onset of the COVID-19 pandemic.

CONCLUSIONS

Despite an initial reduction, an increase in rates of self-harm has occurred since the onset of the COVID-19 pandemic with higher rates evident during periods of higher government mandated restrictions. An increase in active patients of MHS presenting with self-harm potentially relates to reduced availability of supports and particularly group activities. The recommencement of group therapeutic interventions for individuals attending MHS in particular is warranted.

A 2-year longitudinal evaluation of the impact of the COVID-19 pandemic on individuals with pre-existing anxiety disorders

OBJECTIVES

To examine if the COVID-19 pandemic is associated with a differential effect over a 2-year time period in relation to its psychological and social impact on patients with established anxiety disorders.

METHODS

Semi-structured interviews were conducted with 21 individuals attending the Galway-Roscommon Mental Health Services in Ireland with an ICD-10 diagnosis of an anxiety disorder. Interviews occurred at three time-points over a 2-year period to determine the impact of the COVID-19 pandemic and associated restrictions on anxiety and depressive symptoms, social and occupational functioning, and quality of life.

RESULTS

No statistical difference in symptomatology was noted between the three time-points in relation to anxiety symptoms as measured utilising psychometric rating scales (Beck Anxiety Inventory (BAI), Hamilton Anxiety Rating Scale (HARS) or Likert Scale measures). The greatest impact of COVID-19 at all time-points related to social functioning and quality of life. Significant variability was noted for individual participants. Qualitative analysis noted a tentative optimism for the future in the setting of vaccination and societal re-opening. Fear of re-emerging anxiety symptoms with the removal of societal restrictions was noted.

CONCLUSIONS

No significant overall change in symptomatology or functioning over time was noted for individuals with pre-existing anxiety disorders, however variability was demonstrated, with some individuals describing ongoing anxiety, social isolation and concern for their future. A strong theme of hope for the future and less concern regarding the COVID-19 pandemic was evident; however tailored supports including the utilisation of tele-psychiatry is suggested, particularly for those experiencing increased anxiety with the removal of societal restrictions.

A longitudinal evaluation of the impact of the COVID-19 pandemic on a cohort of patients treated with clozapine

OBJECTIVES

We previously demonstrated that three months into the COVID-19 pandemic, the impact on individuals with treatment-resistant psychotic disorders was modest. Here, we examined and compared the psychological and social impact of the COVID-19 pandemic on the same patient cohort 12 months after their initial study engagement.

METHODS

Semi-structured interviews were conducted with 54 individuals (85.7% response rate) between June 12 and July 29, 2021, 12 months after their initial interviews. Participants' subjective experience of the impact of the COVID-19 pandemic on anxiety symptoms, social and vocational functioning was measured utilising the same Likert scales at both time points. Anxiety symptoms were additionally measured using subjective (Beck Anxiety Inventory) and objective (Hamilton Anxiety Rating Scale (HARS)) psychometric instruments. Paired t-tests or Wilcoxon ranked tests compared parametric or non-parametric data over time. Free-text responses pertaining to participants' perspectives on the impact of COVID-19 were grouped into themes.

RESULTS

A minor increase in anxiety symptoms was demonstrated utilising the HARS (1.9 points, z = 3.017, p = 0.003), with a minimal increase in depressive symptoms noted using Likert ratings (0.8 points, z = 2.119, p = 0.034). Five themes were identified with the most prevalent being (i) positivity regarding vaccination, (ii) social isolation from family members and (iii) looking forward to post-COVID-19 'normality'. However, negative views pertaining to the psychosocial impact of COVID-19 and vaccination were additionally reported.

CONCLUSIONS

No significant overall clinical change in symptomatology or functioning over time was noted.The study demonstrated that positive views regarding vaccination and optimism for the future were evident for some participants.

Changes on depression and suicidal ideation under severe lockdown restrictions during the first wave of the COVID-19 pandemic in Spain: a longitudinal study in the general population

AIMS

To assess whether there is a change in the prevalence of depression and suicidal ideation after the strict lockdown measures due to the first wave of the COVID-19 pandemic in Spain, and to assess which are the factors associated with the incidence of a depressive episode or suicidal ideation during the lockdown.

METHODS

Data from a longitudinal adult population-based cohort from Madrid and Barcelona were analysed (n = 1103). Face-to-face home-based (pre-pandemic) and telephone interviews were performed. Depression and suicidal ideation were assessed through an adaptation of the Composite International Diagnostic Interview (CIDI 3.0). Population prevalence estimates and multivariable logistic regressions were computed.

RESULTS

Prevalence rates of depression changed significantly from before to after the COVID-19 outbreak (from 3.06% to 12.00%; p = 0.01) and per sex and age groups. Individuals reporting COVID-19 concerns (odds ratio [OR] = 3.11; 95% confidence interval [CI] = 1.45-6.69) and those feeling loneliness (OR = 1.99; 95% CI = 1.52-2.61) during the lockdown were at increased risk of developing depression during the confinement. Resilience showed a protective effect against the risk of depression (OR = 0.57; 95% CI = 0.39-0.83), while individuals perceiving social support during the confinement were at lower risk of developing suicidal thoughts (OR = 0.21; 95% CI = 0.09-0.46). Greater disability during the lockdown was also associated with the risk of suicidal ideation (OR = 2.77; 95% CI = 1.53-5.03).

CONCLUSIONS

Continuous reinforcement of mental health preventive and intervening measures is of global importance, particularly among vulnerable groups who are experiencing the most distress. Future research should strive to evaluate the long-term effects of the COVID-19 crisis on mental health.

Wellbeing and mental health outcomes amongst hospital healthcare workers during COVID-19

BACKGROUND

Global healthcare systems have been particularly impacted by the COVID-19 pandemic. Healthcare workers (HCWs) are widely reported to have experienced increased levels of baseline psychological distress relative to the general population, and the COVID-19 pandemic may have had an additive effect. However, previous studies are typically restricted to physicians and nurses with limited data available on hospital HCWs. We aimed to conduct a cross-sectional, psychological evaluation of Irish HCWs during COVID-19.

METHODS

HCWs across five adult acute level-4 Dublin-based hospitals completed an online survey of wellbeing and COVID-19 experience.

RESULTS

There were 1898 HCWs who commenced the survey representing 10% of the total employee base. The sample comprised nurses (33%), doctors (21%), Health and Social Care Professionals (HSCPs) (24%) and 'Other' disciplines (22%), and 81% identified as female. Clinical levels of depression, anxiety and PTSD symptoms were endorsed by 31%, 34% and 28% of respondents, respectively. Professional grouping effects included: nurses reporting significantly greater levels of COVID-19 exposure, infection, COVID-fear, moral injury, and post-traumatic distress; HSCPs were significantly less likely to report mood dysfunction. In terms of gender, males were significantly less likely to report negative pandemic experiences, low resilience, and significantly more likely to endorse 'minimal' depression, anxiety, and traumatic distress. Logistic regression modelling revealed mental health outcomes (depression, anxiety and PTSD symptoms) were associated with increased frontline exposure, fewer career years' experience, elevated pre-pandemic stress, and female gender.

DISCUSSION

To our knowledge, this is the largest evaluation of psychological wellbeing amongst HCWs in acute hospitals in the Dublin region. Our findings have implications for healthcare workforce wellbeing and future service delivery.

The Impact of the COVID-19 Pandemic on the Interest in Antidepressants: An Analysis of Worldwide Internet Searches With Google Trends Data

OBJECTIVE

It is known that in the digital age we live in, people try to get information on many medical issues through Internet searches. Especially as a result of the COVID-19 pandemic triggering mental problems and health professionals' stay-at-home warnings, it has become difficult for individuals to receive psychiatric help, and this has encouraged accessing information about mental problems and their treatments through Internet searches. In this context, infodemiologic research, especially with Google Trends (GT; Google LLC, Mountain View, California, United States), has become very popular in recent years. In our study, it was aimed to examine the interest in frequently used antidepressants and the effect of the COVID-19 pandemic on Internet searches.

METHODS

Search densities for five antidepressant drugs (sertraline, fluoxetine, citalopram, venlafaxine, duloxetine) that are frequently used around the world were examined on GT on 24/07/2023, and these searches were compared. Searches made within the last five years (24/07/2018-24/07/2023) were included in this study. Images were obtained using GT and Microsoft Excel 2019 (Microsoft Corporation, Redmond, Washington), and appropriate statistical analyses were performed with the SPSS Statistics version 22 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.).

RESULTS

Sertraline was the most sought-after antidepressant before, during, and after the COVID-19 pandemic in the world. The searches related to sertraline increased gradually during the pandemic period, and this increase continued in the post-pandemic period. Other antidepressants whose search for it increased with the pandemic are fluoxetine, duloxetine, and venlafaxine. Searches for citalopram decreased during the pandemic process compared to the pre-pandemic period.

CONCLUSION

According to worldwide Internet searches, the prominence of some antidepressant group drugs during the pandemic period may be a reflection of the effects of the COVID-19 pandemic on mental health. Additionally, GT can provide psychiatrists with valuable insights into which depression medications are gaining popularity with the general public over time.

The effect of interpersonal relationship and epidemic attention on negative emotion among medical students: the mediating role of social satisfaction

BACKGROUND

Individuals are required to avoid close contact to reduce the probability of contracting the virus during the epidemics, which can lead to social isolation and exacerbate interpersonal relationship issues. Social satisfaction plays a crucial role in management in the period of pandemics and is strongly correlated with negative emotion. Medical students, as a special group of students, have a heavier burden of academic workload and greater pressure. They are also more likely to have access to epidemic information, which increases their susceptibility to negative emotions such as depression and anxiety. Therefore, it is necessary to investigate the impact and mechanisms among interpersonal, epidemic attention, social satisfaction, and negative emotions during the epidemics outbreak among medical students for improving the level of mental health in the post-epidemic era.

METHODS

A total of 1,451 university students were included in this study. Self-administered questionnaires, including the Comprehensive Interpersonal Relationship Diagnostic Scale, the Self-Rating Anxiety Scale, and the Self-Rating Depression Scale, were utilized to construct structural equations to examine the mediating effects of social satisfaction. The study employed a multi-stage whole-group sampling approach for university students.

RESULTS

Interpersonal relationships and epidemic attention positively predicted negative emotion levels. Interpersonal relationships negatively predicted social satisfaction, while epidemic attention positively predicted social satisfaction. Moreover, social satisfaction negatively predicted negative emotion levels. Notably, both interpersonal relationships and epidemic attention indirectly affected negative emotions through the mediating effect of social satisfaction.

CONCLUSIONS

Social satisfaction plays a mediating role in the effect of interpersonal relationships and epidemic attention on negative emotion. In the post-epidemic era, it is crucial to enhance support from family, school and society to improve social satisfaction of medical students. Immediate identification of negative emotions is essential, and targeted strategies should be developed to address mental health issues among medical students.

Did Cognitive Attentional Syndrome Symptoms Predict Stress- and Trauma-Related Symptoms in the Initial Phase of the COVID-19 Pandemic? Results from a Two-Wave Study on a Sample of Polish Internet Users

BACKGROUND

According to metacognitive theory, Cognitive Attentional Syndrome (CAS) is a transdiagnostic factor and a main mechanism of psychopathology maintenance. The main goal of this study is to examine whether CAS predicted stress- and trauma-related symptomatology in the first months of the COVID-19 pandemic and three months later.

METHODS

Initially, 1792 participants were recruited online via social media; the data were collected at two time points. The measures included the Cognitive Attentional Syndrome Questionnaire, the Adjustment Disorder-New Module 20, the International Trauma Questionnaire, and additional measures.

RESULTS

Structural equation modeling was conducted in order to determine the relations between the reported stressors, CAS, and symptomatology. At both time points, CAS was a significant mediator between the stressors and symptoms of adjustment disorder. Despite the decrease in the intensity of adjustment disorder symptoms between waves, it was a significant predictor of other psychopathologies at both time points, except for traumatic stress.

CONCLUSIONS

The findings confirm the assumption that CAS is a transdiagnostic factor of psychopathology and has a mediating role in the relationship between stressors and adjustment disorder and co-occurring symptomatology. The effect was particularly significant in the initial phase of the pandemic, which was highly stressful for many people.

Suicide Following the COVID-19 Pandemic Outbreak: Variation Across Place, Over Time, and Across Sociodemographic Groups. A Systematic Integrative Review

PURPOSE OF REVIEW

To systematically examine changes in suicide trends following the initial COVID-19 outbreak, focusing on geographical and temporal heterogeneity and on differences across sociodemographic subgroups.

RECENT FINDINGS

Of 46 studies, 26 had low risk of bias. In general, suicides remained stable or decreased following the initial outbreak - however, suicide increases were detected during spring 2020 in Mexico, Nepal, India, Spain, and Hungary; and after summer 2020 in Japan. Trends were heterogeneous across sociodemographic groups (i.e., there were increases among racially minoritized individuals in the US, young adults and females across ages in Japan, older males in Brazil and Germany, and older adults across sex in China and Taiwan). Variations may be explained by differences in risk of COVID-19 contagion and death and in socioeconomic vulnerability. Monitoring geographical, temporal, and sociodemographic differences in suicide trends during the COVID-19 pandemic is critical to guide suicide prevention efforts.

Coping with COVID: risk and resilience factors for mental health in a German representative panel study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic might affect mental health. Data from population-representative panel surveys with multiple waves including pre-COVID data investigating risk and protective factors are still rare.

METHODS

In a stratified random sample of the German household population (n = 6684), we conducted survey-weighted multiple linear regressions to determine the association of various psychological risk and protective factors assessed between 2015 and 2020 with changes in psychological distress [(PD; measured via Patient Health Questionnaire for Depression and Anxiety (PHQ-4)] from pre-pandemic (average of 2016 and 2019) to peri-pandemic (both 2020 and 2021) time points. Control analyses on PD change between two pre-pandemic time points (2016 and 2019) were conducted. Regularized regressions were computed to inform on which factors were statistically most influential in the multicollinear setting.

RESULTS

PHQ-4 scores in 2020 (M = 2.45) and 2021 (M = 2.21) were elevated compared to 2019 (M = 1.79). Several risk factors (catastrophizing, neuroticism, and asking for instrumental support) and protective factors (perceived stress recovery, positive reappraisal, and optimism) were identified for the peri-pandemic outcomes. Control analyses revealed that in pre-pandemic times, neuroticism and optimism were predominantly related to PD changes. Regularized regression mostly confirmed the results and highlighted perceived stress recovery as most consistent influential protective factor across peri-pandemic outcomes.

CONCLUSIONS

We identified several psychological risk and protective factors related to PD outcomes during the COVID-19 pandemic. A comparison of pre-pandemic data stresses the relevance of longitudinal assessments to potentially reconcile contradictory findings. Implications and suggestions for targeted prevention and intervention programs during highly stressful times such as pandemics are discussed.

Assessment of Anxiety among People with Various Physical Activity Levels during Lockdown in Karachi, Pakistan

Background  The purpose of this study is to make it easier to counsel the general public on how to promote their psychological health and better lifestyle by boosting their physical activity in the event of more devastating future waves of coronavirus disease 2019. Coronavirus disease is a viral infection first reported in Wuhan, China, which led to a worldwide pandemic and lockdown. In addition to physical health, the uncertainty of situation and fear of infection have further affected the mental health of the individuals. Lockdown has also halted the physical activity of people further adding into the stress and anxiety. Methods  A sample size of 376 was required, but a convenient sampling technique collected 400 responses due to overwhelming Participation. A well-structured questionnaire was used for data collection, which contained sections such as a demographics section. We used the International Physical Activity Questionnaire scale to measure various physical activity levels and the generalized anxiety disorder scale to measure anxiety levels, because of their considerate validity and feasibility. Later both of our variables were compared to find out the correlation of anxiety levels with different physical activity levels. Results  Mean Anxiety and its prevalence rates in the sample were 7.32 ± 5.767 and 33%. On performing Pearson correlation, increasing age was found to be a risk factor for Anxiety. One-way analysis of variance showed a significant difference between Physical Activity and Anxiety. In the post-hoc Tukey test, a considerable difference in anxiety level was found between people with no physical activity and vigorous physical activity. Conclusion  During the lockdown period, the mean anxiety was found to be 7.0 ± 5.56 with prevalence rate of 33% among the people with no, low, moderate or vigorous physically active levels was found to be associated with better perceived mental health status which suggests the need to promote physically active style to cope with anxiety and awareness sessions to be conducted especially among those who could not maintain a physically active lifestyle. Also, among the general population e-Health programs could provide an appropriate way to promote a physically active lifestyle.

Combatting negative bias: a mental contrasting and implementation intentions online intervention to increase help-seeking among individuals with elevated depressive symptomatology

Background

There are many reasons why individuals with depression may not seek help. Among those with elevated depressive symptomatology, some previous interventions aimed at increasing help-seeking have unintentionally decreased help-seeking intentions. Beck's cognitive theory of depression posits that individuals with elevated depressive symptomatology process information differently from those without depression (i.e., increased cognitive errors, negative bias); potentially explaining the iatrogenic results of previous interventions. Mental contrasting and implementation intentions (MCII; a self-regulatory strategy) interventions have successfully influenced physical and mental health behaviors. However, MCII has not been used specifically for initiating help-seeking for depression. The goal of this research was to ascertain whether an online MCII intervention could increase actual help-seeking or the intention to seek help for depression.

Method

Two online randomized pre-post experiments were conducted to measure the primary outcome measures 2 weeks post-intervention (Study 1 collected Summer 2019: information-only control ["C"], help-seeking MCII intervention ["HS"], and comparison MCII intervention ["E"]; Study 2 collected Winter 2020: "C" and "HS"). At Time 1, adults recruited from MTurk had a minimum Beck Depression Inventory (BDI-II) score of 14 (mild depressive symptoms) and were not seeking professional help.

Results

Study 1 (N = 74) indicated that the intervention was feasible, provided preliminary support, and clarified intervention components for Study 2. Study 2 (N = 224) indicated that the HS group reported greater intentions to seek help and actual help-seeking than the C group. Proportionally, actual help-seeking was more likely among individuals who received the HS intervention and either did not perceive themselves as depressed at Time 2 or had BDI-II scores indicating that their depressive symptomatology decreased from Time 1.

Limitations

Participation was limited to US residents who self-reported data.

Discussion

These studies indicate that a brief online MCII intervention to encourage help-seeking is feasible and preliminarily successful. Future studies should consider using ecological momentary assessment measurements to establish the temporal precedence of intervention effects and whether MCII is effective for encouraging help-seeking among individuals prone to experiencing cognitive errors who may not be experiencing negative bias (e.g., bipolar disorder or anxiety). Clinicians may find this method successful in encouraging ongoing treatment engagement.

Psychiatric and non-psychiatric population vulnerabilities in time of a crisis: the unsuspected aggression factor

OBJECTIVES

In March 2020, France faced a health crisis due to the COVID-19 outbreak that, like previous infectious disease crises, involved high psychological and emotional stress, a series of factors that influenced the ongoing mental health crisis.

METHODS

We recruited 384 respondents to complete an online questionnaire during the second month of isolation: 176 psychotherapy recipients (68 were currently attending psychiatric care) and 208 healthy controls. We measured demographic characteristics, impulsivity, aggression, hopelessness, suicidal risk, and the global level of anxiety and depression in order to estimate potential discrepancies in clinical measures across these populations.

RESULTS

Our results indicate that the group currently undergoing psychiatric care was prone to loneliness and social isolation. Regarding clinical and nonclinical population, there were differences in suicidal risk, depression, anxiety, and hopelessness but mainly in aggression. Regression analysis also demonstrated that aggression surprisingly influenced anxiety levels. Patients undergoing therapy compared with patients who were not displayed differences only in suicidal risk, anxiety, and hopelessness, with those undergoing therapy having higher scores. The outpatient group undergoing therapy had a significantly lower level of impulsivity. Moreover, the regression to predict anxiety and depression levels from correlated factors highlighted the potentially heightened role of aggression in predicting anxiety in the clinical group.

CONCLUSION

New research into stress reactions should assess other clinical signals, such as aggression, and examine preventive mental health interventions in times of crisis.

Generalised anxiety disorder, depressive symptoms and their subjective change after the first wave of COVID-19 among gamers in Poland

Previous studies have indicated that levels of emotional distress were considerably elevated during the COVID-19 pandemic; however, some longitudinal studies did not confirm these findings. There is a very limited number of studies on specific subpopulations, such as video gamers in this particular period. Playing video games may have either a beneficial influence on mental health by diminishing stress or a detrimental impact in terms of increasing depression and anxiety. It is, therefore, important to establish whether regular gamers differ from the general population in terms of symptoms of depression and anxiety during COVID-19. A total of 1023 participants (aged 18-50) participated in the study. The sample was composed of gamers and was representative of the Polish population. Participants completed a modified version of GAD-7, PHQ-9 online, addressing subjective change in anxiety and depressive symptoms. 25% of the sample reported clinically significant anxiety levels, and 35% mentioned depression. There were no differences in anxiety and depression levels between the investigated sample of gamers and the general population. However, up to 30% of individuals reported an increase in subjective change in anxiety or depressive symptoms during COVID-19. A further 30% reported a downward subjective change in anxiety or depressive symptoms during COVID-19. The remaining 40% declared a lack of change in the subjective change in anxiety or depressive symptoms during COVID-19. Those who reported an increase scored substantially higher in anxiety and depression than other groups. This indicates that the COVID-19 pandemic may have impacted people's mental health along a syndemic-syndaimonic continuum. COVID-19 might have been harmful to those with already poorer mental health and beneficial to those with good mental health. It is also important to plan interventions targeting vulnerable individuals who report clinically significant levels of anxiety and depression - women and younger adults and those who subjectively perceive their emotional condition to deteriorate during the COVID-19 lockdown.

Anxiety and depressive symptoms among migrants during the COVID-19 pandemic in Norway: A two-wave longitudinal study

This study was designed to examine the impact of the COVID-19 pandemic on the mental health of migrants living in Norway. We conducted a longitudinal two-waves survey among a sample of 574 migrants and multilevel modelling was used to analyse anxiety, health anxiety and depressive symptoms. Demographic and psychological predictors were investigated. The levels of anxiety, health anxiety and depressive symptoms among migrants decreased from the lockdown (strict social distancing protocols) to phaseout. Reductions in maladaptive coping strategies were related to parallel reductions in anxiety, health anxiety, and depression, and a reduction in loneliness was related to a reduction in depression. The results indicate that the elevated levels of anxiety, health anxiety and depressive symptoms among migrants in the first phase of the pandemic may be temporary.

Anxiety, anhedonia, and related food consumption in Israelis populations:An online cross-sectional study two years since the outbreak of COVID-19

Background

The COVID-19 pandemic has significantly impacted daily life. Beyond severe health and economic consequences, psychological consequences have surfaced that require in-depth research to understand the pandemic's effects on mental health. Aims: This study aimed to evaluate the association between anxiety levels and anhedonia with food consumption patterns and changes in body weight over the two years since the COVID-19 outbreak in Israel.

Methods

This cross-sectional study utilized non-randomized sampling through an online survey that included 741 study participants aged 18 to 94. participants were asked to complete the Beck's Anxiety Questionnaire, the Snaith-Hamilton Pleasure Scale for Anhedonia Measurement, the Mediterranean Nutrition Questionnaire, and self-reports of body weight and serving size changes.

Results

Those who reported severe anxiety and anhedonia reported the highest intake of fats, sugars, and carbohydrates and the highest weight gain (e.g., Butter and cream food: severe anxiety (M = 1.342, SEM = 0.217); low anxiety (M = 0.682, SEM = 0.042), Sweet pastries: severe anxiety (M = 4.078, SEM = 0.451); low anxiety (M = 3.175, SEM = 0.436)). Anhedonic participants consumed more sweetened beverages (M = 0.987, SEM = 0.013) than hedonic participants (M = 0.472, SEM = 0.231). Among participants that gained weight, severe anxiety participants consumed significantly more salty pastries (M = 2.263, SEM = 0.550) than those with low anxiety (M = 1.096, SEM = 0.107; p = .003). A significant interaction was found between weight, anxiety, and consuming salty pastries. High anxiety subjects and weight gain declared the highest intake of this food (p = .018); Significant interactions were found between those with severe anxiety and anhedonia, who reported the highest consumption of butter and cream (p = .005) and salty pastries (p = .021). Significant associations were found between weight and anhedonia and weight and anxiety levels (p = .000, p = .006 - respectively).

Conclusions

The outbreak of COVID-19 and its long-term presence strengthen the negative psychological aspects and increase the consumption of foods high in fat and sugar. Further attention to nutritional health is needed since crises may occur, and we must be prepared to prevent adverse consequences.

The impact of the COVID-19 pandemic on suicide mortality in Spain: Differences by sex and age

BACKGROUND

Variations in suicide following the initial COVID-19 pandemic outbreak were heterogeneous across space, over time, and across population subgroup. Whether suicide has increased during the pandemic in Spain, a major initial COVID-19 hotspot, remains unclear, and no study has examined differences by sociodemographic group.

METHODS

We used 2016-2020 data on monthly suicide deaths from Spain's National Institute of Statistics. We implemented Seasonal Autoregressive Integrated Moving Average (SARIMA) models to control seasonality, non-stationarity, and autocorrelation. Using January 2016-March 2020 data, we predicted monthly suicide counts (95 % prediction intervals) between April and December 2020, and then compared observed and predicted monthly suicide counts. All calculations were conducted for the overall study population and by sex and age group.

RESULTS

Between April and December 2020, the number of suicides in Spain was 11 % higher-than-predicted. Monthly suicide counts were lower-than-expected in April 2020 and peaked in August 2020 with 396 observed suicides. Excess suicide counts were particularly salient during the summer of 2020 - largely driven by over 50 % higher-than-expected suicide counts among males aged 65 years and older in June, July, and August 2020.

DISCUSSION

The number of suicides increased in Spain during the months following the initial COVID-19 pandemic outbreak in Spain, largely driven by increases in suicides among older adults. Potential explanations underlying this phenomenon remain elusive. Important factors to understand these findings may include fear of contagion, isolation, and loss and bereavement - in the context of the particularly high mortality rates of older adults during the initial phases of the pandemic in Spain.

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

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

The impact of the COVID-19 pandemic on depression in community-dwelling older adults: a prospective cohort study

BACKGROUND

There are growing concerns about the impact of the COVID-19 pandemic on the mental health of older adults. We examined the effect of the pandemic on the risk of depression in older adults.

METHODS

We analyzed data from the prospective cohort study of Korean older adults, which has been followed every 2 years. Among the 2308 participants who completed both the third and the fourth follow-up assessments, 58.4% completed their fourth follow-up before the outbreak of COVID-19 and the rest completed it during the pandemic. We conducted face-to-face diagnostic interviews using Mini International Neuropsychiatric Interview and used Geriatric Depression Scale. We performed generalized estimating equations and logistic regression analyses.

RESULTS

The COVID-19 pandemic was associated with increased depressive symptoms in older adults [b (standard error) = 0.42 (0.20), p = 0.040] and a doubling of the risk for incident depressive disorder even in euthymic older adults without a history of depression (odds ratio = 2.44, 95% confidence interval 1.18-5.02, p = 0.016). Less social activities, which was associated with the risk of depressive disorder before the pandemic, was not associated with the risk of depressive disorder during the pandemic. However, less family gatherings, which was not associated with the risk of depressive disorder before the pandemic, was associated with the doubled risk of depressive disorder during the pandemic.

CONCLUSIONS

The COVID-19 pandemic significantly influences the risk of late-life depression in the community. Older adults with a lack of family gatherings may be particularly vulnerable.

Efficacy of Intellect's self-guided anxiety and worry mobile health programme: A randomized controlled trial with an active control and a 2-week follow-up

Digital self-guided mobile health [mHealth] applications are cost-effective, accessible, and well-suited to improve mental health at scale. This randomized controlled trial [RCT] evaluated the efficacy of a recently developed mHealth programme based on cognitive-behavioral therapy [CBT] principles in improving worry and anxiety. We also examined psychological mindedness [PM] as a mediator by which app engagement is thought to improve outcomes. The Intervention group completed a 2-week "Anxiety and Worry" programme with daily CBT-informed activities, while the active waitlist-control completed a matched 2-week mHealth programme on procrastination. Participants filled out the Generalized Anxiety Disorder [GAD-7], Patient Health Questionnaire [PHQ-9], and Psychological Mindedness Scale [PMS] at baseline, post-intervention, and 2-week follow-up. App engagement was measured at post-intervention only. Contrary to prediction, the Intervention group did not perform better than the Active Control group; both groups showed significant improvements on anxiety and depressive symptoms from baseline to follow-up. From post-intervention to follow-up, only the Intervention group showed further improvements for anxiety symptoms. Higher engagement with the mHealth app predicted lower anxiety and depressive symptoms at follow-up, and this relationship was fully mediated by psychological mindedness. This study provides evidence that [a] engaging in a CBT mHealth programme can reduce anxiety and worry, and [b] Psychological mindedness is a potential pathway by which engaging with a mHealth app improves anxiety and depressive symptoms. While overall effect sizes were small, at the population level, these can make significant contributions to public mental health.

The association between risk perceptions, anxiety, and self-reported changes in tobacco and nicotine product use due to COVID-19 in May-June 2020 in Israel

BACKGROUND

Early in the COVID-19 pandemic, reports about a possible protective effect of nicotine on COVID-19 conflicted with messaging by public health organizations about increased risks of COVID-19 due to smoking. The ambiguous information the public received, combined with COVID-19-induced anxiety, may have led to changes in tobacco or other nicotine product use. This study examined changes in use of combustible cigarettes (CCs), nargila (hookah/waterpipe), e-cigarettes, and IQOS and home-smoking behaviors. We also assessed COVID-19 related anxiety and perceptions regarding changes in risk of COVID-19 severity due to smoking.

METHODS

We used cross-sectional data from a population telephone survey that was conducted in Israel in the early phase of the COVID-19 pandemic (May-June 2020) and included 420 adult (age 18+) individuals who reported having ever used CCs (n = 391), nargila (n = 193), and/or electronic cigarettes (e-cigarettes)/heated tobacco products (e.g., IQOS) (n = 52). Respondents were asked about the effect that COVID-19 had on their nicotine product use (quit/reduced use, no change, increased use). We assessed changes in product use, risk perceptions, and anxiety using adjusted multinomial logistic regression analyses.

RESULTS

Most respondents did not change their frequency of product use (CCs: 81.0%, nargila: 88.2%, e-cigarettes/IQOS: 96.8%). A small percentage either decreased use (CCs: 7.2%, nargila: 3.2%, e-cigarettes/IQOS:2.4%) or increased use (CCs:11.8%, nargila:8.6%, e-cigarettes/IQOS:+ 0.9%). 55.6% of respondents used a product in the home prior to COVID-19; but during the first lockdown COVID-19 period, a greater percentage increased (12.6%) than decreased (4.0%) their home use. Higher levels of anxiety due to COVID-19 were associated with increased home smoking (aOR = 1.59, 95% CI:1.04-2.42, p = 0.02). Many respondents believed that increased severity of COVID-19 illness was associated with CCs (62.0%) and e-cigarettes/vaping (45.3%), with uncertainty about the association being lower for CCs (20.5%) than for vaping (41.3%).

CONCLUSIONS

While many respondents believed that nicotine product use (particularly CCs and e-cigarettes) was associated with increased risk of COVID-19 disease severity, the majority of users did not change their tobacco/nicotine use. The confusion about the relationship between tobacco use and COVID-19 calls for clear evidence-based messaging from governments. The association between home smoking and increased COVID-19-related stress suggests the need for campaigns and resources to prevent smoking in the home, particularly during times of stress.

Effect of the COVID-19 Pandemic on the Psychological Health of Patients Who Underwent Liver Transplantation Due to Hepatocellular Carcinoma

BACKGROUND

The primary aim of this study was to compare liver transplant (LT) recipients with and without hepatocellular carcinoma (HCC) in terms of COVID-19-related depression, anxiety, and stress.

METHOD

A total of 504 LT recipients with (HCC group; n = 252) and without HCC (non-HCC group; n = 252) were included in the present case-control study. Depression Anxiety Stress Scales (DASS-21) and Coronavirus Anxiety Scale (CAS) were used to evaluate the depression, stress, and anxiety levels of LT patients. DASS-21 total and CAS-SF scores were determined as the primary outcomes of the study. Poisson regression and negative binomial regression models were used to predict the DASS and CAS scores. The incidence rate ratio (IRR) was used as a coefficient. Both groups were also compared in terms of awareness of the COVID-19 vaccine.

RESULTS

Poisson regression and negative binomial regression analyses for DASS-21 total and CAS-SF scales showed that the negative binomial regression method was the appropriate model for both scales. According to this model, it was determined that the following independent variables increased the DASS-21 total score: non-HCC (IRR: 1.26; p = 0.031), female gender (IRR: 1.29; p = 0.036), presence of chronic disease (IRR: 1.65; p < 0.001), exposure to COVID-19 (IRR: 1.63; p < 0.001), and nonvaccination (IRR: 1.50; p = 0.002). On the other hand, it was determined that the following independent variables increased the CAS score: female gender (IRR:1.75; p = 0.014) and exposure to COVID-19 (IRR: 1.51; p = 0.048). Significant differences were found between the HCC and non-HCC groups in terms of median DASS-21 total (p < 0.001) and CAS-SF (p = 0.002) scores. Cronbach's alpha internal consistency coefficients of DASS-21 total and CAS-SF scales were calculated to be 0.823 and 0.783, respectively.

CONCLUSION

This study showed that the variables including patients without HCC, female gender, having a chronic disease, being exposed to COVID-19, and not being vaccinated against COVID-19 increased anxiety, depression, and stress. High internal consistency coefficients obtained from both scales indicate that these results are reliable.