Information uncertainty: a correlate for acute stress disorder during the COVID-19 outbreak in China

Media portrayals and social stigma surrounding COVID-19 survivors: a content analysis of Chinese media coverage

BACKGROUND

The COVID-19 pandemic has generated widespread uncertainty, leading to an overabundance of information and fuelling public fear and confusion. Concerns regarding the transmissibility and long-term effects of the virus on survivors have exacerbated societal stigma towards those who have recovered from COVID-19. This study analyses Chinese media coverage to explore the ways in which COVID-19 survivors are portrayed and how these portrayals may contribute to the broader narrative of stigmatisation.

METHODS

This study employs content analysis of 440 news articles from four major Chinese media outlets, spanning the period from January 2020 to March 2023. The sample includes two state-sponsored outlets, People's Daily and Global Times, and two market-oriented outlets, Caixin Weekly and Sanlian Lifeweek. By comparing media coverage across these outlets, the research investigates how representations of COVID-19 survivors varied across different media outlets.

RESULTS

Disparities in media portrayals of COVID-19 survivors were found. State-sponsored media, such as People's Daily and Global Times, generally depicted COVID-19 as less severe, downplaying fear and emphasising positive developments. In contrast, both Caixin Weekly and Sanlian Lifeweek frequently reported on cases of recovered individuals testing positive again, with Caixin Weekly offering more in-depth discussions on the potential for survivors to remain contagious. While the negative impacts of COVID-19 on survivors' labour and social capacities were not a major focus in most outlets, these impacts were still present, particularly in People's Daily and Sanlian Lifeweek, which reported more significant negative effects on survivors' social functions. Across both state-sponsored and market-oriented outlets, mixed messages emerged regarding the social acceptance of survivors, with articles simultaneously advocating for social distancing while promoting reintegration. These findings underscore the complexity of media portrayals, revealing a diverse reporting landscape characterised by mixed messages.

CONCLUSION

This study reveals the presence of conflicting media narratives, which have potentially contributed to the societal stigma surrounding COVID-19 survivors. The mixed messages-simultaneously promoting both fear and acceptance-have exacerbated public confusion and misconceptions. The findings underscore the critical need for clear, consistent, and evidence-based reporting during public health crises to mitigate stigma and enhance the public's understanding of health-related information.

Appropriate trust in online health information is associated with information platform, commercial status, and misinformation in patients with high cardiovascular risk

Background

The quality of online health information (OHI) on cardiovascular health is highly variable. Trusting poor quality OHI can lead to poorer health decisions. This study examined information characteristics associated with appropriate trust in OHI among patients with high cardiovascular risk.

Methods

This is a secondary analysis from a cohort study of 270 participants with high cardiovascular risk from a primary care clinic in Malaysia. Participants recorded OHI entries and their trust levels over 2 months using a digital diary. Overall, 1194 OHI entries were included and categorised by platform, commercial status, content focus, and presence of misinformation, and assessed for quality using the DISCERN tool. Appropriate trust was determined by trust-quality matching (trusting high quality or distrusting low quality OHI). The association between information characteristics and appropriate trust was analysed using multiple logistic regression.

Results

Most entries were from websites (62%) and non-commercial sources (88.2%). Misinformation was found in 23.3% (278 of 1194) of entries; 30.8% (367 of 1194) were of good or excellent quality; 51.5% (615 of 1194) were appropriately trusted. Information from websites (vs social media) (AOR 4.31, 95% CI 3.14-5.91, P < .001), non-commercial source (vs commercial) (AOR 1.59, 95% CI 1.01-2.50, P = .047), and absence of misinformation (vs presence of misinformation) (AOR 2.11, 95% CI 1.40-3.20, P < .001) were associated with higher appropriate trust.

Conclusions

OHI from websites, non-commercial sources, and information without misinformation has higher appropriate trust among patients with high cardiovascular risk. This study highlighted the need for good-quality OHI and dissemination through reliable sources.

Risk Perception, Cooperation, and Emotional Distress During the COVID-19 Pandemic: Exploring Adaptive Risk Perception

During the COVID-19 pandemic, while risk perception may promote public cooperation with pandemic prevention, it may also increase emotional distress and thus endanger mental health. This study aimed to examine whether there is an adaptive risk perception pattern that fits both needs of pandemic control and mental health protection. Two waves of Chinese participants (N sample 1 = 1633, N sample 2 = 1899) completed the Scale of Pandemic Risk Perception, the Scale of Public Cooperation with Pandemic Prevention, the Epidemic Worry Scale, and the Positive and Negative Affective Schedule during Feb 3rd to 5th, and during Feb 18th to 20th, 2021 respectively. Four risk perception profiles were identified by using latent profile analysis based on pandemic risk perception. Regression mixture models found that individuals in the perceived-controllable-high-perceived-risk profile were the most cooperative and reported the least worries and negative affect. The perceived-uncontrollable-high-perceived-risk profile demonstrated high cooperation but serious worry and negative affect. Individuals in the ignoring-risk profile reported the least levels of cooperation and worry but the highest levels of negative affect. Finally, the perceived-moderate-perceived-risk profile reported moderate levels of both cooperation and emotional distress. These results were well repeated in two samples. Present findings point towards an adaptive risk perception pattern (the controllable-high-perceived-risk profile) which may optimize cooperation while also avoid serious emotional distress.

How has health literacy and digital health literacy scholarship evolved? A global, qualitative study

Health literacy (HL) is a key social determinant of health (SDoH) and is of increasing importance in public health research and intervention for improved health outcomes. Definitions of HL and digital health literacy (DHL) have evolved over time as the field has expanded conceptualization from an individual focus to the broader community and organizational levels. Careful consideration of HL and DHL for a variety of contexts and audiences is critical given increased global adoption of digital technologies and responses to emerging public health challenges. This study aimed to capture researchers' conceptualizations of HL/DHL and their motivations to engage in this research with attention to SDoH and equity principles. We developed a survey comprising 32 open-ended and multiple-choice questions from which we present participant demographics and overall research affiliations (n = 193), and results from two multiple-choice and three open-ended questions. The three open-ended questions were inductively reviewed and coded using thematic analysis and iterative discussions between multiple coders, while the two multiple-choice questions were descriptively analyzed via SPSS. Findings are situated within the context of the coronavirus disease 2019 (COVID-19) pandemic and inform the international field of HL/DHL research by highlighting momentum and opportunities for increased scholarship.

COVID-19 vaccine acceptance among college students in South Carolina: do information sources and trust in information matter?

BACKGROUND

For college students who are exposed to multimedia, the sources of COVID-19 vaccine information and their trust in these sources may play a role in shaping the vaccine acceptance spectrum (refusal, hesitancy, and acceptance).

METHODS

Based on an online survey among 1,062 college students in South Carolina, we investigated vaccine information sources among college students and examined how COVID-19 vaccine acceptance was associated with information source and trust level in each source.

RESULTS

The top three sources of COVID-19 vaccine information were health agencies, mass media, and personal social networks. Trust in mass media, health agencies, scientists, and pharmaceutical companies was negatively associated with vaccine refusal. Trust in government and scientists was negatively associated with vaccine hesitancy.

DISCUSSION

Our findings highlight the importance of restoring trust in government, healthcare system, scientists, and pharmaceutical industries in the COVID-19 era.

The effect of fear on health information searching behavior during the pandemic: The case of COVID-19

BACKGROUND AND OBJECTIVES

Fear can cause people to panic, lead to erroneous decisions, and trigger inappropriate behavior. This study aims to investigate the effects of fear of COVID-19 on the perception of the reliability and the use of health information sources.

METHODS

This study is both a cross-sectional and explanatory study. The participants selected by convenience sampling method were 323 students attending a state university in Turkey. The Fear of COVID-19 Scale (FCV-19S) and the Health Information Sources Survey were used as data collection tools. Descriptive statistics, correlation coefficients, and linear regression analyses were used.

RESULTS

The participants' mean FCV-19S score was 2.30 ± 0.93 on a five-point Likert scale. In the range of 0-10, the information source with the highest reliability perception mean score was the doctor (8.05 ± 2.54), whereas that with the highest usage was the Internet (7.98 ± 2.77). Although the fear of COVID-19 had a negative effect on Internet use (b = -0.38; p < 0.05), the effects on the use of other health information sources were positive (b = 0.37-0.83; p < 0.05). Trust in radio (b = 0.60; p < 0.05) and newspapers/magazines (b = 0.49; p < 0.05) also increased with fear.

CONCLUSIONS

These results showed that as university students' fear of COVID-19 increased, the use of the Internet for health information decreased; however, the use of doctors, nurses, pharmacists, other health workers, scientific articles, television, radio, and newspapers/journals increased. Nurses were the source of information whose use increased the most, along with increased fear. The findings can guide health policies to be followed. Not only doctor talks but also nurse talks and scientific videos should be increased on the Internet, social media, and other mass media.

Description and Analysis of Research on Death and Dying during the COVID-19 Pandemic, Published in Nursing Journals Indexed in SCOPUS

AIM

To offer an overall picture of the research published regarding the different aspects of death and dying during the COVID-19 pandemic in journals covering the field of nursing in the Scopus database.

DESIGN

bibliometric analysis.

METHODS

The metadata obtained were exported from Scopus for subsequent analysis through Bibliometrix. Using the VOSviewer co-word analysis function, the conceptual and thematic structure of the publications was identified.

RESULTS

A total of 119 papers were retrieved, with the participation of 527 authors. The publications were found in 71 journals covering the nursing area. The main lines of research revolved around the keywords "palliative care" and "end-of-life care" in regard to the ethical, psychological, and organizational challenges faced by the health professionals who cared for these patients.

CONCLUSION

The results obtained offer a range of data and images that characterize the scientific production published on this topic, coming to the conclusion that, due to the multifaceted and multidisciplinary approach to the experience of death, care, and accompaniment in the dying process, bibliometric maps improve the comprehensive understanding of the semantic and conceptual structure of this field of research. This study was retrospectively registered with the OSF Registries on the 14 March 2024.

Temporal and Spatial Analysis of Negative Emotions in China during the COVID-19 Pandemic

This research aims to explore the spatiotemporal distribution patterns of negative emotions in mainland China during different stages of the COVID-19 pandemic and the external factors influencing this clustering. Using Baidu Index data for 91 negative emotion keywords, a retrospective geographic analysis was conducted across Chinese provinces from 14 October 2019 to 7 July 2022. Four spatial analysis methods (Global Moran's Index, Local Moran's Index, Bivariate Global Moran's Index, and Bivariate Local Moran's Index) are employed to identify potential clustering patterns and influencing factors of negative emotions at different stages. The results indicate that the COVID-19 pandemic significantly intensified the clustering effect of negative emotions in China, particularly with a more pronounced radiation effect in northwestern provinces. Spatial positive correlations are observed between pandemic-related Baidu indices (pandemic Baidu index, government Baidu index, nucleic acid Baidu index) and negative emotions. These findings contribute to understanding the spatiotemporal distribution characteristics of negative emotions in China post the COVID-19 outbreak and can guide the allocation of psychological resources during emergencies, thereby promoting social stability.

Impact of 10-Min Daily Yoga Exercises on Physical and Mental Discomfort of Home-Office Workers During COVID-19

OBJECTIVE

Evaluate the effects of 10 min/day of yoga for 1 month on musculoskeletal discomfort and mood disturbance of home-office workers.

BACKGROUND

The COVID-19 pandemic forced many people to switch to teleworking. The abrupt change from an office setting to an improvised home-office may negatively affect the musculoskeletal and emotional health of workers. By providing mental and physical exercises, yoga may be effective in reducing adverse effects.

METHOD

Fifty-four participants (42 women, 12 men) followed a 1-month yoga program, while 40 participants (26 women, 14 men) continued with their common work routine. The Cornell Musculoskeletal Discomfort Questionnaire was used to evaluate severity, interference with work and frequency of pain, and to obtain a total discomfort score for 25 body areas. Mood disturbance was evaluated with the Profile of Mood States questionnaire. Both groups completed both questionnaires, before and after the experimentation period.

RESULTS

After 1 month, for the yoga group only, significant reductions were observed in the discomfort of eyes, head, neck, upper and lower back, right wrist, and hips/buttocks, as well as reductions in discomfort severity, frequency and interference for the neck, upper and lower back. Total mood disturbance was also significantly reduced for the yoga group only. No favorable changes occurred for the control group.

CONCLUSION

The yoga intervention program appears to reduce musculoskeletal discomfort and mood disturbance of home-office workers.

APPLICATION

Sedentary workers may benefit from 10 min/day of yoga during the workday to attenuate potential physical and emotional discomfort during the current pandemic and beyond.

Stress Among the Adult Population During COVID-19 Pandemic in Kedah, Malaysia: Association Between Sociodemographics and the Movement Control Order Period

Background The COVID-19 pandemic has led to a significant increase in the prevalence of stress worldwide. However, the extent and factors associated with psychological distress during COVID-19 among the local population in Kedah, Malaysia, have not been adequately explored. This study aimed to determine the prevalence and factors associated with stress among the adult population in Kedah, Malaysia, during the COVID-19 pandemic. Materials and methods We conducted a cross-sectional study using a retrospective record review. A simple random sampling was applied among the adult population of Kedah who were screened for mental health well-being from January 2021 until March 2022. A proforma checklist that consists of sociodemographic and clinical factors and the date of screening was used to collect the data. A descriptive and multiple logistic regression was conducted, and analysis was done by SPSS version 26 (IBM Inc., Armonk, New York). The dependent variables were the presence of stress incorporated self-reported symptoms ranging from mild to very severe. The independent variables were sociodemographic, clinical factors, and movement control order period, which refers to the period when the state of Kedah experienced all the different phases of movement control order (MCO), which were from 1 January 2021 until 28 June 2021. Results In total, 562 adults were included. The mean age was 31.75 years, and the majority were female (69.6%). The prevalence of stress was 45.7% (95% CI 41.6%, 49.8%), with a total of 257 people. The majority of them did not have stress, consisting of 305 people (54.3%), followed by 69 people (12.3%) who reported severe stress, 67 people (11.9%) who reported moderate, 66 people (11.7%) who reported mild, and 55 people (9.8%) who reported very severe stress. The significant factor associated with stress among the adult population in Kedah, Malaysia, during the COVID-19 pandemic was the female gender (Adj OR 3.035 95% CI: 2.007 to 4.591, p-value <0.001). Being unemployed (Adj OR 2.171 95% CI: 1.480 to 3.185, p-value <0.001) and being under movement control order period was also associated with stress (Adj OR 0.383 95% CI: 0.264 to 0.555, p-value <0.001). Conclusion The prevalence of stress among the adult population during the COVID-19 pandemic in Kedah was 45.7%, with a total of 257 people, higher than other studies. Being female and unemployed was associated with stress, while the movement control order period was a protective factor against stress. Preventive strategies should be tailored based on the vulnerabilities of these groups, such as the development of more effective community-based interventions for safeguarding the mental health of the general public during future pandemics.

Protecting public's wellbeing against COVID-19 infodemic: The role of trust in information sources and rapid dissemination and transparency of information over time

Objectives

This study examined how trust in the information about COVID-19 from social media and official media as well as how the information was disseminated affect public's wellbeing directly and indirectly through perceived safety over time.

Methods

Two online surveys were conducted in China, with the first survey (Time1, N = 22,718) being at the early stage of the pandemic outbreak and the second one (Time 2, N = 2,901) two and a half years later during the zero-COVID policy lockdown period. Key measured variables include trust in official media and social media, perceived rapid dissemination and transparency of COVID-19-related information, perceived safety, and emotional responses toward the pandemic. Data analysis includes descriptive statistical analysis, independent samples t-test, Pearson correlations, and structural equation modeling.

Results

Trust in official media, perceived rapid dissemination and transparency of COVID-19-related information, perceived safety, as well as positive emotional response toward COVID-19 increased over time, while trust in social media and depressive response decreased over time. Trust in social media and official media played different roles in affecting public's wellbeing over time. Trust in social media was positively associated with depressive emotions and negatively associated with positive emotion directly and indirectly through decreased perceived safety at Time 1. However, the negative effect of trust in social media on public's wellbeing was largely decreased at Time 2. In contrast, trust in official media was linked to reduced depressive response and increased positive response directly and indirectly through perceived safety at both times. Rapid dissemination and transparency of COVID-19 information contributed to enhanced trust in official media at both times.

Conclusion

The findings highlight the important role of fostering public trust in official media through rapid dissemination and transparency of information in mitigating the negative impact of COVID-19 infodemic on public's wellbeing over time.

Perceptions and tolerance of uncertainty: relationship to trust in COVID-19 health information and vaccine hesitancy

The COVID-19 crisis has exposed the public to considerable scientific uncertainty, which may promote vaccine hesitancy among individuals with lower tolerance of uncertainty. In a national sample of US adults in May-June 2020, we examined how both perceptions of uncertainty about COVID-19 and trait-level differences in tolerance of uncertainty arising from various sources (risk, ambiguity, and complexity) are related to vaccine hesitancy-related outcomes, including trust in COVID-19 information, COVID-19 vaccine intentions, and beliefs that COVID-19 vaccines should undergo a longer testing period before being released to the public. Overall, perceptions of COVID-19 uncertainty were not associated with trust in information, vaccine intentions, or beliefs about vaccine testing. However, higher tolerance of risk was associated with lower intentions to get vaccinated, and lower tolerance of ambiguity was associated with lower intentions to get vaccinated and preferring a longer period of vaccine testing. Critically, perceptions of COVID-19 uncertainty and trait-level tolerance for uncertainty also interacted as predicted, such that greater perceived COVID-19 uncertainty was more negatively associated with trust in COVID-19 information among individuals with lower tolerance for risk and ambiguity. Thus, although perceptions of uncertainty regarding COVID-19 may not reduce trust and vaccine hesitancy for all individuals, trait-level tolerance of uncertainty arising from various sources may have both direct and moderating effects on these outcomes. These findings can inform public health communication or other interventions to increase COVID-19 vaccination uptake.

Fostering uncertainty tolerance in anatomy education: Lessons learned from how humanities, arts and social science (HASS) educators develop learners' uncertainty tolerance

Uncertainty tolerance, individuals' perceptions/responses to uncertain stimuli, is increasingly recognized as critical to effective healthcare practice. While the Covid-19 pandemic generated collective uncertainty, healthcare-related uncertainty is omnipresent. Correspondingly, there is increasing focus on uncertainty tolerance as a health professional graduate "competency," and a concomitant interest in identifying pedagogy fostering learners' uncertainty tolerance. Despite these calls, practical guidelines for educators are lacking. There is some initial evidence that anatomy education can foster medical students' uncertainty tolerance (e.g., anatomical variation and dissection novelty), however, there remains a knowledge gap regarding robust curriculum-wide uncertainty tolerance teaching strategies. Drawing upon humanities, arts and social sciences (HASS) educators' established uncertainty tolerance pedagogies, this study sought to learn from HASS academics' experiences with, and teaching practices related to, uncertainty pedagogy using a qualitative, exploratory study design. Framework analysis was undertaken using an abductive approach, wherein researchers oscillate between inductive and deductive coding (comparing to the uncertainty tolerance conceptual model). During this analysis, the authors analyzed ~386 min of data from purposively sampled HASS academics' (n = 14) discussions to address the following research questions: (1) What teaching practices do HASS academics' perceive as impacting learners' uncertainty tolerance, and (2) How do HASS academics execute these teaching practices? The results extend current understanding of the moderating effects of education on uncertainty tolerance and supports prior findings that the anatomy learning environment is ripe for supporting learner uncertainty tolerance development. This study adds to growing literature on the powerful moderating effect education has on uncertainty tolerance and proposes translation of HASS uncertainty tolerance teaching practices to enhance anatomy education.

Nonlinear effects of pandemic uncertainty on depression, pandemic preventive behavior intentions, and positive life attitudes: Moderating effects of high and low uncertainty grouping

Backgrounds

COVID-19 is difficult to end in a short time and people are still facing huge uncertainties. Since people's lives are gradually returning to normal, the sense of control and intolerance of uncertainty, which were mainly focused by past studies, are not specific to COVID-19 and will be more influenced by some factors unrelated to the pandemic. Therefore, they may be difficult to accurately reflect the individuals' perceptions of uncertainty. Besides, past research just after the outbreak mainly investigated people in high levels of uncertainty, we don't know the impact of uncertainties on individuals' psychological states when people gradually recovered their sense of control. To solve these problems, we proposed the concept of "pandemic uncertainty" and investigated its impact on people's daily lives.

Methods

During October 20, 2021 to October 22, 2021, this study obtained data about uncertainty, depression, positive attitude, pandemic preventive behavior intentions, personality, and social support from 530 subjects using convenient sampling. The subjects were all college students from the Dalian University of Technology and Dalian Vocational and Technical College. According to the distribution of uncertainty, we divided the dataset into high and low groups. Subsequently, by using uncertainty as the independent variable, the grouping variable as the moderating variable, and other variables as the control variables, the moderating effects were analyzed for depression, positive attitude, and pandemic preventive behavior intentions, respectively.

Results

The results showed that the grouping variable significantly moderate the influence of uncertainty on positive attitude and pandemic preventive behavior intentions but had no significant effect on depression. Simple slope analysis revealed that high grouping uncertainty significantly and positively predicted positive attitude and pandemic preventive behavior intentions, while low grouping effects were not significant.

Conclusion

These results reveal a nonlinear effect of pandemic uncertainty on the pandemic preventive behavior intentions and positive life attitudes and enlighten us about the nonlinear relationship of psychological characteristics during a pandemic.

The impact of COVID-19 on social support perception and stress of prehospital care providers

BACKGROUND

This study seeks to explore the impact of COVID-19 outbreak on the social support perception and acute stress disorder of prehospital care providers (PCPs) in the province of Denizli.

METHODS

This descriptive and cross-sectional study was conducted between December 25, 2020 and January 25, 2021. Out of 510 ambulatory care staff constituting the study population, there were 287 PCPs (%56.2), including 13 physicians, 89 paramedics, 134 emergency medical technicians, and 51 individuals from other occupational groups (nurse, driver, cleaning staff, medical secretary) based at emergency health services. The data collection tools employed in the study include an introductory information form, Multidimensional Scale of Perceived Social Support (MSPSS), and National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS), which was organized as an online questionnaire.

RESULTS

We analyzed the data from 287 PCPs that completed the form and scales. The mean score of the NSESSS was calculated as 1.53 ± 0.79. The PCPs who experienced health problems (1.85 ± 0.69), suffered from mental problems and received psychotherapy and medication (2.57 ± 0.57), encountered COVID-19 patients (1.58 ± 0.8), provided care for COVID-19 patients (1.59 ± 0.79), and took polymerase chain reaction (PCR) tests (1.68 ± 0.78) had higher acute stress symptom levels. The total mean score of MSPSS was calculated as 66.28 ± 17.22. Total MSPSS scores of the participants varied significantly in terms of age, marital status, taking a COVID-19 test, suffering from mental problems, status of encountering a COVID-19 patient, and workplace satisfaction (p < 0.05).

CONCLUSIONS

The findings are suggestive of high perceptions of multidimensional social support and low acute stress symptom levels of the PCPs during the COVID-19 pandemic period.

COVID-19-related fear, stress and depression in school principals: impacts of symptoms like COVID-19, information confusion, health-related activity limitations, working hours, sense of coherence and health literacy

BACKGROUND

School principals have been reported to have a higher prevalence of burnout and psychological problems than their colleagues. During the pandemic, extra workload and pressure from unprecedented situations potentially cause fear, stress and depression. Therefore, we aimed to explore associated factors of stress, fear of COVID-19 (F-CoV-19S) and depressive symptoms among school principals.

METHODS

A cross-sectional online survey was conducted in Taiwan from 23 June to 16 July 2021. Data of 413 school principals were collected, including socio-demographic factors, COVID-19-related factors, work-related information, health status, sense of coherence (SoC), health literacy (HL), F-CoV-19S, stress and depression. Multiple linear and logistic regression models were utilized to explore associations.

RESULTS

School principals with symptoms like COVID-19 (S-COVID-19-S), or with health-related activity limitations had a higher score of stress (B = 0.92; p = .039) (B = 1.52; p < .001) and a higher depression likelihood (OR = 3.38; p < .001) (OR = 3.06; p < .001), whereas those with a better SoC had a lower stress score (B = -1.39; p < .001) and a lower depression likelihood (OR = 0.76; p = .020). School principals confusing about COVID-19-related information had a higher score of stress (B = 2.47; p < .001) and fear (B = 3.77; p < .001). The longer working time was associated with a higher fear score (B = 1.69; p = .006). Additionally, school principals with a higher HL score had a lower stress score (B = -1.76; p < .001), a lower fear score (B = -1.85; p < .001) and a lower depression likelihood (OR = 0.53; p = .043).

CONCLUSIONS

Health-related activity limitations, S-COVID-19-S, COVID-19-related information confusion and longer working hours were positively associated with at least one mental health problem (e.g. stress, fear and depression), whereas better SoC and HL showed the benefits to mitigate fear, stress and depressive symptoms in school principals. Our study provides evidence for appropriate strategies to improve principals' mental health during the pandemic.Key messages:School principals with health-related activity limitations or with symptoms like COVID-19 were more likely to be stressed and depressed.Higher levels of stress and fear were observed in school principals who confused about COVID-19-related information, and who had longer working time than before the pandemic.Better sense of coherence and higher health literacy could potentially mitigate the fear, stress and depressive symptoms in school principals.

Posttraumatic stress and COVID-19-related stressors: a prospective observational study

BACKGROUND

The COVID-19 pandemic may trigger posttraumatic stress symptoms (PTSS) due to its threat to health, well-being, and survival.

OBJECTIVES

We sought to assess levels of change in PTSS at three waves during the COVID-19 pandemic. Our second objective was to examine the role of four objective and subjective predictors salient to COVID-19-loss of resources, sense of loneliness, perceived COVID-19 threat, and uncertainty stress-on the trajectory of PTSS.

METHODS

The study consisted of three waves, a month apart, between June and August 2020, with 903, 718, and 684 participants in each wave, respectively.

RESULTS

At T0, participants had a medium level of PTSS (M = 2.07, SD = 0.89), which increased at T1 (M = 2.46, SD = 0.97) and decreased at T2 (M = 2.24, SD = 0.93). Linear mixed-effects modeling showed that loss of resources, sense of loneliness, perceived COVID-19 threat, and uncertainty stress were significant predictors of PTSS over the three time-points. Significant interactions between these predictors (except sense of loneliness) and time were found: At higher levels of resource loss, uncertainty stress, and COVID-19 threat, there was a steeper increase in PTSS from baseline to 1 month.

CONCLUSIONS

The four predictors of PTSS should be addressed via strengthening resilience of individuals and communities.

Cross-sectional survey following a longitudinal study on mental health and insomnia of people with sporadic COVID-19

BACKGROUND

In the post-pandemic era, the emergence of sporadic cases of coronavirus disease 2019 (COVID-19) and the scale of the pandemic are unpredictable. Therefore, the impact of sporadic cases of COVID-19 and isolation measures on mental health and sleep in different groups of people need to be analyzed.

AIM

To clarify the severity of psychological problems and insomnia of staff and community residents around a hospital with sporadic cases of COVID-19, and their relationship with quarantine location and long-term changes.

METHODS

A cross-sectional survey was conducted on community residents and medical staff. Many of these medical staff had been subjected to different places of quarantine. Community residents did not experience quarantine. Hospital anxiety and depression scale (HADS), acute stress disorder scale (ASDS) and insomnia severity index (ISI) were used to evaluate anxiety and depression, acute stress disorder symptoms, and the severity of insomnia. Additionally, we conducted a 1-year follow-up study on medical staff, with related scales measurement immediately after and one year after the 2-wk quarantine period.

RESULTS

We included 406 medical staff and 226 community residents. The total scores of ISI and subscale in HADS of community residents were significantly higher than that of medical staff. Further analysis of medical staff who experienced quarantine showed that 134 were quarantined in hotels, 70 in hospitals and 48 at home. Among all subjects, the proportions of HADS, ASDS and ISI scores above normal cutoff value were 51.94%, 19.17% and 31.11%, respectively. Multivariable logistic regression analysis found that subjects with higher total ASDS scores had a greater risk to develop anxiety and depression. The total ISI score for medical staff in hotel quarantine was significantly higher than those in home quarantine. Total 199 doctors and nurses who completed the 1-year follow-up study. Compared with baseline, HADS and ASDS scores decreased significantly one year after the end of quarantine, while ISI scores did not change significantly.

CONCLUSION

Sporadic COVID-19 cases had a greater psychological impact on residents in surrounding communities, mainly manifested as insomnia and depressive symptoms. Hotel quarantine aggravated the severity of insomnia in medical staff, whose symptoms lasted ≥ 1 year.

Global Trends in Nursing-Related Research on COVID-19: A Bibliometric Analysis

Background

Coronavirus disease 2019 (COVID-19) has significantly impacted healthcare, especially the nursing field. This study aims to explore the current status and hot topics of nursing-related research on COVID-19 using bibliometric analysis.

Methods

Between 2019 and 2022, publications regarding nursing and COVID-19 were retrieved from the Web of Science core collection. We conducted an advanced search using the following search query string: TS = (“Novel coronavirus 2019” or “Coronavirus disease 2019” or “COVID 19” or “2019-nCOV” or “SARS-CoV-2” or “coronavirus-2”) and TS = (“nursing” or “nurse” or “nursing-care” or “midwife”). Bibliometric parameters were extracted, and Microsoft Excel 2010 and VOSviewer were utilized to identify the largest contributors, including prolific authors, institutions, countries, and journals. VOSviewer and CiteSpace were used to analyze the knowledge network, collaborative maps, hotspots, and trends in this field.

Results

A total of 5,267 papers were published between 2020 and 2022. The findings are as follows: the USA, China, and the UK are the top three prolific countries; the University of Toronto, the Harvard Medical School, the Johns Hopkins University, and the Huazhong University of Science &amp; Technology are the top four most productive institutions; Gravenstein, Stefan, and White, Elizabeth M. from Brown University (USA) are the most prolific authors; The International Journal of Environmental Research and Public Health is the most productive journal; “COVID-19,” “SARS-CoV-2,” “nurse,” “mental health,” “nursing home,” “nursing education,” “telemedicine,” “vaccine-related issues” are the central topics in the past 2 years.

Conclusion

Nursing-related research on COVID-19 has gained considerable attention worldwide. In 2020, the major hot topics included “SARS-CoV-2,” “knowledge,” “information teaching,” “mental health,” “psychological problems,” and “nursing home.” In 2021 and 2022, researchers were also interested in topics such as “nursing students,” “telemedicine,” and “vaccine-related issues,” which require further investigation.

The influence of lifestyles to cope with stress over mental health in pregnant and postpartum women during the COVID-19 pandemic

The COVID-19 pandemic affected daily life routines and lifestyles of pregnant and postpartum women and increased their stress and risk of suffering from mental health problems. The aim of this study was to analyse which sociodemographic variables, COVID-19 exposure variables and lifestyles to cope with stress variables predicted anxiety, depression, and PTSD symptoms in pregnant and postpartum women during the COVID-19 pandemic. A cross-sectional design was performed with a sample of 3356 Spanish women participating in the Riseup-PPD-COVID-19 study. These participants completed an online survey composed of measures of anxiety (GAD-7), depression (EPDS), and PTSD related to COVID-19 (Checklist DSM-5), as well as demographics, exposure to COVID-19, and lifestyles to cope with stress. Regarding results, 47.2% showed depression and a third reported anxiety, whereas moderate scores were observed in PTSD symptoms. The most commonly used strategies to cope with stress in the COVID-19 pandemic were talking with friends and family and increasing time with social networks. Better results in mental health were associated with coping strategies such as talking with family and friends or participating in family activities, physical activity, sleeping well at night, eating healthier, and increasing personal care. Furthermore, poor results in mental health were observed in those participants who increased time with screens, ate fast food, reported substance use, and talked more frequently with health professionals. More symptoms were also observed in younger women, primiparous women, and those who reported more exposure to COVID-19. The results underline the need to strengthen the mental health of pregnant and postpartum women. Trial registration: ClinicalTrials.gov Identifier: NCT04595123.

COVID-19 news consumption and distress in young people: A systematic review

BACKGROUND

The COVID-19 pandemic has brought challenges for the mental health of young people. The volume, negative content and potential for misinformation within COVID-19 related news can be an additional cause of distress. This systematic review aims to synthesise the research findings on the relationship between COVID-19 news and distress in young people.

METHODS

Following the PRISMA guidelines, PubMed, Web of Science, and PsycINFO databases were searched on 24 April 2021 for articles that contained empirical research examining the association between COVID-19 news consumption and mental health in samples of young people with a mean age between 10 and 24 years.

RESULTS

The 13 included studies involved 760,474 participants in predominantly cross-sectional studies, with data collected during COVID-19 lockdowns across seven countries. Increased consumption of COVID-19 news was associated with a decline in mental health (n = 11). The results were more consistent for news obtained on social media with variation for traditional media sources. Misinformation may further explain the relationship.

LIMITATIONS

Heterogeneity across study methodologies, lack of longitudinal research and validated measures of news consumption.

CONCLUSIONS

The reviewed literature supports the association between increased consumption of COVID-19 related news and decreased mental health in young people. This group may benefit from support to mitigate the psychological impacts of COVID-19 news. Future research should utilise longitudinal designs, ecological momentary assessments, and reliable/valid measures of news consumption to explore the negative mental health associated with COVID-19 news in young people.

COVID-19 Vaccine Acceptance and its Predictors among College Students in Addis Ababa, Ethiopia, 2021: A Cross-Sectional Survey

BACKGROUND

The coronavirus disease pandemic disrupted the normal social and economic activities of the people resulting in over 3 million deaths worldwide. Piece of literature depicted that predictors of vaccine acceptance are complex, multiple, and vary depending on the type of vaccine involved.

OBJECTIVE

The study aimed at assessing the COVID-19 acceptance and its predictors among college students in Addis Ababa, Ethiopia, 2021.

METHODS

A multi-center-institutional-based cross-sectional study was conducted among 407 participants from three institutions in Addis Ababa selected based on a simple random sampling method from May 01 to July 30, 2021. A self-administered structured questionnaire was used for the collection of data, after which informed consent was obtained from all the included study participants. Descriptive statistics was used for the summarization of the data. Binary (bivariate and multivariate) logistic regression was applied for the identification predictors of vaccine acceptance with their respective 95% confidence interval and less than 5% p-value for the ascertainment of presence of association.

RESULTS

The level of vaccine acceptance was 39.8% (95% CI: 35.0-44.7%). Being male (AOR: 0.463, 95% CI: 0.284-0.755, P < 0.001), living with children under the age of five (AOR: 2.295; 95% CI: 1.416-3.721, P < 0.05), living with an elderly (AOR: 1.609, 95% CI: 1.016-2.548, P < 0.05) and having had poor knowledge (AOR: 2.187, 95% CI: 1.391-3.438, P < 0.001) were predictors significantly associated with an increased level of vaccine acceptance.

CONCLUSION AND RECOMMENDATION

The level of vaccine acceptance among college students in Ethiopia was lower than necessary to achieve herd immunity. Sex, living with under-five children, and elderly, and knowledge were predictors of COVID-19 acceptance. Concerned bodies were suggested to work over the identified predictors of vaccine acceptance in the study settings.

Fear of COVID-19, prolonged smartphone use, sleep disturbances, and depression in the time of COVID-19: A nation-wide survey

BACKGROUND

The COVID-19 pandemic has had a wide range of behavioral and psychological effects on the general population. This study examined the relationship between fear of COVID-19, daily smartphone use, sleep disturbance, and depression in the general population during the early stage of COVID-19.

METHODS

An online nation-wide survey was conducted from March 20 to April 10, 2020. Sociodemographic information, including age, gender, educational attainment, vocation, and duration of self-isolation, was collected; fear of COVID-19 and other objective exposures, daily hours of smartphone use, night sleep duration, sleep disturbance, and depressive symptoms were measured with structured questions and PHQ-9. There were 1,280 questionnaires in total, and 1,250 valid questionnaires remained.

RESULTS

The prevalence of sleep disturbance and depression were found to be 13.1 and 10.7%, respectively. Feelings of extreme fear, longer smartphone use, difficulty initiating sleep, and early morning awakening were significant risk factors for depression. Daily hours of smartphone use, difficulty initiating sleep, and early morning awakening partially mediated the association between feeling extremely scared of the pandemic and depression.

CONCLUSION

Psychological interventions in a major public health crisis should focus more on the subjective perception of pandemic fear. At the same time, daily smartphone use and sleep disturbances could serve as targets for monitoring and intervention for depression during a pandemic.

Benevolent Childhood Experiences and Depressive Symptoms Among Chinese Undergraduates: A Moderated Mediation Model Examining the Roles of Uncertainty Stress and Family Relationship

Background: The evidence on the association between benevolent childhood experience (BCE) and depressive symptoms in students is complex. This study aims to explore the underlying mediation mechanism of BCE toward depressive symptoms and whether this link was moderated by the family relationship among Chinese undergraduates. Methods: From March 2021 to May 2021, a cross-sectional study was conducted in China, and 1821 undergraduates were recruited in this study. Participants were asked to complete a self-reported electronic questionnaire. The software SPSS PROCESS macro was used to test the mediation and mediated moderated modeling analysis. Results: Mediation analysis indicated that uncertainty stress (US) partly mediated the link between BCE and depressive symptoms (indirect effect = -0.47, 95% bootstrap CI = -0.55, -0.39). The indirect effect of the US accounted for 39.63% of the total variance in depression. Moderation analysis indicated that the association between the US and depressive symptoms was significantly modified by family relationships (interact effect = -0.019, P < 0.001). An integrative moderated mediation analysis indicated that the indirect effect from BCE to depressive symptoms through the US was also moderated by family relationships (interact effect = -0.012, P = 0.014). Conclusion: Uncertainty stress plays a key role in bridging BCE and depressive symptoms while the family relationship can buffer the impact of the US on depressive symptoms among Chinese undergraduates. Enhancing tolerance of uncertainty and improving family relationships are needed to protect undergraduates from depressive symptoms.

Knowledge, attitude, and use of protective measures against COVID-19 among nurses: a questionnaire-based multicenter cross-sectional study

Background

During this pandemic, nurses have always been on the frontline and are probably the first healthcare providers to interact with patients presenting with symptoms of COVID-19. The main aim of this multicenter study was to assess knowledge, attitude, and use of protective measures against COVID-19 among nurses across the Occupied Palestinian Territory (oPt) during the ongoing pandemic.

Methods

This was a questionnaire-based multicenter cross-sectional study that was conducted in the period between October 2020 to December 2020. The study tool tested knowledge (8-item), attitude (2-item), and use of protective measures against COVID-19 (3-item) among nurses. Associations between nurses’ characteristics and their knowledge, attitude, and use of protective measures were investigated using Student’s t-test, Analysis of Variance, and Pearson’s correlations. To control potentially confounding variables, predictors of higher knowledge, attitude, and use of protective measures were identified using multiple regression analyses.

Results

The study tool was complete by 455 nurses. The mean of knowledge, attitude, and use of protective measures scores were 75.7% (SD:12.4%), 75.1% (SD: 17.7%), and 91.6% (SD: 18.2%), respectively. Multiple linear regression models showed that high knowledge was predicted by being female (p-value = 0.004) and self-rating social status as high (p-value = 0.005). Higher attitude was predicted by being female (p-value = 0.005), self-rating academic achievements as high (p-value = 0.007), and having contracted COVID-19 (p-value = 0.001). Higher use of protective measures was predicted by self-rating academic achievements as high (p-value = 0.010).

Conclusion

Findings of this study suggested that nurses in the oPt had high knowledge, relatively optimistic attitude, and appropriately used protective measures against COVID-19 during the ongoing pandemic. Knowledge, attitude, and use of protective measures among nurses should continuously be updated as information unfold during the ongoing pandemic. More efforts are still needed to ensure protection of healthcare providers including nurses from contracting COVID-19.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00689-x.

Public Awareness and Utilization of 937-Telephone Health Services in the Kingdom of Saudi Arabia Before and During the COVID-19 Pandemic: Longitudinal Study

Background

Telehealth plays a key role in supporting health care systems and influencing methods of health care delivery. Government laws and medical operating protocols have been largely modified to provide remote care to reduce social contact and ensure a safer patient environment. In the Kingdom of Saudi Arabia (KSA), the Ministry of Health (MOH) introduced several forms of telemedicine as alternatives to face-to-face consultations in clinical settings.

Objective

This study aimed to assess the awareness and utilization of telehealth services before and during the COVID-19 outbreak in the KSA.

Methods

In this longitudinal study, we compared the awareness and utilization of 937-telephone health services (ie, a toll-free telephone service to provide medical and administrative health care services at any time for the population) before and during the COVID-19 outbreak in the KSA. Using a convenience sampling technique, a validated web-based questionnaire was distributed on social media platforms (Facebook, Twitter, and WhatsApp) at 2 timepoints: before (February 2019) and during (May 2020) the COVID-19 pandemic.

Results

The study sample comprised a total of 1961 participants who completed the questionnaire before (n=1303, 66%) and during (n=658, 33%) the COVID-19 pandemic. Both awareness (before=46% vs during=78%) and utilization (before=42% vs during=48%) of the 937-telephone health services increased significantly during the pandemic (P<.001). No significant association of the awareness or utilization of 937-telephone health services before and during the COVID-19 pandemic was found with respect to the participants’ age, education level, having children, or having any chronic disease.

Conclusions

Our findings indicate significant increases in the awareness and utilization of 937-telephone health services during the early days of the COVID-19 pandemic, suggesting an increase in public acceptance of the service and providing evidence of an equitable telemedicine service for the population. Further studies are needed to provide a deeper understanding of the barriers and facilitators to the use of 937-telephone health services for different groups of the population.

Adherence to preventive behaviors among college students during COVID-19 pandemic in China: The role of health beliefs and COVID-19 stressors

Before herd immunity is reached, preventive practices still play an important role in controlling the COVID-19 pandemic. Adherence to preventive behaviors could be determined by individuals' health beliefs, which would be influenced by antecedent factors such as previous exposure to pandemic stressors. Applying the health belief model (HBM), this study aims to examine the mediation association among COVID-19 stressors, HBM constructs, and preventive behaviors. Longitudinal data were collected from 1225 Chinese college students using web-based surveys at wave 1 (w1; between January 31 and February 11, 2020) and wave 2 (w2; between March 20 and April 3, 2020). Participants reported their COVID-19 stressors (w1), five HBM constructs (w2), and preventive behaviors (w1 and w2). Paired t-tests suggested that social distancing and self-quarantine behaviors decreased while precautionary behaviors increased from w1 to w2. Path analysis indicated that two HBM constructs (perceived barriers and self-efficacy) mediated the association between COVID-19 stressors and precautionary behaviors. These findings suggested that tailored prevention intervention for college students should attend to perceived barriers and self-efficacy. Individuals who exposed to multiple pandemic stressors merit particular attention and intervention should account for their early pandemic stress experiences.

Effects of High-Intensity Interval Training and Moderate-Intensity Training on Stress, Depression, Anxiety, and Resilience in Healthy Adults During Coronavirus Disease 2019 Confinement: A Randomized Controlled Trial

Objective: This study aimed to compare the effects of two intervention programs, (1) high-intensity interval training (HIIT) and (2) moderate-intensity training (MIT), on anxiety, depression, stress, and resilience during the confinement caused by the coronavirus disease 2019 (COVID-19) in healthy adults. Methods: A total of 67 adults who participated were randomly assigned to two groups: HIIT and MIT groups. The MIT group had to perform a home-based intervention based on aerobic exercises, whereas the HIIT group had to perform a home-based intervention based on HIIT exercises. The two groups (HIIT and MIT) had to complete the same physical exercise volume, 40 min per session (6 days per week) during the confinement period (6 weeks). Depression, anxiety, stress, and resilience were assessed before and after the intervention. Results: Results showed that HIIT and MIT significantly reduced the stress, anxiety, and depression as well as increase the resilience (p < 0.05). Moreover, the improvements obtained in the HIIT group seem to be greater than those of the MIT group in depression (p < 0.05). Conclusions: HIIT and MIT decreased anxiety, stress, and depression as well as increased resilience during the COVID-19 confinement. In addition, the HIIT intervention seemed to be more beneficial to reduce depression than the MIT intervention.

Vaccine acceptance among college students in South Carolina: Do information sources and trust in information make a difference?

BACKGROUND

To control the COVID-19 pandemic, governments need to ensure a successful large-scale administration of COVID-19 vaccines when safe and efficacious vaccines become available. Vaccine acceptance could be a critical factor influencing vaccine uptake. Health information has been associated with vaccine acceptance. For college students who are embracing a digital era and being exposed to multimedia, the sources of COVID-19 vaccine information and their trust in these sources may play an important role in shaping their acceptance of vaccine uptake.

METHODS

In September 2020, we conducted an online survey among 1062 college students in South Carolina to understand their perceptions and attitudes toward COVID-19 vaccination. Descriptive analysis and linear regression analysis were used to investigate vaccine information sources among college students and examine how COVID-19 vaccine acceptance was associated with information source and trust level in each source.

RESULTS

The top three sources of COVID-19 vaccine information were health agencies (57.7%), mass media (49.5%), and personal social networks (40.5%). About 83.1% of the participants largely or always trusted scientists, 73.9% trusted healthcare providers, and 70.2% trusted health agencies. After controlling for key demographics, vaccine acceptance was positively associated with scientists as information sources but negatively associated with pharmaceutical companies as sources. Higher trust levels in mass media, health agencies, scientists, and pharmaceutical companies was significantly associated with higher COVID-19 vaccine acceptance. However, trust in social media was negatively associated with vaccine acceptance.

DISCUSSION

College students use multiple sources to learn about upcoming COVID-19 vaccines including health agencies, personal networks, and social media. The level of trust in these information sources play a critical role in predicting vaccine acceptance. Trust in health authorities and scientists rather than social media is related to higher level vaccine acceptance. Our findings echo the call for restoring trust in government, healthcare system, scientists, and pharmaceutical industries in the COVID-19 era and highlight the urgency to dispel misinformation in social media. Effective strategies are needed to disseminate accurate information about COVID-19 vaccine from health authorities and scientific research to improve vaccine communication to the public and promote COVID-19 vaccine uptake.