Adjustment Disorder in the Face of COVID-19 Outbreak: The Impact of Death Anxiety, Media Exposure, Fear of Contagion and Hypochondriasis Symptoms

Investigating COVID-19-Induced Adjustment Disorder Among Iranian Patients With Multiple Sclerosis in Pandemic Time

BACKGROUND

The coronavirus disease 2019 (COVID-19) outbreak raised many concerns along with physical and mental health complications, including adjustment disorder (AD). Given the utmost importance of this issue for vulnerable groups, the present study was to investigate COVID-19-induced AD among Iranian patients living with multiple sclerosis (MS) in 2020.

METHODS

Adopting a cross-sectional research design, this study was performed on a statistical population of MS patients. Sampling was further done online via Porsline, as a survey tool, in Iran. In total, 247 patients were examined for the period of 2 months, recruiting a sociodemographic-medical information form and the Adjustment Disorder New Module (ADNM). As a final point, the data were analyzed using the SPSS Statistics software (ver. 26).

RESULTS

The MS patients' mean age was 36.10 ± 8.07 years. 82.6% of the participants were female. The AD mean score was also 44.09 ± 13.89, at the moderate level. In this line, a significant relationship was observed between AD among patients with MS and gender (p = 0.001), occupation (p = 0.009), a history of psychiatric disorders (p = 0.001), a history of taking psychiatric medications (p = 0.001), medical appointments canceled due to COVID-19 (p = 0.001), medication shortages amid COVID-19 (p = 0.018), a history of COVID-19 infection (p = 0.018), a history of polymerase chain reaction (PCR) test for COVID-19 (p = 0.042), worry about COVID-19 infection (p = 0.001), fear of familial COVID-19 infection (p = 0.001), and death of friends or relatives caused by COVID-19 (p = 0.025).

CONCLUSION

The present study established that AD in the MS patients was at the moderate level, and it was even associated with some distinctive variables. So, data from multicenter studies are needed to achieve better recommendations regarding screening psychiatric disorders and supportive strategies in clinical practice.

Anxiety, Depression and Death Anxiety in Individuals with COVID-19

This study aimed to determine the death anxiety, anxiety, and depression levels of the individuals staying at the hospital due to COVID-19. The study recruited 300 patients with confirmed COVID-19 who were staying at specialized clinics in the hospital. Three tools - A Patient Information Form, the Death Anxiety Scale (DAS), and the Hospital Anxiety and Depression Scale (HADS)-were used to collect data. The findings of the present study revealed that 28.7% of the participants were at a high risk for developing anxiety and 45.0% were equally at a high risk for developing depression. 33.3% of the participants suffered from high level of death anxiety. There was a positive and highly significant correlation between their death anxiety and their anxiety and depression scores (p < .001). Accordingly, more evidence-based studies need to be conducted that examine how effective non-pharmacological practices are at helping COVID-19 patients by identifying their anxiety, depression, and death anxiety. Furthermore, nurses need to take care of patient care in a holistic manner that would include addressing patients' psychological needs alongside their physical problems.

From dread to disorder: A meta-analysis of the impact of death anxiety on mental illness symptoms

Growing research suggests that death anxiety may be transdiagnostic, playing a key role in the development and symptomology of psychopathology. This meta-analysis examined the relationship between death anxiety and mental illness symptoms. In total, 104 papers were included, representing cross-sectional data from 99 studies (ntotal = 24,434), and experimental data from 11 studies (ntotal = 1372). Meta-analyses of cross-sectional studies indicated a moderate correlation (r = 0.397) between death anxiety and overall mental illness symptoms. The clinical nature of the group emerged as a significant moderator of this effect. In addition, the relationship between death anxiety and mental illness symptoms was larger for clinical samples (r = 0.580), and for anxiety-related symptoms (r = 0.506) than for depression. Additional meta-analyses of 11 mortality salience studies revealed that death reminders had an overall moderate impact on clinical symptoms (Hedge's g = 0.481). The relevance of the sample to the symptom being measured significantly predicted this relationship; that is, the effect was moderate-to-large (Hedge's g = 0.671) when excluding comparison subgroups for which the effect was not predicted by the authors. The clinical nature of the sample did not significantly moderate the effect. The experimental studies were generally of higher quality and lower risk of publication bias compared to cross-sectional studies. These findings support the strong transdiagnostic role of death anxiety across numerous disorders. Clinical implications include the potential need to treat death anxiety directly, to maximise long-term therapy benefits.

Too much focus on your health might be bad for your health: Reddit user's communication style predicts their Long COVID likelihood

Long Covid is a chronic disease that affects more than 65 million people worldwide, characterized by a wide range of persistent symptoms following a Covid-19 infection. Previous studies have investigated potential risk factors contributing to elevated vulnerability to Long Covid. However, research on the social traits associated with affected patients is scarce. This study introduces an innovative methodological approach that allows us to extract valuable insights directly from patients' voices. By analyzing written texts shared on social media platforms, we aim to collect information on the psychological aspects of people who report experiencing Long Covid. In particular, we collect texts of patients they wrote BEFORE they were afflicted with Long Covid. We examined the differences in communication style, sentiment, language complexity, and psychological factors of natural language use among the profiles of 6.107 Reddit users, distinguishing between those who claim they have never contracted Covid -19, those who claim to have had it, and those who claim to have experienced Long Covid symptoms. Our findings reveal that people in the Long Covid group frequently discussed health-related topics before the pandemic, indicating a greater focus on health-related concerns. Furthermore, they exhibited a more limited network of connections, lower linguistic complexity, and a greater propensity to employ emotionally charged expressions than the other groups. Using social media data, we can provide a unique opportunity to explore potential risk factors associated with Long Covid, starting from the patient's perspective.

Data from four consecutive cohorts of students in Australia (2019-2022) show the impact of the COVID-19 pandemic on domestic and international university students' mental health

INTRODUCTION

COVID-19 and related travel and social restrictions caused significant stress for university students in Australia and globally. Learning quickly moved online and many students (particularly international students) were separated from social and economic support. This study examined the impact of the pandemic from pre-pandemic (2019) to the COVID-19 Omicron wave (2022) on domestic and international students' mental health.

METHODS

Participants were 1540 students (72% females, 28% international) in four first-year cohorts (2019, 2020, 2021, 2022). We screened for mental health concerns (% positive) and symptom scores for depression, anxiety and somatic distress using the PsyCheck, and general wellbeing using the Warwick-Edinburgh Mental Well-being scale.

RESULTS

From pre-COVID (2019) to the first wave of COVID-19 (2020), the proportion of students screening positive for mental health problems rose in both domestic students (66-76%) and international students (46-67%). Depression symptoms and wellbeing were worse in 2020 than in 2019, 2021 and 2022. Anxiety symptoms increased from 2019 to 2020 and continued to rise in 2021 and 2022. Somatic symptoms did not show an effect of cohort. Contrary to expectations, domestic students reported higher distress and lower wellbeing than international students across cohorts.

CONCLUSION

The pandemic was associated with a marked increase in psychological distress in first-year university students, not all of which settled with the easing of restrictions. Post-pandemic recovery in the Australian university sector must include university-wide access to mental health information and support for incoming students.

Differential Anxiety Responses in Acute Myocardial Infarction vs. COVID-19 Pneumonia Patients

Background and Objectives: Amidst the COVID-19 pandemic, concerns about the psychological impact of disease-related anxiety on public health have risen. This study aims to compare general and death anxiety levels between acute coronary artery syndrome and COVID-19 pneumonia patients. Materials and Methods: A cross-sectional study of 132 individuals, including acute myocardial infarction (MI), COVID-19 pneumonia patients, and healthy volunteers from Trakya University Hospital (Turkey), was analyzed. Validated scales like the Beck Anxiety Inventory (BAI), Coronavirus Anxiety Scale Short Form, and Thorson-Powell Death Anxiety Scale (TPDAS) were employed. Demographic data such as age, gender, income levels, employment status, presence of a close relative with COVID-19, and whether participants followed COVID-19-related news were collected and compared across groups with significance level of 0.05 set for all analyses. Results: Among 41 COVID-19, 41 MI, and 50 healthy subjects, the pneumonia group showed highest COVID-19 anxiety (p = 0.01) and BAI scores (p = 0.008). Both COVID-19 and MI patients had significantly higher BAI and TPDAS scores compared to healthy controls (p < 0.001). Factors like female gender (p = 0.004), low education (p = 0.003), current employment (p = 0.008), and low income (p = 0.002) correlated with higher BAI scores. Low income (p = 0.001) and COVID-19 news exposure (p = 0.002) correlated with higher TPDAS scores. Males and married patients had lower anxiety scores (p = 0.008). High income, education, and employment reduced anxiety levels (p = 0.008). TPDAS scores decreased with higher income (p = 0.001), but increased in the MI group (p = 0.002) with COVID-19 news exposure. The multivariate linear regression analysis found that MI and COVID-19 pneumonia were associated with TPDAS; female gender, university education, and COVID-19 pneumonia with the Beck scale; and COVID-19 pneumonia with anxiety scores on the COVID-19 Anxiety scale. Conclusions: This research showcases differing anxiety patterns between illnesses such as MI and COVID-19 pneumonia amidst the pandemic, emphasizing the amplifying influence of media coverage on death-related anxieties. It underscores the imperative of targeted interventions and socioeconomic considerations in managing psychological consequences and formulating responsive public health strategies.

Optimism in dire times: The buffering role of optimism in the relationship between food insecurity and mental health during the COVID-19 pandemic

Considering the need to gain a deeper understanding of the protective factors associated with coping with food insecurity, specifically in times of severe prolonged stress, the current longitudinal study seeks to examine the role of optimism in the relationship between food insecurity and adverse mental health outcomes during the COVID-19 pandemic. A three-wave longitudinal study involving 1921 Israeli adults was performed during the COVID-19 pandemic. Participants completed questionnaires assessing food insecurity, anxiety, depression, optimism, and socio-demographic characteristics. To explore the relationship between food insecurity and symptoms of anxiety and depression, as well as the moderating role of optimism in this relationship, we employed a set of panel regression models with individual fixed effects. Our results indicate that the degree and change in food insecurity over time were positively associated with both anxiety and depression symptoms, whereas the degree and change in optimism were negatively correlated. Optimism was found to moderate the association between food insecurity and anxiety symptoms over time, but not the association between food insecurity and depression symptoms. A subgroup analysis revealed that optimism moderated the relationship between food insecurity and anxiety and depression for women, but not for men; for married/coupled individuals but not for singles; for non-parents with regard to anxiety, and for parents with regard to depression. Our results highlight the need to practice and enhance optimism in times of great despair, uncertainty, and hardship, especially in situations of food insecurity where tangible change may take time.

Psychological distress during the COVID-19 pandemic: An integrative perspective

Informed by socio-ecological psychology and the conservation of resources model, the present study proposes an integrative perspective on the association between psychological distress and a constellation of factors, during the COVID-19 outbreak in Israel. Our sample, comprised of 991 adult participants, was measured for psychological distress, locus of control (internal/ external), resilience, loneliness, social support, dimensions of citizens' trust in government organizations (perceived competence, benevolence, and integrity), and demographic characteristics. The findings showed that women, non-religious people, and the unemployed reported higher levels of psychological distress. Internal locus of control, resilience, social support, and the extent to which citizens perceive government organizations as benevolent were negatively associated with psychological distress. Self-reported loneliness and external locus of control positively predicted the level of respondent psychological distress. No association was detected between age, competence and integrity and psychological distress. An overview of the research findings indicates that individuals with greater resources were less likely to suffer from psychological distress during the COVID-19 outbreak. These findings call upon mental health care practitioners to help as well as to enable clients to attain resources in order to lower their levels of psychological distress. Policies developed by policymakers during periods of acute crisis should consider the specific needs and vulnerabilities of certain population groups, including women and the unemployed who may be more susceptible to psychological distress. It is also important for policymakers to be aware that the perception of democratic governments as benevolent can serve as a buffer against psychological distress during times of crisis.

Depression and Anxiety Symptoms "Among the Waves" of the COVID-19 Pandemic in Obsessive Compulsive Disorder and Adjustment Disorder Patients

The COVID-19 pandemic and the associated restrictions caused great psychological suffering to the general population and psychiatric patients. We aimed to explore the course of depression and anxiety symptoms in obsessive compulsive disorder (OCD) patients, adjustment disorder (AD) patients, and participants without psychiatric disorders (control group, CG) across the different phases of the pandemic: the first lockdown, a temporary interruption of restrictions, and the second lockdown. Out of the 158 patients screened, we enrolled 46 OCD and 19 AD patients as well as 29 CG participants. The Beck Depression Inventory-II and the State-Trait Anxiety Inventory-Y were administered to all participants at each time point. The results showed different symptom severities among the groups throughout the whole study, with OCD patients always scoring higher than AD patients and the CG, and the AD patients always scoring higher than the CG. The symptom course within each group was different. OCD patients' symptoms sharply worsened during the first lockdown and then remained stable irrespective of the subsequent pandemic phases. In the AD and CG groups, symptoms waxed and waned following the fluctuations of the restriction provisions, with a complete return to the baseline when the restrictions were stopped only in the CG. These findings suggest that the influence of the pandemic and of the associated restrictions on depression and anxiety manifestations may vary depending on the particular pre-existing mental health status.

Intolerance to uncertainty and self-efficacy as mediators between personality traits and adjustment disorder in the face of the COVID-19 pandemic

In April 2020, early in the COVID-19 outbreak, governments restricted public gatherings and ordered social distancing. These demands led to challenging adaptations, which in some cases resulted in mental health issues, including adjustment disorder. Guided by the transactional stress model, the current study aimed to examine the relations between personality traits and adjustment disorder in crisis situations and vagueness and the role of intolerance to uncertainty and self-efficacy in these relations. During Israel's first lockdown, 673 Israeli adults completed self-reported e-version questionnaires regarding Big Five personality traits, adjustment disorder, intolerance to uncertainty, self-efficacy, and background variables. The study was designed to examine the association between personality traits and adjustment disorder and the potential mediation of intolerance to uncertainty and self-efficacy in associations. The findings revealed that intolerance to uncertainty and self-efficacy mediated the association between personality traits and adjustment disorder. The results are consistent with the transactional stress model. They shed light on the role of intolerance to uncertainty and self-efficacy as cognitive mechanisms that promote the development of adjustment disorder. Recommendations for future studies and practice are discussed.

Public perception of social workers as a source for providing help during the COVID-19 pandemic

Summary

The current study examined the contribution of select demographic and psychosocial variables, as well as prior experience with social workers (SWs), to explaining the likelihood of seeking their help by the general public in Israel during the COVID-19 pandemic. For the purpose of the study, an online questionnaire was administered to a sample of 582 respondents older than 20.

Findings

The findings show that the respondents reported a fairly low likelihood of seeking help from SWs. Women, those not in a significant relationship, people who had prior experience with SWs, and those reporting higher levels of loneliness, had a higher likelihood of seeking help from SWs. At the same time, no association was found between age, employment status, depression, and anxiety, and the likelihood of seeking help from SWs.

Applications

When dealing with the mental, health, and social consequences of the COVID-19 crisis, it is important to identify groups with a lower likelihood of seeking help from SWs and to actively offer them help. Furthermore, it is important to develop a policy aimed at promoting knowledge of SW roles and reducing barriers to seeking SW help, while attending to the unique needs of diverse population groups.

Being a parent, emotional stability, and adjustment disorder symptoms in the face of COVID-19

Objective

The current study examines the correlation between emotional stability and symptoms related to adjustment to the stresses related to the pandemic for parents and nonparents at the initial stage of the COVID-19 outbreak in Israel.

Background

At the early stage of the COVID-19 outbreak, governments prohibited public gatherings and demanded social distancing. These challenges may be especially difficult for individuals with low levels of emotional stability as adaptation difficulties may lead to stress-related outcomes, such as adjustment disorder symptoms. Additionally, in the face of a significant external threat and the demand for intensive joint familial time at home, the parental role becomes especially salient.

Methods

Two hundred forty-four Israeli adults filled in self-reported e-version questionnaires regarding emotional stability, adjustment disorder symptoms, and background variables. A cross-sectional design was used to examine the association between emotional stability and adjustment disorder symptoms, as well as the potential moderation by parenting status.

Results

The findings revealed that the levels of emotional stability were negatively correlated with adjustment disorder symptoms, while being a parent mitigated this correlation. This correlation was nonsignificant among parents.

Conclusion and Implications

It appears that the identity salience of parental role in the current stressful situation and its associated strain may have overcome the advantage of emotional stability. The identity of being a parent has the potential to dismiss it. Here, the social role emerges as more forcible than the personality trait. Recommendations for practice are discussed.