Anxiety and depression among people living in quarantine centers during COVID-19 pandemic: A mixed method study from western Nepal

Impact of the COVID-19 pandemic and a supertyphoon: A quantitative study in Cebu, Philippines

Pandemics and natural disasters are recognized to cause major disruptions. The main objective of this study was to explore the impacts of COVID-19 and supertyphoon Odette in Cebu, Philippines. A total of 2630 participants were interviewed exploring the impacts of COVID-19 and supertyphoon Odette. The majority of the respondents (2486/2630; 94.5%) had financial problems due to COVID-19. Almost three out of four respondents (1962/2630; 74.6%) experienced moderate to severe impact on their mental health. Almost a third of the respondents (874/2630; 33.2%) reported moderate to severe impact on their physical well-being, mostly related to weight-related disorders. Almost half of the respondents (1248/2630; 47.5%) experienced moderate to severe impacts on their relationships with family members, relatives, friends and neighbors. More than two-thirds of the respondents (1673/2360; 63.6%) reported moderate to severe financial problems due to supertyphoon Odette. Households who were financially impacted by Supertyphoon Odette were more likely not have recently migrated to their current residence (p<0.001), and to have lower monthly expenditure (p = 0.020). The specific financial problems reported by the majority (1671/2360; 64.5%) were increased expenses, followed by inability to work (623/2360; 23.7%). Almost two-thirds of the respondents (1680/2360; 63.9%) reported having mental health problems. The majority of respondents (1853/2360; 70.5%) had moderate to severe impacts on their living conditions, disrupted by interruption in electricity, water supplies, and house damage. The COVID-19 pandemic and supertyphoon Odette had multi-faceted effects with immediate and long-term implications and greater impacts among poorer households. Public health measures to counteract the consequences of both of these incidents require a multi-pronged and targeted approach.

The psychological impact of supervised quarantine facilities for the mitigation of COVID-19: A systematic review

BACKGROUND

Government mandated quarantine outside the home was implemented to mitigate COVID-19 in some countries. Individual studies report that this can result in psychological distress. Investigating levels of distress and associated risk factors across different settings would inform public health models of care during future pandemics. However, no previous systematic reviews have been conducted on the topic. Therefore, we systematically reviewed international research on the prevalence and risk factors of psychological distress within supervised quarantine facilities during the COVID-19 pandemic.

METHODS

A systematic review of the literature was conducted using Medline, Psychological and Behavioural Sciences, Psych Info, Cochrane databases and Google Scholar from January 2020 until June 2023. Relevant quantitative studies published in English were included.

RESULTS

13 studies (pooled participants n = 4366) were included in this review. The prevalence of psychological distress varied widely across the included studies (depression 4%-63%; anxiety 4%-100%; stress 1%-68%). Associated risk factors identified were also heterogeneous between studies and facilities.

CONCLUSION

In future pandemics, the benefits of infection mitigation need to be weighed against the risk of psychological distress. Models of care utilising specifically designed facilities, with greater freedoms, increased comfort and ease of access to mental health services may limit psychological distress.

Prevalence, determinants and care-seeking behaviour for anxiety and depression in Nepalese population: a secondary analysis of data from Nepal Demographic and Health Survey 2022

OBJECTIVE

To determine the prevalence and factors associated with anxiety and depression and the care-seeking behaviour among Nepalese population.

DESIGN AND SETTINGS

Secondary analysis of the data from nationally representative Nepal Demographic and Health Survey 2022.

PARTICIPANTS

Analysed data of 12 355 participants (7442 females and 4913 males) aged 15-49 years.

OUTCOME MEASURES

Depression and anxiety were assessed using Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder Assessment (GAD-7) tools, respectively.

STATISTICAL ANALYSIS

We performed weighted analysis to account for the complex survey design. We presented categorical variables as frequency, per cent and 95% confidence interval (CI), whereas numerical variables were presented as median, inter-quartile range (IQR) and 95% CI. We performed univariate and multivariable logistic regression to determine factors associated with anxiety and depression, and results were presented as crude OR (COR), adjusted OR (AOR) and their 95% CI.

RESULTS

The prevalence of depression and anxiety were 4.0% (95% CI 3.5 to 4.5) and 17.7% (95% CI 16.5 to 18.9), respectively. Divorced or separated participants were found to have higher odds of developing anxiety (AOR 2.40, 95% CI 1.74 to 3.31) and depression (AOR 3.16, 95% CI 1.84 to 5.42). Among ethnic groups, Janajati had lower odds of developing anxiety (AOR 0.77, 95% CI 0.65 to 0.92) and depression (AOR 0.67, 95% CI 0.49 to 0.93) compared with Brahmin/Chhetri. Regarding disability, participants with some difficulty had higher odds of developing anxiety (AOR 1.81, 95% CI 1.56 to 2.10) and depression (AOR 1.94, 95% CI 1.51 to 2.49), and those with a lot of difficulty had higher odds of anxiety (AOR 2.09, 95% CI 1.48 to 2.96) and depression (AOR 2.04, 95% CI 1.06 to 3.90) compared with those without any disability. Among those who had symptoms of anxiety or depression, only 32.9% (95% CI 30.4 to 34.4) sought help for the conditions.

CONCLUSIONS

Marital status and disability status were positively associated with anxiety and depression, whereas Janajati ethnicity had relatively lower odds of experiencing anxiety and depression. It is essential to develop interventions and policies targeting females and divorced individuals to help reduce the burden of anxiety and depression in Nepal.

A systematic review on the relationship between socioeconomic conditions and emotional disorder symptoms during Covid-19: unearthing the potential role of economic concerns and financial strain

BACKGROUND

Covid-19 has disrupted the lives of many and resulted in high prevalence rates of mental disorders. Despite a vast amount of research into the social determinants of mental health during Covid-19, little is known about whether the results are consistent with the social gradient in mental health. Here we report a systematic review of studies that investigated how socioeconomic condition (SEC)-a multifaceted construct that measures a person's socioeconomic standing in society, using indicators such as education and income, predicts emotional health (depression and anxiety) risk during the pandemic. Furthermore, we examined which classes of SEC indicators would best predict symptoms of emotional disorders.

METHODS

Following PRISMA guidelines, we conducted search over six databases, including Scopus, PubMed, etc., between November 4, 2021 and November 11, 2021 for studies that investigated how SEC indicators predict emotional health risks during Covid-19, after obtaining approval from PROSPERO (ID: CRD42021288508). Using Covidence as the platform, 362 articles (324 cross-sectional/repeated cross-sectional and 38 longitudinal) were included in this review according to the eligibility criteria. We categorized SEC indicators into 'actual versus perceived' and 'static versus fluid' classes to explore their differential effects on emotional health.

RESULTS

Out of the 1479 SEC indicators used in these 362 studies, our results showed that 43.68% of the SEC indicators showed 'expected' results (i.e., higher SEC predicting better emotional health outcomes); 51.86% reported non-significant results and 4.46% reported the reverse. Economic concerns (67.16% expected results) and financial strains (64.16%) emerged as the best predictors while education (26.85%) and living conditions (30.14%) were the worst.

CONCLUSIONS

This review summarizes how different SEC indicators influenced emotional health risks across 98 countries, with a total of 5,677,007 participants, ranging from high to low-income countries. Our findings showed that not all SEC indicators were strongly predictive of emotional health risks. In fact, over half of the SEC indicators studied showed a null effect. We found that perceived and fluid SEC indicators, particularly economic concerns and financial strain could best predict depressive and anxiety symptoms. These findings have implications for policymakers to further understand how different SEC classes affect mental health during a pandemic in order to tackle associated social issues effectively.

C. TB, Mandal RK, Pokharel S, Gupta R, G. C. KB. Internalized stigma related to COVID-19 and its psychosocial and mental health correlates: a multicentric health facility based observational study from Nepal

Introduction

The COVID-19 pandemic has led to physical and psychological complications and social consequences in the form of illness-related stigma. This study aimed (1) to assess the sociodemographic and clinical variable, as well as COVID-19 related knowledge and perception of persons admitted for COVID-19/Suspected COVID-19 in Nepal, (2) to determine their levels of COVID-19- related internalized stigma, depression, and anxiety symptoms, and (3) to evaluate the correlates of COVID-19- related internalized stigma.

Materials and methods

It was a cross-sectional exploratory study with a convenience sample of 395 participants (306 confirmed cases, 89 suspected cases) conducted between July-October 2020 in four health facilities in Madhesh and Lumbini provinces of Nepal. We used a semi-structured questionnaire to assess sociodemographic details, clinical information, COVID-19-related knowledge, perception, COVID-19-related internalized stigma, and the Hamilton Anxiety Depression Scale (HADS) in Nepali language. Descriptive statistics, correlation analyses, and linear regression analyses were performed. The level of statistical significance was considered at p < 0.05.

Results

Around 23.3% of the patients had anxiety symptoms, 32.9% had depressive symptoms, and 20.3% had high COVID-19-related internalized stigma (mean ISMI score: 2.51-4.00). Linear regression analyses showed a significant positive association of COVID-19-related internalized stigma total score, with the following eight factors, i.e., no income in the past one month (p = 0.013), below average socioeconomic status (p = 0.004), anxiety symptoms (p = <0.001), depressive symptoms (p = <0.001), recent testing positive for COVID-19 (p = <0.001), involuntary admission (p = <0.001), prior experience of being in isolation and quarantine (p = 0.045), and those who blame others for COVID-19 (p = 0.025).

Conclusion

COVID-19 survivors and suspects are vulnerable to symptoms of depression, anxiety, and COVID-19-related internalized stigma. For the first time from Nepal, our data suggests that COVID-19-related internalized stigma is associated with anxiety and depression symptoms, perceived below-average socioeconomic status, involuntary admission, prior experience of being in isolation and quarantine, recent COVID-19 positive report, self-blame, below-average socioeconomic status and no income in the past one month. Mitigating and preventing internalized stigma associated with a public health crisis such as COVID-19 is imperative by diagnosing and treating such mental health issues early and designing interventions and policies especially targeting vulnerable populations focusing on their economic background and socio-cultural beliefs.

Impact of COVID-19 on Anxiety and Depression - Biopsychosocial Factors

Anxiety and depression are prevalent mental disorders around the world. The etiology of both diseases is multifactorial, involving biological and psychological issues. The COVID-19 pandemic settled in 2020 and culminated in several changes in the routine of individuals around the world, affecting mental health. People infected with COVID-19 are at greater risk of developing anxiety and depression, and individuals previously affected by these disorders have worsened the condition. In addition, individuals diagnosed with anxiety or depression before being affected by COVID-19 developed the severe illness at higher rates than individuals without mental disorders. This harmful cycle involves several mechanisms, including systemic hyper-inflammation and neuroinflammation. Furthermore, the context of the pandemic and some previous psychosocial factors can aggravate or trigger anxiety and depression. Disorders are also risks for a more severe picture of COVID-19. This review discusses research on a scientific basis, which brings evidence on biopsychosocial factors from COVID-19 and the context of the pandemic involved in anxiety and depression disorders.

The Impact of Stress from Social Isolation during the COVID-19 Pandemic on Psychiatric Disorders: An Analysis from the Scientific Literature

The COVID-19 pandemic generated, in addition to severe symptoms, hospitalizations and deaths worldwide, as well as stress from the fear of the disease and social uncertainties, from restriction measures and social isolation. Stress from social isolation impacts mental health, aggravating existing conditions and triggering neuropsychiatric symptoms in individuals with biopsychosocial vulnerability. During and immediately after the period of social restriction imposed by the pandemic, the scientific community carried out several research protocols. These revealed results that relevantly demonstrate the harmful effect of the stress induced by the pandemic situation. This narrative review reports and discusses research results demonstrating impairments in psychiatric disorders such as autism spectrum disorder, dementia, eating disorders, schizophrenia, anxiety, and depression. In this sense, the community has identified a significant negative influence of social isolation on the mental health of individuals through the modification of individual routines and the absence of social interactions. Moreover, the community identified perceived differences related to the impacts on men and women. In addition to studies showing the effect of social isolation on disorders, an evaluation of protocols with some possible therapeutic intervention strategies during times of social restriction was developed.

The psychological well-being of people in a COVID-19 supervised quarantine facility: A mixed methods study

WHAT IS KNOWN ON THE SUBJECT?: Supervised Quarantine has been shown to impact the psychological well-being of those in quarantine both during the COVID-19 pandemic and in previous pandemics. There are few studies regarding the psychological impact of supervised quarantine for the purpose of COVID-19 mitigation. There is little research regarding the psychological well-being of professionals maintaining quarantine, despite the fact they risk potential psychological distress. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper addresses the paucity of knowledge regarding the psychological well-being of those undergoing quarantine in a purpose-built facility. The quarantined study population involved uniquely domestic arrivals and also professionals maintaining quarantine. Lack of control, isolation and miscommunication were perceived as challenging mental well-being. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Although psychological distress in Domestic arrivals appeared low, there are still identifiable stresses on mental well-being. Mental health workers need to be cognizant that point entry to COVID-19 quarantine (Domestic vs. International as well as specific regions) may influence risk of psychological distress. Mental Health nurses supporting those in quarantine should afford quarantined individuals a degree of choice, establish regular clear communication and consider how to establish peer support mechanisms within the quarantine environment.

ABSTRACT

INTRODUCTION: Supervised quarantine may compromise psychological well-being. There is equivocal evidence regarding psychological distress in compulsory supervised quarantine facilities.

AIMS

To evaluate the mental well-being of people undergoing and working in a supervised COVID-19 quarantine facility.

METHOD

Mixed methodology was used, including a cross-sectional analysis of psychological distress (DASS-21) and individual semi-structured interviews (10 professionals maintaining quarantine and 10 quarantined persons).

RESULTS

Overall levels of psychological distress were low. Those quarantining from Victoria had significantly lower depression scores compared to all other departure points. Qualitative analysis identified distress being linked to a lack of control, isolation and miscommunication.

DISCUSSION

Quarantine was associated with low levels of psychological distress. This was lower in people travelling from Victoria, a state where there were higher rates of infections and restrictions. Interviews showed that psychological distress was conceptualized as being associated with supervised quarantine, but participants recognized the overall importance of quarantine.

IMPLICATIONS FOR PRACTICE

Mental health professionals supporting quarantined people should consider original departure points may predict levels of psychological distress. Implementing ways of gaining control through affording choice, improving communication channels and establishing peer support networks within quarantine settings may help maintain mental well-being.

Perceptions around COVID-19 and vaccine hesitancy: A qualitative study in Kaski district, Western Nepal

Burgeoning morbidity and mortality due to COVID-19 pandemic including the peaks in outbreaks due to different variants have attracted global attention. Although the development and rolling out of vaccines have been impressive, low- and middle-income countries suffer from a double burden: (1) lack of adequate vaccines; and (2) low vaccine uptake (vaccine hesitancy). The main objective of this study was to explore perceptions around COVID-19 and vaccine hesitancy among urban and rural population in Western Nepal. A qualitative study was conducted in six urban wards of Pokhara municipality and four rural municipalities in Kaski district of Nepal. A semi-structured interview guide was used to interview participants who were selected purposively to explore the perceived burden of COVID-19 pandemic, roles, and contributions of vaccine. Nineteen interviews were conducted by telephone following a government recommendation to avoid face-to-face meetings. Audio-recorded interviews were thematically analysed after transcription and translation into English. COVID-19 is a major (public) health concern and affects people at an individual, societal and national level. People dreaded its health hazards and consequences and seemed to be compliant with public health measures such as maintaining social distance, wearing masks and maintaining hygiene. Vaccine was considered to be a major intervention to fight the pandemic, nonetheless, the rationale and benefits of vaccines were blemished by the perceived lack of the vaccine's effectiveness, duration of protection, and its potential side-events. Expedited development of vaccine was embraced with suspicion that vaccine may have incurred compromise in quality. Science and rationale behind vaccine were smeared by misinformation and clearly counteracting the misinformation were deemed critical. Providing information about vaccines through government entities (who are trusted) and respected individuals may engender trust and uptake of vaccine. Fighting off misinformation of COVID-19 is critical to curb the course of pandemic. Increased attention towards monitoring and investing in legitimacy of information and offering information through trusted sources can help improve the vaccine coverage.

Management of COVID-19 and vaccination in Nepal: A qualitative study

OBJECTIVE

The aim of this research is to investigate the perspective of citizens of Nepal on the management COVID-19, the roll-out of the vaccine, and to gain an understanding of attitudes towards the governments' handling of the COVID-19 pandemic.

METHOD

A qualitative methodology was used. In-depth interviews were conducted with 18 males and 23 females aged between 20 and 86 years old from one remote and one urban district of Nepal. Interviews were conducted in November and December 2021. A thematic approach was used to analyse the data, utilising NVivo 12 data management software.

RESULT

Three major themes were identified: (1) Peoples' perspective on the management of COVID-19, (2) people's perception of the management of COVID-19 vaccination and (3) management and dissemination of information. It was found that most participants had heard of COVID-19 and its mitigation measures, however, the majority had limited understanding and knowledge about the disease. Most participants expressed their disappointment concerning poor testing, quarantine, vaccination campaigns and poor accountability from the government towards the management of COVID-19. Misinformation and stigma were reported as the major factors contributing to the spread of COVID-19. People's knowledge and understanding were mainly shaped by the quality of the information they received from various sources of communication and social media. This heavily influenced their response to the pandemic, the preventive measures they followed and their attitude towards vaccination.

CONCLUSION

Our study concludes that the study participants' perception was that testing, quarantine centres and vaccination campaigns were poorly managed in both urban and rural settings in Nepal. Since people's knowledge and understanding of COVID-19 are heavily influenced by the quality of information they receive, we suggest providing contextualised correct information through a trusted channel regarding the pandemic, its preventive measures and vaccination. This study recommends that the government proactively involve grassroots-level volunteers like Female Community Health Volunteers to effectively prepare for future pandemics.

PATIENT AND PUBLIC CONTRIBUTION

This study was based on in-depth interviews with 41 people from diverse socioeconomic backgrounds. This study would not have been possible without their participation.

Understanding the Psychological Well-Being of International Arrivals in a Purpose-Designed Australian COVID-19 Quarantine Facility

Equivocal evidence suggests that mandatory supervised quarantine can negatively affect psychological well-being in some settings. It was unclear if COVID-19 supervised quarantine was associated with psychological distress in Australia. The sociodemographic characteristics associated with distress and the lived experiences of quarantine are also poorly understood. Therefore, this study aimed to evaluate the mental well-being of international arrivals undergoing supervised COVID quarantine in a purpose designed facility in the Northern Territory, Australia. We conducted a concurrent triangulation mixed-methods study comprising of an observational cross-sectional survey (n = 117) and individual qualitative interviews (n = 26). The results revealed that several factors were associated with distress, including significantly higher levels of depression for those who smoked, drank alcohol, had pre-existing mental health conditions and had no social networks in quarantine. Levels of psychological distress were also related to waiting time for re-entry (the time between applying to repatriate and returning to Australia) and flight origin. Qualitative data showed that despite quarantine being viewed as necessary, unclear communication and a perception of lack of control were affecting emotional well-being. This information is useful to inform the further development of models to identify those at most risk and support psychological well-being in quarantine settings.

Anxiety and depressive symptoms among home isolated patients with COVID-19: A cross-sectional study from Province One, Nepal

Home isolated patients infected with COVID-19 might be at increased risk of developing mental health problems. The study aimed to identify the prevalence and factors associated with anxiety and depression among COVID-19 home isolated patients in Province One, Nepal. This was a cross-sectional study conducted between February 17, 2021, to April 9, 2021. A total of 372 home isolated patients from Province One were phone interviewed in the study. Anxiety and depression were measured using a 14-items Hospital Anxiety and Depression Scale (HADS). Multivariable logistic regression analysis was done to determine the risk factors of anxiety and depression. Among home isolated COVID-19 infected participants, 74.2% and 79% had symptoms of anxiety (borderline: 48.7% and abnormal: 25.5%) and depression (borderline: 52.7% and abnormal: 26.3%), respectively. Watching television was significantly associated with lower odds of experiencing symptoms of anxiety and depression. Females had significantly higher odds of having depression symptoms compared to males while ever married, those with COVID-19 related complications, and those taking medicine for the treatment of COVID-19 symptoms had a higher likelihood of exhibiting symptoms of anxiety. A focus on improving the mental health well-being of COVID-19 infected patients in home settings with connection to the health services is warranted with timely psychological interventions.

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.

Assessment of fear, anxiety, obsession and functional impairment due to COVID-19 amongst health-care workers and trainees: A cross-sectional study in Nepal

Background:

The emergence of the COVID-19 epidemic threw the world into turmoil. The medical community bore the brunt of the pandemic's toll. Long work hours, and a lack of personal protective equipment (PPE) and social support all had an influence on mental health.

Methods:

This cross-sectional study was conducted among Lumbini Medical College Teaching Hospital students and employees in Palpa, Nepal. Data entailing their demographic details, pre-existing comorbidities, or death in the family due to COVID-19 was collected using a self-administered survey. In addition, the level of fear, anxiety, obsession, and functional impairment due to COVID-19 was recorded using previously validated respective scales.

Results:

In total, 403 health-care workers and trainees participated in our study. The mean age of the study participants was 23±4 years, and more than half of them (n=262, 65%) were females. A significant association was found between fear score with age (p-value=0.04), gender (p-value <0.01) and occupation (p-value<0.001). The participants suffering from chronic diseases (p-value=0.36), were not found to be significantly obsessed with COVID-19. Age (p-value=0.34), was not found to be significantly associated with higher anxiety levels. Nursing students suffered from a significantly greater functional impairment than other health-care professionals (mean rank score=269.15, p-value < 0.001). A moderately positive correlation was observed between fear, anxiety, obsession, and functional impairment scales.

Conclusion:

This study revealed various socio-demographic characteristics as risk factors for psychological stress in the people related to the health-care profession of Nepal during the COVID-19 pandemic. A viable answer to this quandary might be adequate psychosocial intervention by health-care authorities, increased social support, and the introduction of better mental health management measures for the front-line health-care workers.

The impact of COVID-19 and control measures on public health in Thailand, 2020

BACKGROUND

The COVID-19 virus has been an emerging disease causing global outbreaks for over a year. In Thailand, transmission may be controlled by strict measures that could positively and negatively impact physical health and suicidal behavior.

METHODS

The incidence of COVID-19 was retrieved from the Department of Disease Control (DDC). The impact of viral diseases was retrieved from the open-source of the DDC and King Chulalongkorn Memorial Hospital. The road accidents data were from the Thai Ministry of Transport. The suicidal behavior data were obtained from the Department of Mental Health. We compared data from the year 2019 with the pandemic COVID-19 outbreak period in 2020, before lockdown, during lockdown, easing, and new wave period using unpaired t-test and least-squares linear regression. We compared the impact of the outbreak on various data records in 2020 with corresponding non-outbreak from 2019.

RESULTS

There was a significant decline in cases of influenza (p < 0.001) and norovirus (p = 0.01). However, there was no significant difference in RSV cases (p = 0.17). There was a dramatic increase in attempt to suicides and suicides (p < 0.001). There was no impact on roadside accidents and outpatient department visits.

DISCUSSION

The extensive intervention measures during lockdown during the first wave positively impacted total cases for each period for acute respiratory and gastrointestinal tract diseases, car accidents, and injuries and negatively impacted indicators of suicidal behavior. The data support government policies that would be effective against the next outbreak by promoting the "new normal" lifestyle.

The lived experience of hotel isolation and quarantine at the Aotearoa New Zealand border for COVID-19: A qualitative descriptive study

Hotel-based Managed Isolation and Quarantine (MIQ) is a key public health intervention in Aotearoa New Zealand's (NZ) COVID-19 border control strategy for returning citizens and permanent residents. We aimed to investigate the experience of transiting through MIQ in NZ, to inform future refinements of this type of system. A qualitative thematic analysis method was utilised to explore experiences in depth with seventy-five individuals who had undergone MIQ in NZ between April 2020 and July 2021. Participants were interviewed by telephone or Zoom or completed an online qualitative questionnaire. Interviews were audio recorded, transcribed and coded; questionnaire responses were sorted and coded. All data were subjected to thematic analysis. Three main themes described the key elements of the participants' experience of MIQ that influenced their overall experiences: 1) The MIQ process, 2) MIQ Hotels, and 3) Individual experience. The variation in participants' overall experience of MIQ was strongly influenced by their perceptions of how well the MIQ process was managed (including communication, flexibility, and compliance with disease prevention and control measures); and the quality of the hotels they were allocated to (in particular hotel staff, meals and information). This valuable insight into the experience of individuals in NZ MIQ hotels can inform better planning, management and implementation of the MIQ process for NZ and adds to the literature of countries utilising such strategies to minimise the transmission of COVID-19, whilst protecting the wellbeing of those using the system.

Impact of the COVID-19 pandemic on children's mental health: A systematic review

BACKGROUND

The outbreak of COVID-19 in December 2019 has caused unprecedented disruption to the structure of children's daily lives due to school closures, online learning, strict social distancing measures, limited access to outdoor activities and many other restrictions. Since children are more susceptible to stress than adults and there is a growing concern about the potential debilitating consequences of COVID-19 for children's mental health, the present review aims to provide empirical evidence on the groups who are most at risk of mental health problems and uncover the risk and protective factors of children's mental health.

METHODS

A systematic search was performed, in accordance with PRISMA guidelines, in the electronic databases Web of Science (including SSCI and A&HI) and EBSCOhost (including ERIC, MEDLINE and APA PsycArticles and APA PsycINFO), for any empirical studies published between January 2020 and February 2022 that focused on children ≤ 12 years old.

RESULTS

An initial search identified 2,133 studies. A total of 30 studies fulfilled the inclusion criteria and were analyzed. The evidence showed that many children were affected by the COVID-19 pandemic and experienced internalizing and externalizing behaviors. Worsened child mental health outcomes reflected socioeconomic inequalities as most at-risk children had parents with low educational attainment, were from families of low socioeconomic status and lived in small homes. Key risk factors were identified, including unhealthy lifestyle behaviors (extended screen time, sleep disturbances and less physical activity), increased pandemic-related stressors among parents and deteriorated mental health of parents, which were directly or indirectly associated with the pandemic safety measures, such as home confinement or social distancing. Protective factors including parents' resilience, positive parent-child relationship and school connectedness in relation to children's mental health were reported.

CONCLUSION

The overall results highlight the urgent need for the implementation of tailor-made interventions for children with signs of internalizing and externalizing behaviors. Health promotion and prevention strategies by the government to maintain the mental health of children, particularly those from lower SES families who are at higher risk of worsened mental health are essential for post-pandemic policies.

Health System Preparedness for COVID-19 and Its Impacts on Frontline Health-Care Workers in Nepal: A Qualitative Study Among Frontline Health-Care Workers and Policy-Makers

BACKGROUND

Rapidly growing coronavirus disease 2019 (COVID-19) pandemic has brought unprecedented challenges to the health system in Nepal. The main objective of this study was to explore the health system preparedness for COVID-19 and its impacts on frontline health-care workers in Nepal.

METHODS

Semi-structured interviews were conducted among 32 health-care workers who were involved in clinical care of COVID-19 patients and four policy-makers who were responsible for COVID-19 control and management at central and provincial level. Interviews were conducted through telephone or Internet-based tools such as Zoom and Skype. All interviews were audio-recorded, transcribed into English, and coded using inductive and deductive approaches.

RESULTS

Both health-care workers and policy-makers reported failure to initiate pre-emptive control measures at the early stages of the outbreak as the pivot in pandemic control. Although several measures were rolled out when cases started to appear, the overall health system preparedness was low. The poor governance, and coordination between three tiers of government was compounded by the inadequate personal protective equipment for health-care workers, insufficient isolation beds for patients, and poor engagement of the private sector. Frontline health-care workers experienced various degrees of stigma because of their profession and yet were able to maintain their motivation to continue serving patients.

CONCLUSION

Preparedness for COVID-19 was affected by the poor coordination between three tiers of governance. Specifically, the lack of human resources, inadequate logistic chain management and laboratory facilities for testing COVID-19 appeared to have jeopardized the health system preparedness and escalated the pandemic in Nepal. Despite the poor preparedness, and health and safety concerns, health-care workers maintained their motivation. There is an urgent need for an effective coordination mechanism between various tiers of health structure (including private sector) in addition to incentivizing the health-care workers for the current and future pandemics.