Scarlett Letter: A study based on experience of stigma by COVID-19 patients in quarantine

The assessment of health system responsiveness from the viewpoints of COVID-19 patients

BACKGROUND

Pandemics such as Corona are currently major health concerns worldwide. Health system responsiveness to the medical and non-medical needs of patients during pandemics is essential. This study aimed to examine hospitals' responsiveness to Corona patients.

METHODS

This descriptive and analytical research had a cross-sectional design. The study population included Corona patients discharged from 17 public hospitals of Mashhad University of Medical Sciences, Iran, in the spring of 2021. WHO questionnaire for health system responsiveness was used to collect data. 413 patients participated in the study who were selected by random classified sampling. To analyze the data, descriptive statistics, including frequency, and deviation, and to examine the relationship between variables, Kruskal-Wallis and Mann-Whitney tests were used.

RESULTS

In this study, one-third participants were in the age range of 31 to 40 (32.6%). The ability of 277 (70.5%) participants to pay treatment costs was very low, and low. 380 (96.7%) of the respondents had basic health insurance and 101 (25.7%) had supplementary insurance. In general, respondents evaluated the responsiveness of hospitals as 75.6. The highest score was related to confidentiality, and the lowest to prompt attention. There was no significant relationship between the total response score with demographic information.

CONCLUSION

The responsiveness of studied hospitals to Corona patients was adequate. However, there was dissatisfaction with the lack of timely treatment and medication. Moreover, the most important dimension of responsiveness was dignity. Healthcare providers need to pay attention to different aspects of responsiveness and improving the quality of and access to health services during pandemics and disasters.

COVID-19-related stigma among infected people in Sweden; psychometric properties and levels of stigma in two cohorts as measured by a COVID-19 stigma scale

BACKGROUND

Epidemics have historically been accompanied by stigma and discrimination. Disease-related stigma has often been shown to have severe consequences for physical, mental and social wellbeing and lead to barriers to diagnosis, treatment and prevention. The aims of this study were to investigate if a HIV-related stigma measure could be adapted and valid and reliable to measure COVID-19-related stigma, and also to investigate levels of self-reported stigma and related factors among people in Sweden with experience of COVID-19 and compare levels of COVID-19-related stigma versus HIV-related stigma among persons living with HIV who had experienced a COVID-19 event.

METHODS

Cognitive interviews (n = 11) and cross-sectional surveys were made after the acute phase of the illness using a new 12-item COVID-19 Stigma Scale and the established 12-item HIV Stigma Scale in two cohorts (people who had experienced COVID-19 (n = 166/209, 79%) and people living with HIV who had experienced a COVID-19 event (n = 50/91, 55%). Psychometric analysis of the COVID-19 Stigma Scale was performed by calculating floor and ceiling effects, Cronbach's α and exploratory factor analysis. Levels of COVID-19 stigma between groups were analysed using the Mann-Whitney U test. Levels of COVID-19 and HIV stigma among people living with HIV with a COVID-19 event were compared using the Wilcoxon signed-rank test.

RESULTS

The COVID-19 cohort consisted of 88 (53%) men and 78 (47%) women, mean age 51 (19-80); 143 (87%) living in a higher and 22 (13%) in a lower income area. The HIV + COVID-19 cohort consisted of 34 (68%) men and 16 (32%) women, mean age 51 (26-79); 20 (40%) living in a higher and 30 (60%) in a lower income area. The cognitive interviews showed that the stigma items were easy to understand. Factor analysis suggested a four-factor solution accounting for 77% of the total variance. There were no cross loadings, but two items loaded on factors differing from the original scale. All subscales had acceptable internal consistency, showed high floor and no ceiling effects. There was no statistically significant difference between COVID-19 stigma scores between the two cohorts or between genders. People living in lower income areas reported more negative self-image and concerns about public attitudes related to COVID-19 than people in higher income areas (median score 3 vs 3 and 4 vs 3 on a scale from 3-12, Z = -1.980, p = 0.048 and Z = -2.023, p = 0.024, respectively). People from the HIV + COVID-19 cohort reported more HIV than COVID-19 stigma.

CONCLUSIONS

The adapted 12-item COVID-19 Stigma Scale may be valid and reliable for measurement of COVID-19-related stigma. However, specific items may need to be rephrased or replaced to better correspond to the COVID-19 context. People who had experienced COVID-19 reported low levels of COVID-19-related stigma in general but people from lower income areas had higher levels of negative self-image and concerns about public attitudes related to COVID-19 than people from areas with higher income, which may call for targeted interventions. Although exhibiting more pronounced HIV stigma levels, people living with HIV who had experienced COVID-19 reported COVID-19-related stigma of the same low magnitude as their peers not living with HIV.

Prevalence and risk for symptoms of PTSD among survivors of a COVID-19 infection

COVID-19 pandemic has profound psychological effects worldwide and the psychological sequelae will persist for a long time among COVID-19 survivors. This cross-sectional study aimed to explore the prevalence of PTSD and its associated risk factors in COVID-19 survivors of the first wave pandemic. Demographics questionnaire, the Impact of Events Scale-Revised, the Pittsburgh Sleep Quality Index, the Fatigue Scale-14, the Resilience Style Questionnaire, the Short Version of COVID-19 Stigma Scale, the Peace of Mind Scale, and the Perceived Social Support Questionnaire were used to collect relevant information of the participants. The propensity score-matching (PSM) method was employed to adjust covariate or confounding variables in order to derive more accurate conclusions. After PSM, adjusted odds ratios and 95% confidence intervals were determined by binary conditional logistic regression. A total of 1541 COVID-19 survivors were included firstly and 15.2% reported PTSD symptoms, 1108 participants left after PSM. Four risk factors were identified: higher severity of COVID-19 infection, fatigue, COVID-19 related stigma and poor sleep quality. When designing psychological interventions to alleviate PTSD symptoms of COVID-19 survivors, reducing stigma and fatigue, and improve their sleep quality are suggested.

Mediating role of resilience in the relationship between COVID-19 related stigma and mental health among COVID-19 survivors: a cross-sectional study

BACKGROUND

The global coronavirus disease 2019 (COVID-19) has caused many negative effects on physical and mental health of patients who have survived COVID-19. Apart from some long-lasting physical sequelae, those COVID-19 survivors are also suffering stigma and discrimination at different levels around the world. The current study aims to assess the role resilience played in stigma and mental disorders among COVID-19 survivors.

METHODS

The cross-sectional study was carried out among former COVID-19 patients in Jianghan District (Wuhan, China) from June 10 to July 25, 2021. The demographic questions, the Impact of Events Scale-Revised, the Generalized Anxiety Disorder Questionnaire, the Patient Health Questionnaire, the Resilience Style Questionnaire and the Short Version of COVID-19 Stigma Scale of 12 items were used to collect relevant information of the participants. Descriptive analyses, Pearson correlation analysis and Structural Equation Modeling were used to make data description and analysis.

RESULTS

A total of 1541 out of 1601 COVID-19 survivors (887 females and 654 males) were included in the analysis. Perceived stigma of those COVID-19 survivors correlates significantly with anxiety (r = 0.335, P < 0.001), depression (r = 0.325, P < 0.001) and post-traumatic stress disorder (PTSD) (r = 0.384, P < 0.001). It has a direct effect on COVID-19 survivors' anxiety (β = 0.326, P < 0.001), depression (β = 0.314, P < 0.001), PTSD (β = 0.385, P < 0.001) and their resilience (β = - 0.114, P < 0.01). Resilience partially mediated the association between perceived stigma and anxiety (β = 0.020, P < 0.01), depression (β = 0.020, P < 0.01), and PTSD (β = 0.014, P < 0.01) among COVID-19 survivors.

CONCLUSION

Stigma has a significant negative impact on mental health, while resilience plays a mediator role in the relationship between stigma and mental health among COVID-19 survivors. Based on our study, we suggested that when designing psychological interventions for COVID-19 survivors, consideration should be taken into account to reduce stigma and improve resilience.

The unsanitary other and racism during the pandemic: analysis of purity discourses on social media in India, France and United States of America during the COVID-19 pandemic

The global rise of populism and concomitant polarizations across disenfranchised and marginalized groups has been magnified by so-called echo chambers, and a major public health crisis like the COVID-19 pandemic has only served to fuel these intergroup tensions. Media institutions disseminating information on ways to prevent the propagation of the virus have reactivated a specific discursive phenomenon previously observed in many epidemics: the construction of a defiled 'Other'. With anthropological lenses, discourse on defilement is an interesting path to understand the continuous emergence of pseudo-scientific forms of racism. In this paper, the authors focus on 'borderline racism', that is the use of an institutionally 'impartial' discourse to reaffirm the inferiority of another race. The authors employed inductive thematic analysis of 1200 social media comments reacting to articles and videos published by six media in three different countries (France, United States and India). Results delineate four major themes structuring defilement discourses: food (and the relationship to animals), religion, nationalism and gender. Media articles and videos portrayed Western and Eastern countries through contrasting images and elicited a range of reaction in readers and viewers. The discussion reflects on how borderline racism can be an appropriate concept to understand the appearance of hygienic othering of specific subgroups on social media. Theoretical implications and recommendations on a more culturally sensitive approach of media coverage of epidemics and pandemics are discussed.

Pakistan's COVID-19 Prevention and Control Response Using the World Health Organization's Guidelines for Epidemic Response Interventions

Massive coronavirus disease 2019 (COVID-19) devastation was anticipated in Pakistan due to poor track record of responding to epidemics. However, by adopting effective and timely response measures under strong government leadership, Pakistan averted a significant number of infections. We present the government of Pakistan's efforts to curb the spread of COVID-19, using the World Health Organization's guidelines for epidemic response intervention. The sequence of interventions is presented under the epidemic response stages, namely anticipation, early detection, containment-control, and mitigation. Key factors of Pakistan's response included decisive political leadership and implementation of a coordinated and evidence-informed strategy. Moreover, early control measures, mobilization of front-line health workers for contact tracing, public awareness campaigns, 'smart lockdowns', and massive vaccination drives are key strategies that helped flatten the curve. These interventions and lessons learnt can help countries and regions struggling with COVID-19 to develop successful strategies to flatten the curve and enhance disease response preparedness.

Perceived stigma among discharged patients of COVID-19 in Wuhan, China: A latent profile analysis

Background

Perceived stigma has greatly influenced the life quality of the COVID-19 patients who recovered and were discharged (RD hereafter). It is essential to understand COVID-19 stigma of RD and its related risk factors. The current study aims to identify the characteristics of perceived COVID-19 stigma in RD using latent profile analysis (LPA), to explore its psycho-social influencing factors, and to determine the cut-off point of the stigma scale using receiver operating characteristic (ROC) analysis.

Methods

A cross-sectional study was conducted among COVID-19 RD in 13 communities in Jianghan District, Wuhan City, Hubei Province, China from June 10 to July 25, 2021, enrolling total 1,297 participants. Data were collected on demographic characteristics, COVID-19 perceived stigma, post-traumatic stress disorder (PTSD), anxiety, depression, sleep disorder, fatigue, resilience, social support, and peace of mind. LPA was performed to identify different profiles of perceived COVID-19 stigma level. Univariate analysis and multinominal logistic regression analysis were conducted to explore the influencing factors in different profiles. ROC analyses was carried out to identify the cut-off value of perceived stigma.

Results

Among the participants, three profiles of perceived stigma were identified: "low perceived COVID-19 stigma" (12.8%), "moderate perceived COVID-19 stigma" (51.1%), and "severe perceived COVID-19 stigma" (36.1%). Multinominal logistic regression analysis revealed that older age, living with other people, anxiety, and sleep disorder were positively associated with moderate perceived COVID-19 stigma, while higher educational level was negatively associated with moderate perceived COVID-19 stigma. Female, older age, living with other people, anxiety, and sleep disorder were positively associated with severe perceived COVID-19 stigma, while higher educational level, social support, and peace of mind were negatively associated with severe perceived COVID-19 stigma. ROC curve of the Short Version of COVID-19 Stigma Scale (CSS-S) for screening perceived COVID-19 stigma showed that the optimal cut-off value was ≥ 20.

Conclusion

The study focuses on the issue of perceived COVID-19 stigma and its psycho-socio influencing factors. It provides evidence for implementing relevant psychological interventions to COVID-19 RD.

Quality of Life of People Living with HIV in Australia: The Role of Stigma, Social Disconnection and Mental Health

HIV is a manageable chronic illness, due to advances in biomedical management. However, many people living with HIV (PLHIV) continue to experience psychosocial challenges, which have been associated with poorer quality of life (QoL). This study aimed to explore how psychosocial factors contributed to the QoL of PLHIV in Australia; specifically, the relationship between HIV-related stigma, social connectedness, mental health, and QoL. Participants were 122 PLHIV attending The Albion Centre (a tertiary HIV clinic in Sydney, Australia), who completed questionnaires which measured HIV-related stigma, social support, mental health symptomology and QoL. Results indicated that HIV-related stigma predicted poorer QoL, as did mental health symptomology. Conversely, social connectedness improved QoL. Additionally, social connectedness was found to mediate the relationship between HIV-related stigma and QoL, whereas the hypothesized moderating role of mental health symptomology on this model was not significant. These findings provide insight into the impact of psychosocial factors on QoL, offering practitioners various points of clinical intervention.

Influencing factors of anxiety and depression of discharged COVID-19 patients in Wuhan, China

Objectives

This study is intended to assess the prevalence of depression and anxiety in individuals who had recovered from COVID-19 and been discharged from hospital (RD hereafter) in Wuhan, China, and to explore the factors associated with these mental disorders.

Methods

Participants of this study were the RD who were infected at the beginning of the outbreak from 13 communities in Jianghan District of Wuhan City, Hubei Province, China by convenience sampling in mid-2021. The Generalized Anxiety Disorder Questionnaire, the Patient Health Questionnaire, the Short Version of COVID-19 Stigma Scale, the Peace of Mind Scale, the Resilience Style Questionnaire, and the Perceived Social Support Questionnaire were used to collect relevant information of the participants. Descriptive analyses, Pearson correlation analysis, and logistic regression analysis were used to describe and analyze the data and to examine the factors associated with the mental health status of this population.

Results

In total, we recruited 1601 participants from 3059 COVID-19 patients, and 1541 participants completed the questionnaire survey, with a response rate of 96.25%. Finally, 1297 participants met the inclusion and exclusion criteria in this study, of whom 28.8% and 37.9% reported mild to severe levels of anxiety and depression symptoms. Perceived better mental health status during hospitalization, higher frequency of alcohol use per week, peace of mind, higher education level, and resilience were negatively associated with anxiety, while stigma and history of psychological or emotional counseling before infection was positively associated with anxiety. More severe clinical classification of COVID-19 and stigma (AOR = 1.057, P<0.001) were both positively associated with depression, while perceived better mental health status during hospitalization (AOR = 0.564, P<0.001), higher frequency of alcohol use per week (AOR = 0.462, P = 0.004), peace of mind (AOR = 0.857, P<0.001), and social support (AOR = 0.972, P = 0.034) were negatively associated with depression.

Conclusions

Tailored interventions on reducing stigma, enhancing mindfulness and social support should be taken into account to alleviate anxiety and depression among RD.

Conceptualizing the COVID-19 Pandemic: Perspectives of Pregnant and Lactating Women, Male Community Members, and Health Workers in Kenya

Pregnant women are at greater risk of adverse outcomes from SARS-CoV-2 infection. There are several factors which can influence the ways in which pregnant women perceive COVID-19 disease and behaviorally respond to the pandemic. This study seeks to understand how three key audiences-pregnant and lactating women (PLW), male community members, and health workers-in Kenya conceptualize COVID-19 to better understand determinants of COVID-19 related behaviors. This study used qualitative methods to conduct 84 in-depth interviews in three counties in Kenya. Data were analyzed using a grounded theory approach. Emerging themes were organized based on common behavioral constructs thought to influence COVID-19 related behaviors and included myths, risk perception, economic implications, stigma, and self-efficacy. Results suggest that risk perception and behavioral attitudes substantially influence the experiences of PLW, male community members, and health workers in Kenya during the COVID-19 pandemic. Public health prevention and communication responses targeting these groups should address potential barriers to preventive health behaviors, such as the spread of misinformation, financial constraints, and fear of social ostracization.

Experienced stigma and applied coping strategies during the COVID-19 pandemic in Germany: a mixed-methods study

OBJECTIVE

Health-related stigma is considered a social determinant of health equity and a hidden burden of disease. This study aimed to assess the level and dimensions of stigma and respective coping mechanisms in COVID-19 survivors.

METHODS

A mixed-methods study with sequential explanatory design was conducted at the University Hospital of Ulm, Germany. Stigma was assessed using the Social Impact Scale (SIS) including adult COVID-19 survivors with mild-to-severe disease. Subsequently, 14 participants were sampled with regard to gender, age and severity of disease for in-depth interviews to understand how stigma was experienced and coping strategies were applied. The questionnaire was analysed using descriptive statistics, t-test and analysis of variance. Content analysis was used for qualitative data.

RESULTS

From 61 participants, 58% were men and mean age was 51 years. The quantitative analysis of the SIS indicated an intermediate level of experienced stigma. Participants experienced stigma mainly as 'social rejection' (M=14.22, SD=4.91), followed by 'social isolation' (M=10.17, SD=4.16) and 'internalised shame' (M=8.39, SD=3.32). There was no significant difference in experienced stigma regarding gender, education, occupational status or residual symptoms. However, participants between 30 and 39 years of age experienced higher levels of stigma than other age groups (p=0.034). The qualitative analysis revealed how stigma seemed to arise from misconceptions creating irrational fear of infection, leading to stereotyping, vilification, discrimination and social exclusion of COVID-19 survivors, leaving them feeling vulnerable. Stigma cut through all social levels, from the individual level at the bottom to the institutional and societal level at the top. Social networks protected from experiencing stigma.

CONCLUSION

COVID-19-related stigma is a relevant burden in the ongoing pandemic. Providing accurate information and exposing misinformation on disease prevention and treatment seems key to end COVID-19-related stigma.

Social Life of Females with Persistent COVID-19 Symptoms: A Qualitative Study

Persistent COVID-19 symptoms (long COVID) may bring challenges to long haulers’ social lives. Females may endure more profound impacts given their special social roles and existing structural inequality. This study explores the effects of long COVID on the social life of female long haulers. We conducted semi-structured interviews via Zoom between April and June 2021 with 15 female long haulers in the United States, purposely recruited from Facebook and Slack groups and organization websites related to long COVID. Interviews were audio-recorded and transcribed verbatim with consent. The interview data were managed using MAXQDA and examined by thematic analysis. Long COVID negatively affected female long haulers’ social lives by causing physical limitations, economic issues, altered social relationships, social roles’ conflicts, and social stigma. Long COVID prevented female long haulers’ recovery process. Physical limitations altered their perceptions on body, and family–work conflicts caused tremendous stress. They also experienced internalized stigma and job insecurities. This study provides insights into challenges that COVID-19 female long haulers could face in their return to normal social life, underscoring the vulnerability of females affected by long COVID due to significant alterations in their social lives. Shifting to new methods of communication, especially social media, diminished the adverse effects of long COVID (e.g., social isolation).

Covid-19 stigmatization: A systematic literature review

Covid-19 has severe implications for the emergence of negative stigmatization of specific individuals and community groups. Due to labeling and discrimination, mental attacks cause psychological distress so seriously that it requires proper handling. Therefore, this study aims to conduct a systematic literature review on articles on COVID-19 stigmatization. This paper used descriptive analysis that 248 articles are from the Scopus database obtained by keyword Covid-19 stigmatization in the 2020–2021 time span were then processed and visualized using the Vosviewer software. The results reveal the three most dominant concepts studied: anxiety, isolation, and knowledge. The Covid-19 stigma arises due to low public knowledge, widespread Covid-19 disinformation, and lack of trust in the government. This research contributes to a description of the root causes and adverse effects of stigmatization during Covid-19 to help formulate recommendations for preventive and treatment actions that can be taken. Meanwhile, the limitation of this research is that the articles reviewed are only sourced from Scopus, so they do not have comparative data. Therefore, future studies require using a comparative analysis approach that uses a Web of Science (WoS) database.

Perceived Epidemic Risk and Depression Symptoms during the COVID-19 Pandemic: The Mediating Role of Security and the Moderation Role of Perceived Discrimination

The 2019 coronavirus disease pandemic has resulted in a significant increase in the incidence and prevalence of mental health problems such as anxiety and depression, posing a threat to peoples’ lives and health safety all over the world. Research suggests some potential relationships among perceived risk, discrimination, security, and depression symptoms. However, little attention has been paid to the complex mechanisms of the associations between these variables. This study aimed to examine the mediating role of security and moderation role of perceived discrimination in the prediction of perceived epidemic risk on depression symptoms. Thus, we aimed to identify if perceived epidemic risk is a positive predictor of depression. A cross-sectional study was conducted through an anonymous online survey in China during the COVID-19 pandemic which measured perceived epidemic risk, discrimination, security, and depression symptoms. A total of 3443 valid questionnaires were obtained. The results indicated that depression symptoms were predicted by perceived epidemic risk through the mediating role of security, and this mediating role of security was moderated by perceived discrimination. Specifically, high levels of perceived discrimination may lead to a significant decrease in personal security, thus clustering depressive symptoms. These findings shed light on the influence of the perceived risk of the epidemic on depression symptoms in the context of the epidemic situation, which may help to develop targeted interventions.

Self-control in Quarantined Individuals during the COVID-19 Pandemic in South Korea

PURPOSE

This study generated a model of self-control in quarantined individuals during the COVID-19 pandemic in South Korea.

DESIGN

Grounded theory methodology was utilized.

METHOD

21 participants who underwent quarantine participated in interviews.

FINDINGS

"Adhering to the quarantine rules to achieve a goal for the public good" was determined to be a core category describing self-control in quarantined individuals. They showed enduring behaviors with a specific pattern, which were classified into five phases.

CONCLUSION

With careful consideration, quarantine can be an effective means of protecting community.

CLINICAL EVIDENCE

Public health nursing interventions that fulfill basic needs and provide information are needed.

Validity and reliability of a modified short version of a stigma scale for use among Tunisian COVID ‐19 patients after quarantine: A cross‐sectional study

Background and Aim

The COVID‐19 is a stigmatizing infectious disease even after healing. Until now, no COVID‐19 stigma scale validated in Tunisian Arabic language among the general population is available. Developing such tools is necessary to detect COVID‐19 stigma and reduce it effectively. Indeed, stigmatization of COVID‐19 patients could increase the spread of this disease and its related mental health issues. We aimed at testing the validity of a translated and modified version of the 12‐item HIV stigma scale among Tunisian COVID‐19 patients.

Methods

A cross‐sectional study was conducted between November and December 2020 among a representative sample of COVID‐19 patients in the governorate of Sousse, Tunisia, after quarantine. The 12‐item HIV stigma scale was translated in Tunisian Arabic and then modified to be adapted to the Tunisian context. The preliminary modified version was administrated to the participants by pretrained medical doctors during phone calls. It consisted on 20 items covering the four stigma dimensions (personalized stigma, disclosure concerns, concerns with public attitudes, and negative self‐image). The psychometric evaluation of this version included internal consistency as well as principal component analysis (PCA).

Results

The responses of 346 COVID‐19 patients were obtained. Their median age was 40 years (interquartile range: 30‐54.5). Females represented 60.4% of them. The PCA resulted in a three factor solution with 14 items. This 14‐item scale demonstrated good internal consistency with a global Cronbach's α of 0.91 and values of 0.94, 0.93, and 0.98 for social stigma, negative self‐image, and disclosure concerns, respectively.

Conclusion

This study provides a reliable and valid instrument for stigma measuring among Tunisian COVID‐19 patients. The use of this scale would contribute in reducing the spread of this new infectious disease and its related mental health issues.

Depressive symptoms mediate COVID-associated stigma and quality of life: Stigma instrument validation and path analysis

BACKGROUND

The aim of this study was to adapt and modify the HIV/AIDS Stigma Instrument-Patient to develop the COVID-19 Stigma Instrument-Patient (CSI-P) and validate its psychometric characteristics, as well as explore how affected individuals in China experienced COVID-related stigma and its associated variables, including depressive symptomology and quality of life (QOL).

METHODS

From September to October 2020, 151 COVID-19 survivors recruited in Shanghai, China, completed a set of measures of demographic characteristics, depression, stigma, and QOL.

RESULTS

The 15-item CSI-P-2 achieved a Cronbach's α of 0.67 to 0.91. The six-factor structure was obtained by exploratory factor analysis. The mean score for the CSI-P-2 in Chinese COVID survivors was 8.14 ± 9.98. Regression analysis showed that survivors' age, comorbid diseases, education levels, and loneliness level were the factors influencing their COVID-19 stigma, explaining 37.80% of the total variance (F = 19.25, p < 0.001). Also, stigma's effect on QOL was significant in direct and indirect paths mediated by depressive symptomology.

LIMITATIONS

First, this sample might limit the generalization of the findings to other Chinese-speaking regions. Second, future longitudinal or experimental studies are warranted for checking and further refinement of the scale. Finally, future studies are needed on the changing dynamics of stigma in different stages of the pandemic.

CONCLUSIONS

The 29-item CSI-P-2 with six domains is an instrument with sound psychometric properties that can be used to measure COVID-19 stigma during the COVID-19 outbreak and, later, for COVID-19 survivors. Future studies should explore how to integrate the significant demographic and psychological characteristics influencing the experience of stigma work on this study into the development of stigma-reducing interventions.

Suicide, Stigma and COVID-19: A Call for Action From Low and Middle Income Countries

Suicide is a global health issue that needs to be addressed. The COVID-19 pandemic has resulted in an increased mental health burden. Stigma has obstructed efforts to prevent suicide as individuals who need urgent support do not seek appropriate help. The influence of stigma is likely to grow in tandem with the COVID-19 pandemic. The stigmatization of persons with mental illnesses is widespread worldwide, and it has substantial effects on both the individual and society. Our viewpoints aim to address the probable link between stigma and suicide in the wake of the current pandemic and propose ideas for reducing suicide-related stigma.

Development & validation of scales to assess stigma related to COVID-19 in India

Background & objectives

COVID-19 pandemic has triggered social stigma towards individuals affected and their families. This study describes the process undertaken for the development and validation of scales to assess stigmatizing attitudes and experiences among COVID-19 and non-COVID-19 participants from the community.

Methods

COVID-19 Stigma Scale and Community COVID-19 Stigma Scale constituting 13 and six items, respectively, were developed based on review of literature and news reports, expert committee evaluation and participants' interviews through telephone for a multicentric study in India. For content validity, 61 (30 COVID-19-recovered and 31 non-COVID-19 participants from the community) were recruited. Test-retest reliability of the scales was assessed among 99 participants (41 COVID-19 recovered and 58 non-COVID-19). Participants were administered the scale at two-time points after a gap of 7-12 days. Cronbach's alpha, overall percentage agreement and kappa statistics were used to assess internal consistency and test-retest reliability.

Results

Items in the scales were relevant and comprehensible. Both the scales had Cronbach's α above 0.6 indicating moderate-to-good internal consistency. Test-retest reliability assessed using kappa statistics indicated that for the COVID-19 Stigma Scale, seven items had a moderate agreement (0.4-0.6). For the Community COVID-19 Stigma Scale, four items had a moderate agreement.

Interpretation & conclusions

Validity and reliability of the two stigma scales indicated that the scales were comprehensible and had moderate internal consistency. These scales could be used to assess COVID-19 stigma and help in the development of appropriate stigma reduction interventions for COVID-19 infected, and mitigation of stigmatizing attitudes in the community.

Exploring COVID-19 patients' experiences of psychological distress during the disease course: a qualitative study

BACKGROUND

The Coronavirus Disease 2019 (COVID-19) is an emerging disease with many unknown clinical and therapeutic dimensions. Patients with COVID-19 experience a variety of psychological problems during the disease. Understanding patients' mental condition and their distress during the disease is the first step to help these patients. So, the aim of this study was to explain COVID-19 patients' experiences of psychological distress during the disease course.

METHODS

The present qualitative research was conducted in Iran from April 2020 to April 2021 using the conventional content analysis method. The participants included patients with COVID-19, selected by the purposeful sampling method. Data was collected through 34 telephone and in-person interviews and analyzed based on the method proposed by Lundman and Graneheim.

RESULTS

Qualitative data analysis led to the emergence of sources of psychological distress as the main theme as well as seven categories and seven sub-categories. The categories were the disease's nature (the subcategories of disease's unknown dimensions, and disease severity), the anxiety caused by preventive behaviors (the subcategories of quarantine, worry about transmitting the infection to others and obsessive thoughts related to disinfection measures), the inefficient management by the health system (the subcategories of poor health care condition and lack of spiritual care), death anxiety, stigma, anxiety after recovery, and sleep pattern disturbance.

CONCLUSION

Patients with COVID-19 experience great psychological distress during the acute phase of the disease or even long after recovery. It is suggested that psychological and spiritual counseling, as a key element of treatment and support for these patients, is provided to patients in the acute phase of the disease, as well as after recovery. National and local media should boost awareness about the disease as a dangerous yet preventable and curable infectious disease. People should follow health instructions and leave their seeing the disease as a taboo.

TRIAL REGISTRATION NUMBER

Not applicable.