Post-Ebola psychosocial experiences and coping mechanisms among Ebola survivors: a systematic review

COVID-19's Impact in Long-Term Care Facilities: The Health and Coping Strategies of Older Adults and Their Families

AIM

Describe the stressors that long-term care facility (LTCF) residents and their family members were exposed to during the COVID-19 pandemic, the resources they mobilised to cope with them, and the strategies used by professionals to support them.

DESIGN

A descriptive qualitative design study.

METHOD

Between March 2021 and February 2022, we carried out semi-structured interviews with 8 LTCF residents, 11 family members, and 6 focus groups made up of healthcare and support staff from 8 LTCFs.

RESULTS

Three themes emerged: (1) residents and family members: separated and suffering, (2) residents and family members: reinventing themselves, and (3) staff: attempts to maintain residents' well-being.

CONCLUSION

LTCF Residents' and their family members' exposure to the various stressors linked to the COVID-19 pandemic generated suffering. Healthcare and support staff implemented strategies to support them, notably to maintain links between them. Some deep reflection must occur on the concepts of LTCF residents' autonomy and self-determination when implementing protective measures in future pandemic situations.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

This study has provided new insights into the nature of the stressors faced by LTCF residents and their families, and the measures implemented by professionals to support them. The role of the families of LTCF residents needs to be better recognised. Our results indicate the importance of involving nurses in discussions on patient autonomy and self-determination when implementing protective measures (in a pandemic situation).

IMPACT

Exploring the nature of the stressors experienced by LTCF residents and their families enables professionals to tailor strategies to support them. Maintaining residents' self-determination is essential when implementing protective measures. Families involved with residents must be recognised and included in the assessment of stressors and the personalisation and implementation of strategies to support LTCF residents.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Embedding treatment in stronger care systems

A key lesson from the west Africa (2014-16) Ebola disease epidemic was that outbreak responses fail when they respond to patients through a narrow clinical lens without considering the broader community and social context of care. Here, in the second of two Series papers on the modern landscape of Ebola disease, we review progress made in the last decade to improve patient-centred care. Although the biosafety imperatives of treating Ebola disease remain, recent advances show how to mitigate these so that patients are cared for in a safe and dignified manner that encourages early treatment-seeking behaviour and provides support after the return of patients to their communities. We review advances in diagnostics, including faster Ebola disease detection via real-time RT-PCR, and consider design improvements in Ebola disease treatment units that enhance patient safety and dignity. We also review advances in care provision, such as the integration of palliative care and mobile communication into routine care, and address how greater access to research is possible through harmonised clinical trials. Finally, we discuss how strengthened community engagement and psychosocial programmes are addressing stigma and providing holistic support for survivors.

Prevalence and factors related to psychological distress among Ebola survivors and healthcare workers in the Eastern DR Congo

This article examines for the first-time prevalence and factors associated with psychological distress among Ebola survivors and healthcare workers (HCWs). A representative sample of 563 participants completed the survey (309 survivors; 202 HCWs; 52 survivors/HCWs). Prevalence of psychological distress was higher among survivors (85.25 %) compared to HCWs (51.24 %), and combined group (73.08 %), χ2=69.32, p<.001. Logistic regression models showed that COVID-19 (OR=1.02, 95 %CI: [1.01-1.03], p=.005) and Ebola stigmatization (OR=1.06, 95 %CI: [1.04-1.07], p<.001) were the most important predictors of psychological distress. Significant main effects of social support (B=-.05, p=.001) was observed. This study shows the need of implementing culturally adapted trauma-informed prevention and intervention programs among survivors and HCWs.

Assessment of prevalence and determinants of anxiety and psychological distress symptoms in Ebola child and adolescent survivors and orphans in Eastern Democratic Republic of the Congo during the COVID-19 pandemic

BACKGROUND

To date, only three studies investigated the mental health of youth affected by Ebola virus disease (EVD). None explored anxiety and psychological distress symptoms in survivors or orphans. This study aimed to investigate the prevalence and determinants of anxiety and psychological distress symptoms among survivors and orphans of the 2018-2020 Ebola epidemic in Eastern Democratic Republic of the Congo (DRC) during the COVID-19 pandemic.

METHODS

A representative sample of 416 participants (mean age = 13.37, SD = 2.79, 51.20 % girls, 146 survivors, 233 orphans, and 34 orphan-survivor participants) completed measures evaluating anxiety, psychological distress, exposure, resilience, stigmatization related to Ebola and COVID-19.

RESULTS

55.88 % and 55.96 % of survivors and orphans experienced severe symptoms of anxiety and psychological distress. Participants who were both survivors and orphans presented higher prevalence of anxiety and psychological distress (94.12 % and 100 %) compared to survivors (74.03 % and 81.82 %) or orphans (37.99 % and 33.33 %), χ2 = 70.63, p < .001; χ2 = 113.50, p < .001. Ebola and COVID-19 related stigmatization were the most important determinants of anxiety (B = 0.40, p < .001; B = 0.37, p < .001) and psychological distress (B = 0.48, p < .001; B = 0.44, p < .001). Resilience was negatively associated with both anxiety and psychological distress. The final regression models explained 49 % and 85 % of the variance of anxiety and psychological distress.

LIMITATIONS

The cross-sectional design used prevents to establish causal link.

CONCLUSIONS

Ebola children and adolescents' survivors and orphans are at major risk of experiencing anxiety and psychological distress in Eastern RDC affected by years of armed conflict. Massive resources are needed to develop and implement programs to reduce stigma and support mental health.

Understanding Ethical Concerns Involving Vulnerable Human Participant Populations in Medical Research: Mixed-Method Analysis of Liberian Ebola Survivors' Experiences in PREVAIL I-VII

Background: As the number of large-scale outbreaks continues to rise worldwide, clinical trials are increasingly engaging disease-affected peoples within the Minority World (nations with over 80% poverty rates). Yet global health research inadequately addresses potential ethical issues of including impoverished, disease-affected populations and their contextual vulnerabilities in medical research. Objective: This paper presents a mixed-method analysis from our 2022 semi-structured survey capturing the experiences of Liberian Ebola Virus Disease (EVD) survivors serving as study participants in the Partnership for Research on Ebola Virus in Liberia (PREVAIL) clinical trials. Methods: Firstly, we conducted an extensive literature review of the scholarship related to biomedical research and ethical standards protecting study participants to inform our survey method and design. Applying a theoretical framework on vulnerability, we then qualitatively explored the survey responses of 19 EVD survivors' perceptions and experiences taking part in PREVAIL, including their expectations, treatment, delivered benefits, and quality of care. We further quantitatively codified their statements for underlying themes of reported negative experiences against standard ethical regulations in biomedical research, conducting a statistical analysis to inform generalizability. Most of the 19 survivors reported facing extreme ongoing vulnerabilities related to their disease status, including physical impairments, psychosocial stress, and socio-economic inequity. Results: Initially, the survivors tended to experience a sense of hope and pride in volunteering for PREVAIL. One in five participants reported benefiting from PREVAIL's regular medical diagnoses. However, most of their survey responses indicated prevalent negative shared experiences, including continually being confused or misinformed of their study participant rights, roles, and benefits; being burdened by heavy participation transaction costs; and repeated incidents of poor treatment and discrimination by PREVAIL staff after initial recruitment. PREVAIL participant satisfaction ranking is negatively correlated with receiving insufficient financial compensation (r = -0.51), extensive time requirements for each medical visit (-0.40), and being poorly treated by clinical staff (-0.67).

The state of mental health among Ebola virus disease survivors through a cross-sectional study in Sierra Leone

BACKGROUND

The West African Ebola virus disease (EVD) epidemic resulted in >28 000 disease cases and >11 000 fatalities. The unprecedented number of survivors from this epidemic has raised questions about the long-term mental health impacts of EVD survivorship and the capacity to meet these needs.

OBJECTIVES

Assess the frequency and factors associated with mental health consequences of EVD survivorship in Sierra Leone.

METHODS

A cross-sectional study of 595 EVD survivors and 403 close contacts (n=998) from Sierra Leone assessed via in-person survey between November 2021 and March 2022. The assessment included validated mental health screening tools (Patient Health Questionnaire-9, PTSD Checklist-5, Alcohol Use Disorders Identification Test, Drug Abuse Screening Test-20) to indicate the presence/absence of disorder. The frequency of each disorder and factors associated with each disorder were assessed.

FINDINGS

EVD-associated post-traumatic stress disorder (PTSD) was reported by 45.7% (n=257) of EVD survivors. Moreover, 3.9% (n=22) and 12.0% (n=67) of EVD survivors reported major depression (MD) and substance use, respectively; all mental health outcomes were higher than baseline rates in the region (PTSD: 6%-16%, MD: 1.1%, substance use: 2.2%). PTSD among EVD survivors was associated with acute EVD duration of ≥21 days (adjusted OR, AOR 2.24, 95% CI 1.16 to 4.43), 35-44 years of age (AOR 3.31, 95% CI 1.33 to 8.24; AOR 2.99, 95% CI 1.09 to 8.24) and residential mobility (AOR 4.16, 95% CI 2.35 to 7.35).

CONCLUSIONS

Concerningly, the levels of mental health disorders among EVD survivors in Sierra Leone remained elevated 6-8 years after recovery.

CLINICAL IMPLICATIONS

Results can be used to inform policy efforts and target resources to address mental health in EVD survivors.

Stigmatization of Ebola virus disease survivors in 2022: A cross-sectional study of survivors in Sierra Leone

BACKGROUND

Evidence has demonstrated a high proportion of Ebola virus disease (EVD) survivors experienced stigma due to the disease. This study sought to understand the longer-term effects of stigma encountered by survivors of the 2014-2016 EVD epidemic living in Sierra Leone.

METHODS

This was a cross-sectional study of 595 EVD survivors and 403 close contacts (n = 998) from Sierra Leone. Assessments were conducted using a three-part survey between November 2021 to March 2022. We explored the socio-demographic factors associated with stigma experienced by EVD survivors.

FINDINGS

50·6 % (n = 301) of EVD survivors reported that they continued to experience at least one aspect of stigma. Females were disproportionately affected by stigma, with 45·2 % of females reporting isolation from friends and family compared to 33·9 % of men (p = 0·005). Multivariable logistic regression models revealed those aged 40-44, living rurally, and reporting an acute infection longer than seven days was associated with EVD-related stigma at the time of survey.

INTERPRETATION

This study demonstrates stigma is still prevalent among people who survived EVD in 2022. It also identified socio-demographic factors associated with stigma that can be used for targeting interventions. Importantly, this highlights the continued need for EVD survivors to access mental healthcare and social support systems well after disease recovery.

FUNDING

This study was funded by the Canadian Institutes for Health Research (Grant no. PJT-175098. JK is funded by a Tier 2 Canada Research Chair in the Molecular Pathogenesis of Emerging and Re-Emerging Viruses. SS is funded by a Tier 2 Canada Research Chair in Program Science and Global Public Health.

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.

Quality of life and factors associated among caregivers of adolescent and young adult Ebola survivors in Democratic Republic of the Congo, a cross-sectional study

BACKGROUND

Ebola virus disease is a medical condition whose consequent effects on quality of life of patients. In the history of infectious diseases, there have been pathologies that have had significant repercussions for caregivers, healthcare providers and the community.

OBJECTIVES

This study investigate determinants of quality of life among caregivers of adolescent and young adult Ebola survivors in Democratic Republic of the Congo.

METHODS

This was a cross sectional study. The study sites were the two health districts of Beni and Katwa, in North-Kivu province in the Eastern part of Democratic Republic of the Congo. The study period was from April to August 2022. Participants of the study were caregivers of adolescents and young adult Ebola virus survivors. Simple random sampling technique was used to select the 68 study participants. A questionnaire was administered. Data was collected using pretested questionnaire of WHO quality of life Bref (WHOQOL-BREF) and CommCare by Dimagi.Inc. lastest Version 2.52.1 and  a sum of score of 78 or higher indicated a high level of life quality. To determine the quality of life of caregivers of adolescents and young adult EVD survivors, descriptive analysis was used. The Pearson correlation coefficient was utilized to check whether the predictor variables are multicollinear. The regression analysis produced the crude odds ratio (COR), adjusted odds ratio (aOR), 95% confidence interval (CI), and p-value. Statistical significance was defined as a p-value 0.05. The final multivariate model contained variables that were significant in the bivariate analysis. Prior to data collection, a research permit from National Ethical Committee of Research in Democratic Republic of the Congo was obtained. Written informed consents from literate or illiterate caregivers of adolescent and young adult Ebola survivors were obtained. Throughout the study, participants' privacy and confidentiality were respected.

RESULTS

A total of 68 care givers participated in the study, with a majority 54/68(79.41%) having poor quality of life. Men were 3.17 times more likely to record good quality of life than women (p = 0.02); OR:(95% CI), 3.17: (1.2 - 8.36), With regards to place of residence, caregivers who lived in town were less likely to have good quality of life compared to those in rural (p = 0.01); OR: (95%CI), 0.25: (0.09 - 0.72).

CONCLUSION

The quality of life of caregivers of adolescent and young adult Ebola survivors in Democratic Republic of the Congo is poor. To be woman caregiver and to live in town are determinants associated with poor quality of life among caregivers of adolescent and young adult Ebola survivors.

Experiences of hospitalized patients with COVID-19 - A single centre qualitative study

Introduction

COVID-19 pandemic caused a huge impact on the healthcare system worldwide. With a spectrum of outcome ranging from mild symptoms to mortality, the experiences of patients admitted in isolation wards have not been documented.

Objective

To explore the experience of COVID-19 patients during hospitalization during the early phase of pandemic.

Materials and Methods

A qualitative study using in-depth interviews was conducted among 30 COVID positive patients admitted in COVID wards of a private medical college in Coimbatore, South India between May and June 2020. Qualitative data analysis was done using the seven steps of Colaizzi's descriptive phenomenological method.

Results

The experiences of COVID-19 patients during their hospitalization were categorized into three themes. Firstly, their initial reaction to being diagnosed positive for COVID-19. Secondly, experience during hospitalization with regards to their mental health, treatment providers, caregivers (family and relatives) and other COVID patients admitted in the same ward. Lastly, perceived change in their quality of life after discharge.

Conclusion

The study highlights that the psychological experiences of COVID-19 patients admitted to the hospital were heterogeneous. Therefore, primary care physicians should provide individualized psychological interventions based on the needs. Since many expressed fear on diagnosis and stigma of the disease, hence policy makers and health care providers should plan intervention for control and treatment without causing stigma to patients and their families.

"I am scared, I do not want to lie": exploring the impacts of COVID-19 on engagement in care, perceived health, relationship dynamics, and parenting among postpartum women with HIV in South Africa

BACKGROUND

COVID-19 and efforts to manage widespread infection may compromise HIV care engagement. The COVID-19-related factors linked to reduced HIV engagement have not been assessed among postpartum women with HIV, who are at heightened risk of attrition under non-pandemic circumstances. To mitigate the effects of the pandemic on care engagement and to prepare for future public health crises, it is critical to understand how COVID-19 has impacted (1) engagement in care and (2) factors that may act as barriers to care engagement.

METHODS

A quantitative assessment of COVID-19-related experiences was added to a longitudinal cohort study assessing predictors of postpartum attrition from HIV care among women in South Africa. Participants (N = 266) completed the assessment at 6, 12, 18, or 24 months postpartum between June and November of 2020. Those who endorsed one or more challenge related to engagement in care (making or keeping HIV care appointments, procuring HIV medications, procuring contraception, and/or accessing immunization services for infants; n = 55) were invited to complete a brief qualitative interview, which explored the specific factors driving these challenges, as well as other impacts of COVID-19 on care engagement. Within this subset, 53 participants completed an interview; qualitative data were analyzed via rapid analysis.

RESULTS

Participants described key challenges that reduced their engagement in HIV care and identified four other domains of COVID-19-related impacts: physical health, mental health, relationship with a partner or with the father of the baby, and motherhood/caring for the new baby. Within these domains, specific themes and subthemes emerged, with some positive impacts of COVID-19 also reported (e.g., increased quality time, improved communication with partner, HIV disclosure). Coping strategies for COVID-19-related challenges (e.g., acceptance, spirituality, distraction) were also discussed.

CONCLUSIONS

About one in five participants reported challenges accessing HIV care, medications, or services, and they faced complex, multilayered barriers to remaining engaged. Physical health, mental health, relationships with partners, and ability to care for their infant were also affected. Given the dynamic nature of the pandemic and general uncertainty about its course, ongoing assessment of pandemic-related challenges among postpartum women is needed to avoid HIV care disruptions and to support wellbeing.

Modelling the impact of stigmatisation of Ebola survivors on the disease transmission dynamics

Ebola virus disease (EVD) is one of the most highly stigmatised diseases in any affected country because of the disease's high infectivity and case fatality rate. Infected individuals and most especially survivors are often stigmatised by their communities for fear of contagion. We propose and analyse a mathematical model to examine the impact of stigmatisation of Ebola survivors on the disease dynamics. The model captures both the internal stigmatisation experienced by infected individuals after witnessing survivors being stigmatised and the external stigmatisation imposed on survivors by their communities. The results obtained from our analysis and simulations show that both internal and external stigma may lead to an increase in the burden of Ebola virus disease by sustaining the number of infected individuals who hide their infection and the number of unsafe burials of deceased Ebola victims. Strategies that seek to put an end to both forms of stigmatisation and promote safe burials will therefore go a long way in averting the EVD burden.

When Staying Home Is Not Safe: An Investigation of the Role of Attachment Style on Stress and Intimate Partner Violence in the Time of COVID-19

Intimate partner violence (IPV) is a major public health concern, with increasing rates of IPV being seen around the world during the COVID-19 pandemic. Previous research has linked the perpetration of IPV and other forms of sexual violence to aspects of romantic attachment psychology, with insecure anxious/preoccupied attachment most often linked to higher rates of IPV. Stressful events typically activate the attachment system and may either aggravate or disrupt its regulatory functioning. In the present study, we investigated whether COVID-related PTSD and depressive symptoms were associated with increased IPV perpetration and whether this relationship was moderated by levels of attachment security. Our findings indicated that higher COVID-related PTSD was significantly associated with increased IPV perpetration in securely attached individuals, whereas depressive symptoms was significantly associated with decreased IPV perpetration in securely attached individuals. IPV perpetration by insecure individuals was consistently high regardless of COVID-related PTSD or depressive symptoms. These findings suggest that COVID-related PTSD may erode adaptive attachment functioning, particularly among the previously secure, which can have important consequences for secure individuals and their intimate partners. The present findings may explain some of the recent increase in IPV cases worldwide and serve to raise awareness and motivate clinical interventions to more efficiently help both victims and perpetrators of IPV stay safe while staying home.

"I am scared, I do not want to lie": Exploring the impacts of COVID-19 on engagement in care, perceived health, relationship dynamics, and parenting among postpartum women with HIV in South Africa

Background COVID-19 and efforts to manage widespread infection may compromise HIV care engagement. The COVID-19-related factors linked to reduced HIV engagement have not been assessed among postpartum women with HIV, who are at heightened risk of attrition under non-pandemic circumstances. To mitigate the effects of the pandemic on care engagement and to prepare for future public health crises, it is critical to understand how COVID-19 has impacted (1) engagement in care and (2) factors that may act as barriers to care engagement. Methods A quantitative assessment of COVID-19-related experiences was added to a longitudinal cohort study assessing predictors of postpartum attrition from HIV care among women in South Africa. Participants (N = 266) completed the assessment at 6, 12, 18, or 24 months postpartum between June and November of 2020. Those who endorsed one or more challenge related to engagement in care (making or keeping HIV care appointments, procuring HIV medications, procuring contraception, and/or accessing immunization services for infants; n = 55) were invited to complete a brief qualitative interview, which explored the specific factors driving these challenges, as well as other impacts of COVID-19 on care engagement. Within this subset, 53 participants completed an interview; qualitative data were analyzed via rapid analysis. Results Participants described key challenges that reduced their engagement in HIV care and identified four other domains of COVID-19-related impacts: physical health, mental health, relationship with a partner or with the father of the baby, and motherhood/caring for the new baby. Within these domains, specific themes and subthemes emerged, with some positive impacts of COVID-19 also reported (e.g., increased quality time, improved communication with partner, HIV disclosure). Coping strategies for COVID-19-related challenges (e.g., acceptance, spirituality, distraction) were also discussed. Conclusions About one in five participants reported challenges accessing HIV care, medications, or services, and they faced complex, multilayered barriers to remaining engaged. Physical health, mental health, relationships with partners, and ability to care for their infant were also affected. Given the dynamic nature of the pandemic and general uncertainty about its course, ongoing assessment of pandemic-related challenges among postpartum women is needed to avoid HIV care disruptions and to support wellbeing.

Social mobilization, education, and prevention of the Ebola virus disease: A scoping review

The Ebola Virus Disease (EVD) remains a global public health concern with multiple outbreaks over the last five years. This scoping review aimed to synthesize the current state of knowledge on awareness, education, and community mobilization programs on EVD prevention. A comprehensive search strategy was executed in October 2021 across eight databases (APA PsycInfo, CINAHL, Cochrane CENTRAL, Embase, Global Health, MEDLINE, Scopus, and Web of Science). According to the PRISMA flow diagram, out of the 4815 studies generated by the search, 33 were retained for extraction and were included in this scoping review. Findings revealed that cultural practices that increased the risk of Ebola transmission remain very prevalent, even educational and awareness campaigns. Levels of Ebola-related knowledge by community members varied widely. A large proportion of the Ebola-affected populations were not aware of modes of transmission and half were unaware of signs and symptoms. Interventions with deep community mobilization, collaboration and engagement were effective in changing cultural practices, and reducing rates of infection. Interventions in the health sector helped increase willingness to practice preventive methods and the maintenance of social distancing and patient handwashing. A majority of the population members received their information about EVD from the community and mass media (in most instances, through broadcasting stations). Community interventions with a collaborative approach are effective to prevent EVD. It is needed to build trust between communities and health care, but also to use local resources and cultural factors combined with the use of technologies of information to prevent EVD.

A post-outbreak assessment of exposure proximity and Ebola virus disease-related stigma among community members in Kono District, Sierra Leone: A cross-sectional study

Background

Based on findings from other contexts, informed by intergroup contact theory, that more contact is associated with less stigma, we hypothesized that community members with greater exposure to cases of Ebola virus disease (EVD) were less likely to report EVD-related stigma towards EVD survivors. We assessed personal stigmatizing attitudes towards Ebola survivors, which reflects personal fear and judgement, as well as perceived stigma towards EVD survivors, which reflects an individual's perception of the attitudes of the community towards a stigmatized group.

Methods

From September 2016 to July 2017, we conducted a cross-sectional, community-based study of EVD-related stigma among individuals who did not contract Ebola in four EVD-affected rural communities of Kono District, Sierra Leone. We identified individuals from all quarantined households and obtained a random sample of those who were unexposed. Exposed individuals either lived in a quarantined household or were reported to have been in contact with an EVD case. Our explanatory variable was proximity to an EVD case during the outbreak. Our primary outcome was stigma towards EVD survivors, measured by a 6-item adapted HIV-related stigma index validated in Zambia and South Africa, with 1 item reflecting personal stigmatizing attitudes and 5 items reflecting perceived community stigma. The 6-item EVD stigma index had good internal consistency (Cronbach's alpha=0.82). We used modified Poisson and negative binomial regression models, adjusting for potential confounders, to estimate the association between exposure proximity and EVD stigma.

Results

We interviewed 538 participants aged 12 to 85 years. Most (57%) had been quarantined. Over one-third (39%) reported personal stigmatizing attitudes or perceived community stigma; the most frequently endorsed item was fear and judgment towards EVD survivors. Having contact with someone with EVD was significantly associated with a lower likelihood of perceived community stigma (prevalence ratio [PR], 0.26; 95% CI, 0.13-0.54) and personal stigmatizing attitudes (PR, 0.44; 95% CI, 0.29-0.65). In contrast, being quarantined was significantly associated with a higher likelihood of perceived community stigma (PR, 3.9; 95% CI, 1.5-10.1).

Conclusions

In this cross-sectional study, we found evidence of an inverse relationship between EVD-related stigma and contact with an EVD case. This finding substantiates intergroup contact theory and may form the basis for anti-stigma interventions.

Kopfkino: Phases of quarantine among asymptomatic SARS-COV-2 carriers in Germany

Although a majority of SARS-COV-2 diagnosis are asymptomatic, presymptimatic or minimally symptomatic, little has been described and understood about the illness careers of these individuals. This study explored the lived experience of a SARS-COV-2 diagnosis and subsequent quarantine among individuals in Germany who were diagnosed with SARS-COV-2 during the second wave of the pandemic (late 2020-early 2021), but whose diagnosis was unexpected due to a lack of a known contact, or the asymptomatic nature of their case at the time of diagnosis. In-depth interviews (n ​= ​22) were conducted by phone or video call, audio-recorded, and transcribed verbatim. Routine debriefings guided data collection and facilitated analysis, which followed a framework approach. Regardless of age, gender or socioeconomic status, data consistently demonstrated a diagnosis and quarantine career marked by five emotional phases: overconfidence, shock and denial, coming to grips and asking questions, enduring, and cautious optimism as quarantine ended. These experiences suggest that providing trustworthy, easily accessible information regarding certain key aspects of the post diagnosis and quarantine period could benefit patients in terms of reducing stress, understanding the consequences of a diagnosis and mitigating foreseeable challenges in terms of personal, logistical and emotional issues. Follow-up research with providers and public health bureaus could inform how to best tailor such messaging for clients who experience an unexpected diagnosis.

Stigma and its associated factors among patients with COVID-19 in Dhaka City: evidence from a cross-sectional investigation

BACKGROUND

Coronavirus disease 2019 (COVID-19) has become a significant disease pandemic. Dhaka City alone has contributed about one-third to the total COVID-19 cases in Bangladesh. Globally, patients with infectious diseases, including COVID-19, experience stigma. There was no quantitative estimate of stigma experienced by patients with COVID-19 in the country. Therefore, this study aimed to assess the prevalence of stigma and its associated factors among patients with COVID-19 in Dhaka.

METHODS

A cross-sectional study was conducted among 384 respondents aged 18 years or older who had been hospitalized or had stayed at home and were tested negative 15 days to 6 months before the day of data collection. Data collection was done through in-person and telephone interviews using a semi-structured survey questionnaire. A 15-item COVID-19-related stigma scale questionnaire was used to assess stigma. Binary logistic regression analysis was performed to identify the predictors of stigma.

RESULTS

More than half (53.1%) of the respondents experienced stigma when they were COVID-19 positive. Females were at a 3.24 times higher risk of experiencing stigma than their male counterparts. Respondents from the 60+ age group and 40-59 age group were 63.0% and 48.0% less likely to experience stigma than those from the 18-39 age group. Non-hospitalised patients had 1.67 times higher odds of facing stigma than those hospitalised.

CONCLUSIONS

This study reported a high prevalence of stigma among the patients with COVID-19 in Dhaka City. The current evidence base of stigma experience among patients with COVID-19 offers a solid foundation for creating effective strategies and policies and designing appropriate interventions to counter stigma, which will improve the psychological well-being of patients with COVID-19 in Bangladesh.

Ophthalmic sequelae and psychosocial impact in pediatric ebola survivors

Background

Ebola virus disease (EVD) outbreaks in West Africa (2013-2016) and the Democratic Republic of Congo (2018-2020) have resulted in thousands of EVD survivors who remain at-risk for survivor sequelae. While EVD survivorship has been broadly reported in adult populations, pediatric EVD survivors are under-represented. In this cross-sectional study, we investigated the prevalence of eye disease, health-related quality-of-life, vision-related quality-of-life, and the burden of mental illness among pediatric EVD survivors in Sierra Leone.

Methods

Twenty-three pediatric EVD survivors and 58 EVD close contacts were enrolled. Participants underwent a comprehensive ophthalmic examination and completed the following surveys: Pediatric Quality of Life Inventory Version 4.0, Effect of Youngsters Eyesight on Quality-of-Life, and the Revised Child Anxiety and Depression Scale.

Findings

A higher prevalence of uveitis was observed in EVD survivor eyes (10·8%) cohort compared to close contacts eyes (1·7%, p=0·03). Overall, 47·8% of EVD survivor eyes and 31·9% of close contact eyes presented with an eye disease at the time of our study (p=0·25). Individuals diagnosed with an ocular complication had poorer vision-related quality-of-life (p=0·02).

Interpretation

Both health related quality-of-life and vision-related quality-of-life were poor among EVD survivors and close contacts. The high prevalence of eye disease associated with reduced vision health, suggests that cross-disciplinary approaches are needed to address the unmet needs of EVD survivors.

Funding

National Institutes of Health R01 EY029594, K23 EY030158; National Eye Institute; Research to Prevent Blindness (Emory Eye Center); Marcus Foundation Combating Childhood Illness; Emory Global Health Institute; Stanley M. Truhlsen Family Foundation.

Psychological experience of COVID-19 patients: A systematic review and qualitative meta-synthesis

BACKGROUND

Coronavirus disease 2019 (COVID-19) has not only placed an unprecedented strain on healthcare systems worldwide, but has also caused irreparable physical and psychological damage to those infected. It is essential to understand the disease process and psychological experience of patients with COVID-19, to provide them with efficacious psychological guidance and interventions. This qualitative systematic review sought to explore the experience of COVID-19 patients.

METHODS

The meta-analysis methodology developed by the Joanna Briggs Institute guided this systematic review and qualitative meta-analysis. Seven databases were searched, with no language restrictions. This study was registered with PROSPERO under accession number CRD42021279266.

RESULTS

A total of 3107 potentially eligible articles were identified through database and reference list searches, among which 23 studies (from 10 countries) were ultimately included in our analysis. Five interrelated themes emerged: the complex psychological course of COVID-19 patients; the impact of the disease on the body; the expectation of support and guidance from multiple sources; coping strategies; and post-traumatic growth.

CONCLUSIONS

Psychological distress among patients with COVID-19 was found to be widespread. Healthcare providers should pay attention to the psychological changes in patients, ensure continuity of care and provide professional support from hospital to home, and build patients' confidence so that they can return to their families and society. Long-term follow-up studies may provide deeper insight into the psychological needs of survivors.

Role of positive mental health in reducing fears related to COVID-19 and general anxiety disorder in Khyber Pakhtunkhwa, Pakistan

Background

The outbreak of the novel coronavirus disease (COVID-19) has posed multiple challenges to healthcare systems. Evidence suggests that mental well-being is badly affected due to compliance with preventative measures in containing the COVID-19 pandemic. This study aims to explore the role of positive mental health (subjective sense of wellbeing) to cope with fears related to COVID-19 and general anxiety disorder in the Pashtun community in Pakistan.

Methods

A cross-sectional survey was conducted among 501 respondents from Khyber Pakhtunkhwa participating in an online-based study. We performed correlational analysis, hierarchical linear regression and structural equational modeling (SEM) to analyze the role of mental health in reducing fears and general anxiety disorder.

Results

The results of the SEM show that positive mental health has direct effects in reducing the fear related to COVID-19 (β = − 0.244, p < 0.001) and general anxiety (β = − 0.210, p < 0.001). Fears of COVID-19 has a direct effect on increasing general anxiety (β = 0.480). In addition, positive mental health also has an indirect effect (β = − 0.117, p < 0.001) on general anxiety (R² = 0.32, p < 0.001) through reducing fear of coronavirus.

Conclusion

Based on these findings, there is a need to develop community health policies emphasizing on promotive and preventive mental health strategies for people practicing social/physical distancing.

COVID-19—What Price Do Children Pay? An Analysis of Economic and Social Policy Factors

Numerous studies have addressed the indirect consequences of the COVID-19 pandemic for children such as social isolation or increases in reported child maltreatment. Research on the economic and sociopolitical consequences is scarce as they can only be evaluated with a time lag. To improve our understanding of future, long-term developments in the context of the COVID-19 pandemic, we gathered findings from the still unexploited empirical literature on the aftermath of earlier pandemics, epidemics, and other infectious disease outbreaks. On top of this, we scrutinized research on past economic crises to interpret the link between changes in the economy and the health of children. Many of the side effects of battling the spread of the current pandemic, such as school closures, the stigma of infection, or conflicts about vaccines, are not novel and have already been documented in connection with previous infectious disease outbreaks. Results highlight that changes in the financial situation of families and socio-political challenges affect the situation and daily routine of children and youth in the long term. In consequence, the already pronounced socioeconomic inequalities will likely further increase. On top of this, due to reduced revenues, child protective services are likely to face challenges in the availability of human and financial resources.

Commodity Recommendation Model Integrating User Psychological Data Analysis

E-commerce recommendation plays an irreplaceable role in alleviating product information overload and improving consumers' personalized experience and sales conversion rate. According to the idea of recommendation, e-commerce recommendation can be divided into two types: recommendation based on correlation and recommendation based on causality. The former, such as collaborative filtering and other recommendation methods, is highly dependent on data; the latter, such as product recommendation based on consumer psychology, has great superiority in new product recommendation due to the introduction of such domain knowledge as consumer psychology in the recommendation. In this paper, we select three representative consumer psychologies of "consumer motivation," "consumer attitude," and "consumer interest" to explore the recommendation of products with multiple consumer psychologies. On the one hand, according to the theory of consumption psychology and the need of e-commerce recommendation, some product-store attributes are selected as attribute variables. A comprehensive comparison and analysis of the patterns presented by multiple consumer psychology in product recommendations are conducted, and the patterns of multiple consumer psychology product recommendations are analyzed from two perspectives: recommendation stability and recommendation result patterns, respectively, and the reasons for them are analyzed. It is clear that the recommendation method based on dual consumption psychology and triple consumption psychology can also effectively achieve product recommendation. In this paper, we compare and analyze the difference in recommendation accuracy between single consumption psychology, dual consumption psychology, and triple consumption psychology and find that compared with single consumption psychology, product recommendation based on dual consumption psychology and triple consumption psychology can basically improve the accuracy of product recommendation, and the accuracy of dual consumption psychology is generally higher than that of triple consumption psychology, among which the accuracy of product recommendation based on dual consumption motivation-attitude psychology is the highest.

Severe Anxiety and PTSD Symptoms Among Ebola Virus Disease Survivors and Healthcare Workers in the Context of the COVID-19 Pandemic in Eastern DR Congo

Ebola virus disease (EVD) survivors and healthcare workers (HCWs) face stress, fear, and stigma during the COVID-19 pandemic that can induce severe symptoms of anxiety and post-traumatic stress disorder (PTSD). We examined the prevalence and factors related to severe PTSD and anxiety symptoms, using a representative sample of survivors of the 2018-2020 EVD epidemic in DR Congo in comparison HCWs. Five hundred sixty-three participants (55.25% women, 309 survivors, 202 HCWs, and 52 HCWs and survivors) completed questionnaires assessing anxiety, PTSD, exposure to EVD and COVID-19, stigmatization related to EVD and COVID-19, interpersonal traumas, social support. During the COVID-19 pandemic, 45.6 and 75.0% of survivors and HCWs reported severe symptoms of PTSD and anxiety. Significant difference was observed among the three groups for both PTSD (53.7% survivors, 37.1% HCWs, and 30.8% HCWs-survivors, χ2= 18.67, p < 0.0001) and anxiety (88.3% survivors, 56.9% HCWs, and 65.4% HCWs- survivors, χ2= 67.03, p < 0.0001). Comorbidity of severe PTSD and anxiety symptoms was 42.3% between the three groups. Results revealed that exposure to EVD (b = 0.53; p = 0.001; b = 0.12; p = 0.042), EVD-related stigmatization (b = 0.14; p = 0.018; b = 0.07; p = 0.006), COVID-19-related stigmatization (b = 0.22; p < 0.0001; b = 0.08; p = 0.0001) and social support (b = -0.30; p < 0.0001; b = -0.14; p < 0.0001) predicted severe PTSD and anxiety symptoms. The last models explained 63.8 and 56.4% of the variance of PTSD and anxiety. Symptoms of PTSD and anxiety are common among EVD survivors and HCWs during the COVID-19 pandemic. Culturally-sensitive programs that address stigma are necessary to mitigate the cumulative effects of EVD and the COVID-19 pandemic on EVD survivors and HCWs.

Stressors and Information-Seeking by Dialysis and Transplant Patients During COVID-19 Reported on a Telephone Hotline: A Mixed Methods Study

Rationale & Objective

In early 2020, we activated a telephone hotline, the coronavirus disease 2019 (COVID-19) Kidney or Transplant Listening and Resource Center, to learn more about the impact of the COVID-19 pandemic on the stress and information-seeking behaviors of dialysis and transplant patients.

Study Design

A mixed-methods study including semi-structured, qualitative interviews probing about emotional, health, and financial challenges experienced and quantitative surveys assessing depression and anxiety levels and information-seeking behaviors.

Setting & Participants

99 participants (28 dialysis patients; 71 transplant patients), varying by race and ethnicity (Hispanic, 25.3%; White, 23.2%; Asian, 24.2%; Black, 24.2%), shared their COVID-19 pandemic experiences and information-seeking behaviors by telephone. Interviews and surveys were conducted from June 17, 2020, to November 24, 2020.

Analytical Approach

Qualitative themes were identified using thematic analysis. Frequencies were calculated to assess levels of depression and anxiety using the Patient Health Questionnaire for Depression and Anxiety and types of information-seeking behaviors.

Results

7 themes and 16 subthemes emerged. Themes of commonly reported stressors include postponing medical visits; decreased accessibility of getting medication; difficulty in receiving up-to-date, patient-focused health information and dialysis supplies; and delays in medical appointments. Other stressors include losses of health insurance and income, and increased vigilance in behaviors to avoid contracting COVID-19. 15 participants had moderate to severe anxiety and depression symptoms and reported more frequent and severe panic attacks after the COVID-19 pandemic. Participants sought emotional support from family, friends, and faith communities. They also commonly obtained information from news media and reported needing more transplant-specific updates about COVID-19, and frequent communication from their kidney and transplant specialists.

Limitations

This convenience sample of individuals willing to share their experiences through a telephone hotline may not generalize to all dialysis and transplant patients; stressors related to the COVID-19 pandemic for these patients continue to change.

Conclusions

As the impact of the pandemic continues, needs-based interventions tailored for the kidney and transplant community, including access to mental health resources, education, and support for care transitions, should continue.

Post-viral mental health sequelae in infected persons associated with COVID-19 and previous epidemics and pandemics: Systematic review and meta-analysis of prevalence estimates

AIMS

Post-viral mental health problems (MHP) in COVID-19 patients and survivors were anticipated already during early stages of this pandemic. We aimed to synthesize the prevalence of the anxiety, depression, post-traumatic and general distress domain associated with virus epidemics since 2002.

METHODS

In this systematic review and meta-analysis, we searched PubMed, PsycINFO, and Embase from 2002 to April 14, 2021 for peer-reviewed studies reporting prevalence of MHP in adults with laboratory-confirmed or suspected SARS-CoV-1, H1N1, MERS-CoV, H7N9, Ebolavirus, or SARS-CoV-2 infection. We included studies that assessed post-viral MHP with validated and frequently used scales. A three-level random-effects meta-analysis for dependent effect sizes was conducted to account for multiple outcome reporting. We pooled MHP across all domains and separately by severity (above mild or moderate-to-severe) and by acute (one month), ongoing (one to three months), and post-illness stages (longer than three months). A meta-regression was conducted to test for moderating effects, particularly for exploring estimate differences between SARS-Cov-2 and previous pandemics and epidemics. PROSPERO registration: CRD42020194535.

RESULTS

We identified 59 studies including between 14 and 1002 participants and providing 187 prevalence estimates. MHP, in general, decreased from acute to post-illness from 46.3% to 38.8% and for mild and moderate-to-severe from 22.3% to 18.8%, respectively. We found no evidence of moderating effects except for non-random sampling and H1N1 showing higher prevalence. There was a non-significant trend towards lower MHP for SARS-CoV-2 compared to previous epidemics.

CONCLUSIONS

MHP prevalence estimates decreased over time but were still on a substantial level at post-illness. Post-viral mental health problems caused by SARS-CoV-2 could have been expected much earlier, given the previous post-viral sequelae.

Misconceptions and Rumors about Ebola Virus Disease in Sub-Saharan Africa: A Systematic Review

We sought to summarize knowledge, misconceptions, beliefs, and practices about Ebola that might impede the control of Ebola outbreaks in Africa. We searched Medline, EMBASE, CINAHL, and Google Scholar (through May 2019) for publications reporting on knowledge, attitudes, and practices (KAP) related to Ebola in Africa. In total, 14 of 433 articles were included. Knowledge was evaluated in all 14 articles, and they all highlighted that there are misconceptions and risk behaviors during an Ebola outbreak. Some communities believed that Ebola spreads through the air, mosquito bites, malice from foreign doctors, witchcraft, and houseflies. Because patients believe that Ebola was caused by witchcraft, they sought help from traditional healers. Some people believed that Ebola could be prevented by bathing with salt or hot water. Burial practices where people touch Ebola-infected corpses were common, especially among Muslims. Discriminatory attitudes towards Ebola survivors or their families were also prevalent. Some Ebola survivors were not accepted back in their communities; the possibility of being ostracized from their neighborhoods was high and Ebola survivors had to lead a difficult social life. Most communities affected by Ebola need more comprehensive knowledge on Ebola. Efforts are needed to address misconceptions and risk behaviors surrounding Ebola for future outbreak preparedness in Africa.

Stress Experience of COVID-19 Patients as Reported by Psychological Supporters in South Korea: A Qualitative Study

Background

COVID-19 patients experience various stressors during the quarantine period and after release from quarantine. However, stressors experienced during each period remain unclear.

Methods

A total of 15 mental health experts from the integrated psychological support group for COVID-19participated in this study. Psychological support was provided for the total 932 confirmed COVID-19 patients and their families. Qualitative data were collected using Focus Group Interview (FGI). The participants were divided into two groups and semi-structured questions were used to allow participants to speak their minds.

Results

During the quarantine period, difficulties of being diagnosed with COVID-19, concerns about recovery from COVID-19, stress related to quarantine, issues related to the treatment environment, and limited information about COVID-19 and communication were frequently reported. After release from quarantine, the reported main stressors include reinfection or reactivation, concerns about complications, and financial difficulties. Confusion as vectors and victims, stigma and discrimination, and conflicts within a family were observed during both periods.

Conclusions

COVID-19 patients suffered various stressors during the quarantine period and after release from quarantine. Moreover, returning to their daily life required timely psychosocial support, intervention, and treatment for COVID-19 infection.

Health and coping strategies of nursing home residents and their relatives during the COVID-19 pandemic: a mixed-methods study protocol

INTRODUCTION

The COVID-19 pandemic hit older adults particularly hard, especially those living in nursing homes. The present study's primary aim is to quantify the states of physical and mental health of nursing home residents and their relatives following the implementation of the exceptional confinement measures. The secondary aim is to explore the lived experiences of the stressors perceived by older adults and their relatives, as well as the support strategies implemented by health professionals and their results.

METHODS AND ANALYSIS

We chose a mixed-methods (quantitative/qualitative) study to best deliver a profound understanding of this phenomenon.Quantitative phase: participants are asked to complete several questionnaires. The study population includes all the nursing home residents in four French-speaking cantons of Switzerland (and their relatives) who are living through the COVID-19 pandemic. Descriptive statistics will be calculated for the scores of the General Health Questionnaire-12, Impact of Event Scale-6, Perceived Stress Scale, Brief Cope, Post-traumatic Growth Inventory, World Health Organization Quality of Life-BREF (WHOQOL-BREF) and WHOQOL-OLD scales. Correlational analyses will be considered.Qualitative phase: data are collected from several sources (individual semi-structured interviews, focus groups, field notes). Interviews are planned with about 12 representatives of each group of participants (residents and relatives). Two focus groups made up of healthcare professionals will be constituted to explore the lived experiences of the stressors perceived by residents and relatives, the coping strategies those two groups implemented to deal with them. The interviews and focus groups will be subjected to a thematic contents analysis.Integrating the quantitative and qualitative data will take place jointly with data interpretation.

ETHICS AND DISSEMINATION

This project was approved by the Human Research Ethics Committee of the Canton of Vaud on 14 December 2020 (project ID: 2020-02397). The prior written informed consent of the study subjects is collected by a member of the research team before data collection. Study results will be disseminated via professional and peer-reviewed publications.

TRIAL REGISTRATION NUMBER

ISRCTN12345167.

Lived Experiences of COVID-19 Patients With Pulmonary Involvement: A Hermeneutic Phenomenology

The aim of this study was to explore the lived experience of COVID-19 patients with pulmonary involvement. The hermeneutic phenomenology was chosen, as this approach can extract the participant experiences as COVID-19 patients. A total of 10 COVID-19 patients with the pulmonary disease were selected as participants after being discharged from the hospital by purposive sampling method until reaching saturation. Data were collected using semi-structured interviews and by using Greatrex-White and van Manen's methods were analyzed. As a result of data analysis, five main themes were emerged: Symptoms of inducing fear, Annoying loneliness, death anxiety, Spirituality healing factor, and Valuable life again. Based on the results of the interviews, the participants' experiences showed that patients infected with COVID-19, after being discharged from the hospital, due to mental and physical problems experienced during hospitalization, need comprehensive attention and care to regain their health during convalescence.

Cross-sectional study of mental health and sexual behaviours for Ebola Survivors in Beni, Butembo and Katwa health zones of the Democratic Republic of Congo

OBJECTIVES

To understand the prevalence of mental health disorders in Ebola-affected communities and their association with condom use.

DESIGN

Cross-sectional study.

SETTING

Beni, Butembo and Katwa health zones, Democratic Republic of Congo (DRC).

PARTICIPANTS

223 adult Ebola survivors, 102 sexual partners and 74 comparison respondents.

PRIMARY AND SECONDARY OUTCOME MEASURES

Post-traumatic stress disorder (PTSD), depression, anxiety, substance use, suicidal ideation and attempts, stigma, condom use and sexual behaviour.

RESULTS

Most respondents reported to be married, Christian, from the Nande ethnic group, and farmers/herders. Survivors met symptom criteria for depression at higher rates than partners (23.5% (95% CI 18.0 to 29.1) vs 5.7 (1.2 to 10.1); p<0.001). PTSD symptom criteria for survivors (24.1%, 95% CI 18.5% to 29.7%) and partners (16.7%, 95% CI 9.4% to 23.9%) were four times greater than the comparison participants (6.0%, 95% CI 0.6% to 11.4%). Two times as many survivors as partners reported that sexual activity precautions were discussed at discharge (71.5% (95% CI 65.6 to 77.5) vs 36.2% (95% CI 26.9 to 45.5); p<0.001). The majority of survivors (95.0 (95% CI 85.1% to 98.5%) and partners 98.5% (95% CI 89.6% to 99.8%; p=0.26) participated in risky sexual behaviour after the survivor left the Ebola treatment centre. The ability to refuse sex or insist on condom use before Ebola had a threefold increase in the odds of condom use (adjusted OR 3.3, 95% CI 1.7 to 6.1, p<0.001). Up to 36% of the comparison group held discriminatory views of survivors.

CONCLUSIONS

The new outbreaks in both Guinea and DRC show Ebola remains in semen longer than previously known. Understanding and addressing condom non-use and updating condom use guidelines are necessary to protect against future Ebola outbreaks, especially among sexual partners who did not have similar access to health information regarding sexual transmission of Ebola. Mental health treatment and decreasing stigma in Ebola areas is a priority.

COVID-19 behavioral health and quality of life

In addition to concern about physical health consequences of COVID-19, many researchers also note the concerning impact on behavioral health and quality of life due to disruption. The purpose of this paper is to explore pathways of COVID-19 behavioral health and quality of life. We found increased anxiety, depression, and alcohol misuse and that the pandemic exacerbated prior problems. Further community indicators also lead to poorer behavioral health and overall decreased quality of life. The nature of COVID-19 and vast reach of the virus suggests that behavioral health concerns should take a primary role in pandemic recovery.

Health-related quality of life among Ebola survivors in Sierra Leone: the role of socio-demographic, health-related and psycho-social factors

Background

Evidence of how social factors affect the health-related quality of life (HRQoL) of Ebola virus disease (EVD) survivors is limited. Our study explores the association between socio-demographic, health-related and psycho-social (stigma) factors and EVD survivors' health-related quality of life (HRQoL) in Sierra Leone.

Methods

We conducted a nationwide cross-sectional study among 358 EVD survivors between January and August 2018. We used a multistage sampling method to recruit EVD survivors, and the RAND 36-Item Health Survey item was used to assess the HRQoL. Data were analysed using descriptive statistics and multiple linear regression.

Results

When comparing by each dimension in relation to their respective summary scores, role limitation physical [0.00 (50.00)] and role limitation emotional [0.00 (33.33)] were the most affected physical health and mental health domains among EVD survivors respectively. EVD survivors who were older (β = − 3.90, 95% CI − 6.47 to − 1.32, p = 0.003), had no formal education (β = − 2.80, 95% CI − 5.16 to − 0.43, p = 0.021), experienced a unit increase in the number of post-Ebola symptoms (β = − 1.08, 95% CI − 1.74 to − 0.43, p < 0.001) and experienced a unit increase in enacted stigma (β = − 2.61, 95% CI − 4.02 to − 1.20, p < 0.001) were more likely to report a decreased level of physical health. EVD survivors who experienced a unit increase in the time spent in the Ebola treatment centre (β = − 0.60, 95% CI − 0.103 to − 0.18, p = 0.006) and those who experienced a unit increase in enacted Stigma were more likely to report decreased levels of mental health (β = − 1.50, 95% CI − 2.67 to − 0.33, p = 0.012).

Conclusion

Sociodemographic, health-related, and psycho-social factors were significantly associated with decrease levels of HRQoL. Our findings improve our understanding of the factors that might influence the HRQoL and suggest the need for EVD survivors to be provided with a comprehensive healthcare package that caters for their physical and mental health needs.

Prevalence and risk factors of depression symptoms among rural and urban populations affected by Ebola virus disease in the Democratic Republic of the Congo: a representative cross-sectional study

OBJECTIVES

High mortality rates, anxiety and distress associated with Ebola virus disease (EVD) are risk factors for mood disorders in affected communities. This study aims to document the prevalence and risk factors associated with depressive symptoms among a representative sample of individuals affected by EVD.

DESIGN

Cross-sectional study.

SETTING

The current study was conducted 7 months (March 11, 2019 to April 23, 2019) after the end of the ninth outbreak of EVD in the province of Equateur in the Democratic Republic of the Congo (DRC).

PARTICIPANTS

A large population-based sample of 1614 adults (50% women, Mage=34.05; SD=12.55) in health zones affected by the ninth outbreak in DRC.

PRIMARY AND SECONDARY OUTCOME MEASURES

Participants completed questionnaires assessing EVD exposure level, stigmatisation related to EVD and depressive symptoms. The ORs associated with sociodemographic data, EVD exposure level and stigmatisation were analysed through logistic regressions.

RESULTS

Overall, 62.03% (95% CI 59.66% to 64.40%) of individuals living in areas affected by EVD were categorised as having severe depressive symptoms. The multivariable logistic regression analyses showed that adults in the two higher score categories of exposure to EVD were at two times higher risk of developing severe depressive symptoms (respectively, OR 1.94 (95% CI 1.22 to 3.09); OR 2.34 (95% CI 1.26 to 4.34)). Individuals in the two higher categories of stigmatisation were two to four times more at risk (respectively, OR 2.42 (95% CI 1.53 to 3.83); OR 4.73 (95% CI 2.34 to 9.56)). Living in rural areas (OR 0.19 (95% CI 0.09 to 0.38)) and being unemployed (OR 0.68 (95% CI 0.50 to 0.93)) increased the likelihood of having severe depressive symptoms.

CONCLUSIONS

Results indicate that depressive symptoms in EVD affected populations is a major public health problem that must be addressed through culturally adapted mental health programs.

MAPPING MENTAL HEALTH INTERVENTIONS DURING THE COVID-19 PANDEMIC. A COMPARISON REVIEW OF CHINA AND WESTERN EUROPE

OBJECTIVE

The aim: To map and compare mental health interventions during the Covid-19 pandemic in China and Western-Europe. The focus was specifically on the availability, duration, target group, content, setting, and outcomes of the interventions.

PATIENTS AND METHODS

Materials and methods: A scoping review was conducted by utilising several scientific databases. A total of 479 articles were found after removing the duplicate records. After screening, 36 articles were included in the study. Relevant intervention characteristics were systematically mapped, and compared within and among countries.

CONCLUSION

Conclusions: All interventions had shared aims to improve the psychological resilience and to reduce psychological distress. In particular, anxiety- and depression-related symptoms were commonly addressed. On average, interventions in China were larger scaled, had longer durations, and often used combinations of strategies such as therapies and exercises both in-person and remotely. Interventions in Western-Europe tend to be locally implemented on a smaller scale, and often used a single strategy. Most Chinese interventions targeted adolescents, while all interventions in Western-Europe were meant for adults. Most interventions were assessed using quantitative methods using various mental health scales, showing statistically significant effects in improving mental health.

Socio-economic and psychological impact of COVID-19 pandemic in a Spanish cohort BIOVAL-D-COVID-19 study protocol

OBJECTIVE

SARS-CoV-2 outbreak has a negative psychological impact among general population. Data comparing mental health status before and during the outbreak is needed. The BIOVAL-D-COVID-19 study assess the socio-economic and psychological impact of the COVID-19 pandemic and lockdown in a representative sample of non-institutionalized Spanish adult population, and estimate the incidence of mental health disorders, including suicidal behaviours, and possible related factors.

METHOD

Observational longitudinal study including two online surveys: baseline survey (T0) performed during 2019 and follow-up survey (T1) conducted 12-month later. The latter included nine sections: socio-demographic, health status, mental health, employment conditions and status, material deprivation, use of healthcare services, intimate partner violence and resilience. Four of the nine sections are administered in T0 and T1 assessments. Longitudinal data analyses will estimate adjusted incidence rates of mental health disorders using Poisson regression models. Risk and protective factors will be analysed through multiple logistic regression models.

Understanding Long-term Evolution and Predictors of Sequelae of Ebola Virus Disease Survivors in Guinea: A 48-Month Prospective, Longitudinal Cohort Study (PostEboGui)

Background

Longitudinal analyses are needed to better understand long-term Ebola virus disease (EVD) sequelae. We aimed to estimate the prevalence, incidence, and duration of sequelae and to identify risk factors associated with symptom occurrence among EVD survivors in Guinea.

Methods

We followed 802 EVD survivors over 48 months and recorded clinical symptoms with their start/end dates. Prevalence, incidence, and duration of sequelae were calculated. Risk factors associated with symptom occurrence were assessed using an extended Cox model for recurrent events.

Results

Overall, the prevalence and incidence of all symptoms decreased significantly over time, but sequelae remained present 48 months after Ebola treatment center discharge with a prevalence of 30.68% (95% confidence interval [CI] 21.40–39.96) for abdominal, 30.55% (95% CI 20.68–40.41) for neurologic, 5.80% (95% CI 1.96–9.65) for musculoskeletal, and 4.24% (95% CI 2.26–6.23) for ocular sequelae. Half of all patients (50.70%; 95% CI 47.26–54.14) complained of general symptoms 2 years’ postdischarge and 25.35% (95% CI 23.63–27.07) 4 years’ post-discharge. Hemorrhage (hazard ratio [HR], 2.70; P = .007), neurologic (HR 2.63; P = .021), and general symptoms (HR 0.34; P = .003) in the EVD acute phase were significantly associated with the further occurrence of ocular sequelae, whereas hemorrhage (HR 1.91; P = .046) and abdominal (HR 2.21; P = .033) symptoms were significantly associated with musculoskeletal sequelae.

Conclusions

Our findings provide new insight into the long-term clinical complications of EVD and their significant association with symptoms in the acute phase, thus reinforcing the importance of regular, long-term follow-up for EVD survivors.

Fear, distress, and perceived risk shape stigma toward Ebola survivors: a prospective longitudinal study

Background

During the 2014–15 Ebola Virus Disease (EVD) epidemic, thousands of people in Sierra Leone were infected with the devastating virus and survived. Years after the epidemic was declared over, stigma toward EVD survivors and others affected by the virus is still a major concern, but little is known about the factors that influence stigma toward survivors. This study examines how key personal and ecological factors predicted EVD-related stigma at the height of the 2014–2015 epidemic in Sierra Leone, and the personal and ecological factors that shaped changes in stigma over time.

Methods

Using three waves of survey data from a representative sample in the Western Urban and Western Rural districts of Sierra Leone, this study examines factors associated with self-reported personal stigma toward Ebola survivors (11 items, α = 0.77) among 1008 adults (74.6% retention rate) from 63 census enumeration areas of the Western Rural and Western Urban districts of Sierra Leone. Participants were randomly sampled at the height of the EVD epidemic and followed up as the epidemic was waning and once the epidemic had been declared over by the WHO. Three-level mixed effects models were fit using Stata 16 SE to examine cross-sectional associations as well as predictors of longitudinal changes in stigma toward EVD survivors.

Results

At the height of the EVD epidemic, female sex, household wealth, post-traumatic stress, EVD-related fear and perceived infection risk are a few of the factors which predicted higher levels of stigma toward survivors. On average, stigma toward EVD survivors decreased significantly as the epidemic declined in Sierra Leone, but female sex, EVD fear, and risk perceptions predicted a slower rate of change.

Conclusion

This study identified key individual and psychosocial characteristics which may predict higher levels of stigma toward infectious disease survivors. Future studies should pursue a better understanding of how personal characteristics and perceptions, including psychosocial distress, fear, and perceived infection risk serve as pathways for stigma in communities affected by infectious disease.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12146-0.

Post-Ebola sequelae among Ebola child survivors in Sierra Leone

Background

There are limited data regarding the long-term health effects of child survivors of the 2013-2016 West African Ebola virus disease (EVD) outbreak. Here, we assess post-Ebola sequelae among EVD child survivors by comparing the self-reported symptoms between EVD child survivors and their close household contacts over one year after the end of the outbreak.

Methods

EVD child survivors(n=159) and their close contacts(n=303) were enrolled in Western and Eastern Sierra Leone. Demographics and self-reported symptoms data were collected using an interviewer-administered questionnaire. We compared a list of self-reported symptoms between EVD child survivors and their close household contacts using backward stepwise logistic regression.

Results

EVD child survivors were more likely to be orphans compared to their close contacts. Musculoskeletal, ocular, auditory and neurological symptoms were more prevalent among Ebola child survivors than their close contacts (p<0.001). Joint pain and headache were the most common self-reported symptoms in EVD child survivors and their close contacts. Joint pain (AOR=2.633; 95 % CI:1.31-5.28, p=0.006), eye pain (AOR=4.56;95 %CI: 2.16-9.64, p<0.001), hearing loss (AOR=3.85; 95 %CI: 1.15-12.87, p=0.029), memory impairment (AOR=7.76;0.95 %CI: 1.34-45.01 p=0.022), mood changes (AOR=5.07; 95 %CI: 2.35-10.94, p<0.001) were more common among survivors than their contacts.

Conclusions

Our data suggest that EVD child survivors have higher odds than their close contacts of suffering from musculoskeletal, ophthalmic, auditory and neurological impairment more than a year after the end of the EVD outbreak. Routine screening, treatment and monitoring of these symptoms is required to prevent long-term disability among EVD child survivors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02957-w.

Self-Care practices for anxiety during the COVID-19 pandemic in the UK in adults

Introduction. The National Health Service cannot chronically sustain the overwhelming demands being placed on it due to financial cuts, staff numbers and presence of Covid-19. As a result, anxiety levels are on the rise thus increasing the need for effective self-care behaviors.Purpose: The purpose of this study was to comprehend and acknowledge the profound influence Covid-19 has had on anxiety levels and explore what behaviors people engage in to manage their perceived stress levels themselves.Methodology: This study was an exploratory mixed-methods design consisting of 110 self-referred adults aged 18-65 with anxiety completed an online survey guided by the “Harvard Anxiety and Depression Scale”. Data collected from the free-text questions were analyzed using the thematic analyses method to evoke the most relevant themes and generate an evidence-based narrative.Results and Discussion: Self-care behaviors used for anxiety self-management pre and during lockdown were walks, virtual family/social peer support, cooking and aerobic exercise. Additionally, it was apparent that a lack of ongoing family/social support was a key predictor for the proclivity of anxiety-inducing thoughts to be experienced. Interestingly, individuals who continually engaged in activity experienced positive mood states irrespective of the current lockdown environment.Conclusion: This study adds to novel literature on the current anxiety levels of adults living in the UK under the Covid-19 pandemic and what self-care behaviors people implement to self-manage their anxiety levels. This study stresses the significance of ongoing peer support as a self-care behavior that can act as a positive meditator for healthy cognitive processes to ensue. Therefore, future self-care programs advocating this strategy may, if not prevent, slow down the rising cases of anxiety and ill mental health due to the uncertain environment of Covid-19

Social distancing and anxiety among female caregivers of children ages zero-to-five during coronavirus disease (COVID-19) lockdown in the United States

Background

Past studies have linked measures of social isolation to mental health among caregivers of children. As people across the world adjust to social distancing measures, there is a need to understand consequences of social distancing measures on mental health. Thus, the objective of this study is to examine the association between adherence to social distancing measures and feeling worried/anxious among female caregivers of children ages zero-to-five.

Methods

Data for this study came from an online survey that was administered between May and June 2020 to understand stress and mental health among caregivers of children during the COVID-19 pandemic. A sample of 358 female caregivers was analyzed using binary logistic regression with feeling worried/anxious as the outcome variable.

Results

More than a third of the female caregivers (35.2%) reported feeling worried/anxious during the past month and about 42% reported strictly adhering to social distancing measures. Controlling for the effect of other factors, caregivers who reported strictly adhering to social distancing had 1.86 times higher odds of feeling worried/anxious when compared caregivers who were not strictly adhering to social distancing (AOR=1.86, 95% C.I.=1.07–3.24). Caregivers who felt bothered by withdrawal from activities of interest had 4.11 times higher odds of reporting feeling worried/anxious (AOR=4.11, 95% C.I.=2.32–7.24).

Conclusions

As COVID-19 pandemic continues to evolve, it is important to build community response to better support caregivers of infants and young children. Implications for practice, policy, and research as they relate to caregiver's mental health are discussed.

Perception of Iraqi youth towards social and psychological impact of COVID-19

Background

COVID-19 pandemic is recently considered as the most public health challenge with global dramatic changes on different aspects of life and health, including the psychological burden on individuals and communities. A convenience sample of youth (university students) aged 18–24 years was chosen in this cross-sectional study that was conducted during the period from October through December 2020. The questionnaire included questions about COVID-19 and its effect on mental and social wellbeing.

Results

Out of the total 762 young adults who responded, 62% were females, with a mean age of 20.75+2.33; 40.4% of them reported severely impaired social leisure activities; 14.7% expressed severely impaired private leisure activities; and 15.5% had severely impaired ability to form and maintain close relationships. Continuous feeling of nervousness, anxiety, stress, or exaggerated worries about the coronavirus was reported by 18%, while 24.9% felt sad or depressed all the time, and 26.4% of the female respondents had depressive symptoms versus 22.5% males.

Conclusion

The findings of this study indicate that the COVID-19 pandemic had created severe limitations on people’s social activities that may be associated with negative changes in mental condition.

Determining the Religious Coping Styles of Adolescents in Turkey During COVID-19

We sought to evaluate the religious coping styles of adolescents during the coronavirus disease 2019 (COVID-19) pandemic and its restrictions. The study was conducted online during the 2020 academic year among students in three randomly selected high schools in a city center located in Eastern Turkey. The students studying in the chosen high schools who agreed to participate were included in the study (n = 514). We found that most adolescents were anxious, had been affected in terms of health and life satisfaction, and felt sad due to isolation. Almost all subjects attached importance to their religious beliefs. The adolescents' mean Religious Coping Scale score was 2.23 ± 0.50, their mean Positive Religious Coping subscale score was 2.91 ± 0.73, and their mean Negative Religious Coping subscale score was 1.54 ± 0.52. Specifically, male adolescents of ages 15-17 whose incomes were less than their expenditures and who lived in a broken family had the highest level of negative religious coping. In light of these findings, adolescents can be supported by teaching them to develop positive religious coping styles during the COVID-19 pandemic.

Ebola virus disease, stigmatization, peritraumatic distress, and posttraumatic stress disorder in the Democratic Republic of the Congo: A moderated mediation model

BACKGROUND

Mechanisms worsening the development of Posttraumatic stress disorder (PTSD) symptoms among individuals affected by high-mortality epidemics are unclear. This study examined the prevalence of PTSD and related risk factors among populations affected by the Ebola virus disease (EVD) outbreak, and investigated whether peritraumatic distress mediates the impact of exposure level to EVD on PTSD symptoms, and the moderation role of stigmatization.

METHODS

The sample included 1614 participants (50% women) affected by EVD in Democratic Republic of the Congo (DRC). Participants completed the PTSD Check-List for DSM-5, Peritraumatic Distress Inventory, and measures evaluating levels of exposure and stigmatization related to EVD. Descriptive analyses and a moderated mediation model were computed.

RESULTS

A total of 58.81% participants (95% CI: 56.41%; 61.21%) met PTSD diagnostic criteria. Participants living in rural areas presented greater risk, while there is no significant difference between men and women. Peritraumatic distress mediated partially the association between exposure to EVD and PTSD symptoms. Moreover, this relationship was moderated by stigmatization related to EVD.

LIMITATIONS

As the design was cross-sectional, this study could not examine the causality of PTSD symptoms among communities affected by EVD.

CONCLUSIONS

This study shows high prevalence rates and important risk factors associated with PTSD in populations affected by EVD. It indicates elements that could help to develop and implement prevention and intervention programs in affected communities.

Psychological reactions of COVID-19 patients to the stress caused by the disease crisis: A descriptive phenomenological study

PURPOSE

This study was conducted to explain the psychological reactions of COVID-19 patients to the stress caused by the disease crisis from the perspective of the survivors.

DESIGN AND METHODS

A phenomenological approach was adopted to the qualitative study of 14 COVID-19 survivors selected through purposive sampling.

FINDINGS

Two themes extracted as the psychological reactions of the patients to the COVID-19-induced stress included "self-moderating effect of stress" and "psychological maladaptation."

PRACTICE IMPLICATIONS

The present findings appear effective in laying the foundations for performing interventions to improve constructive psychological reactions such as using self-moderating mechanisms of the COVID-19-induced stress and reducing or eliminating maladaptive psychological reactions such as depression, anger, self-blaming, and regret.

Trauma care during the COVID-19 pandemic in the Netherlands: a level 1 trauma multicenter cohort study

PURPOSE

The coronavirus (COVID-19) pandemic has caused major healthcare challenges worldwide resulting in an exponential increase in the need for hospital- and intensive care support for COVID-19 patients. As a result, surgical care was restricted to urgent cases of surgery. However, the care for trauma patients is not suitable for reduction or delayed treatment. The influence of the pandemic on the burden of disease of trauma care remains to be elucidated.

METHODS

All patients with traumatic injuries that were presented to the emergency departments (ED) of the Amsterdam University Medical Center, Location Academic Medical Center (AMC) and VU medical center (VUMC) and the Northwest Clinics (NWC) between March 10, 2019 and May 10, 2019 (non-COVID) and March 10, 2020 and May 10, 2020 (COVID-19 period) were included. The primary outcome was the difference in ED admissions for trauma patients between the non-COVID and COVID-19 study period. Additionally, patient- and injury characteristics, health care consumption, and 30-day mortality were evaluated.

RESULTS

A 37% reduction of ED admissions for trauma patients was seen during the COVID-19 pandemic (non-COVID n = 2423 and COVID cohort n = 1531). Hospital admission was reduced by 1.6 trauma patients per day. Fewer patients sustained car- and sports-related injuries. Injuries after high energetic trauma were more severe in the COVID-19 period (Injury Severity Score 17.3 vs. 12.0, p = 0.006). Relatively more patients were treated operatively (21.4% vs. 16.6%, p < 0.001) during the COVID-19 period. Upper-(17.6 vs. 12.5%, p = 0.002) and lower extremity injuries (30.7 vs. 23.0%, p = 0.002) mainly accounted for this difference. The 30-day mortality rate was higher during the pandemic (1.0 vs. 2.3%, p = 0.001).

CONCLUSION

The burden of disease and healthcare consumption of trauma patients remained high during the COVID-19 pandemic. Results of this study can be used to optimize the use of hospital capacity and anticipate health care planning in future outbreaks.

Food insecurity and mental health of women during COVID-19: Evidence from a developing country

BACKGROUND

This study examines the association between food insecurity and mental health of women during the COVID-19 pandemic in a resource poor setting.

MATERIALS AND METHODS

Data were collected at two time-points (wave 1 and 2) from 2402 women, one per household, participating in a larger study during extended COVID-19 lockdown in the rural areas of the southwest region of Bangladesh. The primary outcome of the analyses is the association between food insecurity, measured using the Food Insecurity Experience Scale (FIES), and stress level, measured using the Perceived Stress Scale (PSS), for women during the lockdown. General awareness about COVID-19 and attitude towards prescribed preventive measures were also measured since COVID-19 health concerns could exacerbate food insecurity.

RESULTS

An individual-level evaluation of the effect of wave 2 FIES score on PSS score showed that worsening of the food security status increasing the stress level of the participants (95% CI: 1.61; 2.13; p-value: <0.001). Additionally, a significant negative association was observed between the PSS score and change in food security status between the two waves (Coefficient: -1.15, 95% CI: -1.30; -0.99, p-value: <0.001), indicating that deterioration in food security status over the pandemic period increasing the stress level. At the village level, the results showed a similar pattern. General awareness around ways coronavirus spreads was high, yet there were misperceptions at a higher level. Maintaining hand hygiene, wearing face masks outside the home, and going outside only when necessary were widely practised. Fewer respondents could maintain a 1.5-metre distance from others in the outside and maintained cough and sneeze etiquette.

CONCLUSION

The results indicate a higher stress level, a potential contributor to poor mental health, as food insecurity deteriorated. Policy initiatives in ameliorating immediate food insecurity during crises, improving long-term wellbeing, and expanding the reach of mental health support are warranted.

Are COVID-19 health-related and socioeconomic stressors associated with increases in cannabis use in individuals who use cannabis for recreational purposes?

Background: The COVID-19 pandemic and associated public health measures implemented to mitigate transmission may increase stress, which, in turn, can be associated with changes in cannabis use. This study examined the associations between health-related and socioeconomic stressors associated with the COVID-19 pandemic, and reported increases in cannabis use. Indirect effects of health-related and socioeconomic stressors on increased cannabis use through cannabis coping motives were also tested. Methods: Cross-sectional survey data, based on responses from a convenience sample of 755 Israeli adults who reported frequent consumption of cannabis for recreational purposes, was analyzed using structural equation models. Results: About 35% of the respondents reported that they agreed to a large/very large extent that their cannabis use had increased since the COVID-19 pandemic had started. Both health and socioeconomic stressors were related to increased cannabis use during the pandemic, and coping motives mediated this relationship. The direct and indirect associations of socioeconomic stressors and increased cannabis use were stronger than the associations of health-related stressors. Conclusions: Cannabis consumption may serve as a means of coping with health and socioeconomic COVID-19 stressors. Particular attention should be placed on socioeconomic stressors as these may be particularly important in understanding coping related cannabis use during the COVID-19 pandemic.

COVID-19-Related Posttraumatic Stress Disorder Among Jordanian Nurses During the Pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) outbreak has been declared a pandemic and has affected both patients and health-care workers. This study was conducted to explore the extent of posttraumatic stress disorder (PTSD) experiences among nurses because of the COVID-19 pandemic in Jordan.

METHODS

This study used a cross-sectional study design with a convenience sampling approach. A sample of 259 participants completed the study questionnaires, including a socio-demographic questionnaire and the Posttraumatic Stress Disorder Checklist for DSM-5 between May and July 2020.

RESULTS

The prevalence of PTSD among the study participants was 37.1%. Most study participants who exhibited PTSD symptoms presented the lowest level of PTSD (17%). The results showed significant differences in overall COVID-19-related PTSD according to the participant's age (F = 14.750; P = 0.000), gender (F = 30.340; P = 0.000), level of education (F = 51.983; P = 0.000), years of experience (F = 52.33, P = 0.000), place of work (F = 19.593; P = 0.000), and working position (F = 11.597; P = 0.000), as determined by 1-way ANOVA.

CONCLUSIONS

Nurses must be qualified and accredited to cope with reported PTSD cases and their consequences in relation to COVID-19 outbreaks. A close collaboration with a multidisciplinary team is required to recognize, manage, and encourage safety literacy among health-care professionals and individuals diagnosed with or suspected of PTSD due to COVID-19 outbreaks or any other viral outbreaks.