Effective recommendations towards healthy routines to preserve mental health during the COVID-19 pandemic

Daylight exposure and mood in real life: Direct association and mediating role of sleep and routine regularity

The light/dark cycle is the main external cue to synchronize the human biological clock. Modern lifestyles typically lead to less daylight exposure and blunted 24 h-amplitude. We evaluated the association of outdoor daylight exposure (frequency, duration, regularity and shift) with chronotype estimated by sleep phase, regularity of routines, sleep, well-being (WHO-5), and depressive symptoms (PHQ-9), in a sample of 1,095 participants (81.8% female; 87.9% aged 18-49) surveyed online between July and November 2020. We analyzed direct and indirect associations in daylight-mood relationship with chronotype-estimate, routine regularity, and sleep as mediators. Outdoor daylight exposure was associated with WHO-5/PHQ-9 scores in mediation models, with higher total effects when the exposure was every day (β = 4.13 ± 0.53/ β = -3.81 ± 0.67), for more than 4 hours (β = 3.77 ± 0.91/ β = -3.83 ± 1.31) and during the morning (β = 3.41 ± 0.53/ β = -3.74 ± 0.70) in reference to lack of exposure. Chronotype-estimate, routine regularity score, and sleep problems acted as mediators, while social jetlag and sleep duration did not play an important role in this association. This study advanced the understanding of the complex interplay between light exposure, mental health, and individual characteristics of sleep and other routine regularities, and showed the benefits of optimizing daylight exposure to improve mental health.

Greater within- and between-day instability is associated with worse anxiety and depression symptoms

BACKGROUND

Depression and anxiety affect hundreds of millions of people worldwide, and their prevalence increased during the COVID-19 pandemic as social schedules were disrupted. This study explores the associations between anxiety and depression and within- and between-day instability of affective, somatic, and cognitive symptoms during the early pandemic stages.

METHODS

Participants (n = 153, ages 18-77, 72 % female) reported daily levels of affective (anxiety/sadness), somatic (appetite/sleepiness), and cognitive (concentration/energy) symptoms for 14-44 days at five timepoints: 0, 3, 6, 9, and 12 h after awakening. At the end of the study, participants completed validated scales for anxiety (GAD-7) and depression (PHQ-9). Symptom instability was assessed using the Absolute Real Variability (ARV) index. Regression models examined within-day instability (WD-I) and between-day instability (BD-I) with GAD-7 and PHQ-9 scores as outcomes.

RESULTS

Greater instability (both WD-I and BD-I) of affective symptoms correlated with elevated GAD-7 and PHQ-9 scores. For somatic and cognitive symptoms, greater BD-I was associated with higher scores.

LIMITATIONS

The study used retrospective daily data, which could benefit from real-time assessments for improved accuracy.

CONCLUSIONS

This study provides empirical evidence of a connection between greater anxiety and depression severity and increased instability in daily mood and physiological symptoms. The findings underscore the importance of consistent symptom monitoring to understand overall mental health trajectories. Additionally, it highlights the role of daily routines in stabilizing the circadian system, potentially regulating physiological and psychological processes and reducing symptom instability.

Assessing anxiety symptoms and Traumatic Event Scale scores among medical staff during the COVID-19 pandemic in Colombia: a descriptive cohort study in Bogotá

Objective

This study aims to assess anxiety and suffering symptoms amid the pandemic, determine factors linked to physicians' anxiety with COVID-19 patients and describe symptom progression in the initial year of follow-up.

Methods

Descriptive cohort study involving general practitioners, specialists and interns in the city of Bogotá. The Zung Anxiety Scale and the Traumatic Event Scale (TES) were employed and completed four times during the pandemic. A sample of 558 participants was taken. Physicians with prior diagnoses of psychiatric disorders were excluded. Bivariate tests and a logistic regression model were used.

Results

Some 7.3% of respondents had anxiety symptoms during the first survey (29/397 physicians) with a clinically significant impact of the traumatic event on 279 of the 397 (70%). Female gender (p=0.04), comorbidities (p=0.01), use of surgical gown (protective, p=0.01), perception of negative thoughts on the part of society (p=0.05), thoughts of wanting to give up or death (p<0.001) and presenting some clinical level of traumatic event impact (p<0.001) were associated with these anxiety symptoms. The multivariate model associated thoughts of quitting (OR 4.55; 95% CI 1.8 to 11.6) and the clinically significant level of TES (OR 7.8; 95% CI 1.0 to 62.5) with anxiety symptoms and the use of a surgical gown as a personal protection element (OR 0.222; 95% CI 0.12 to 0.73; p=0.009) with the protective factor.

Conclusions

The pandemic significantly impacted Bogota physicians, with around 7.3% of exhibiting anxiety symptoms during the initial assessment. This traumatic experience had a clinically significant effect on 70% of respondents. Over time, anxiety symptoms diminished. Addressing post-traumatic stress phenomena is crucial in similar scenarios to alleviate the impact on healthcare personnel's anxiety.

Routine regularity during a global pandemic: Impact on mental health outcomes and influence of chronotype

Among the public health recommendations for supporting mental health during the COVID-19 pandemic, many strategies had an impact on biological rhythms, like sleep hygiene, physical exercise and healthy eating habits. Considering the known relationship between circadian organization and mental health, our aim was to test the association between behavioral regularity and mental health, and its interaction with chronotype, in a large sample surveyed in Brazil. We collected longitudinal data using online questionnaires that assessed sociodemographic characteristics, behavioral routines, mental health (PHQ-9, GAD-7, WHO-5 scales), and chronotype estimation based on midpoint of sleep on free days - MSF (μMCTQ), in a sample of 1390 participants (81% females). We computed a Routine Regularity Score (RRS) that reflects regularity across four behaviors: sleep, eating, working, exercising. There was a strong negative association between RRS and the severity of anxiety and depressive symptoms (GAD-7 and PHQ-9 scores), which was weaker among participants with late MSF, and a strong positive association with well-being (WHO-5 scores). RRS was a mediator of the MSF-mental health association and a predictor of mental health states. This study provides empirical evidence that maintaining behavioral routines during times of hardship may serve as tools to alleviate the negative impact on mental health.

Sense of coherence and social support as predictors of mental health during COVID-19 pandemic

OBJECTIVES

to verify the role of sense of coherence, sense of national coherence, social support and trust in institutions to predict mental health in Brazilians during the COVID-19 pandemic.

METHODS

a cross-sectional study, carried out from November, 2020 to January, 2021 via an online survey. Standardized instruments were used. The sample consisted of 1,630 Brazilians. Pearson's correlation and linear regression were performed in data analysis.

RESULTS

sense of coherence was the only predictor of anxiety [β= -0.61; p<0.001], explaining 38% of the variance in its scores, while sense of coherence [β= 0.52; p<0.001], sense of national coherence [β= 0.16; p<0.001], and social support [β= 0.15; p<0.001] predicted positive mental health and together explained 51% of its variance.

CONCLUSIONS

the findings suggest that sense of coherence, sense of national coherence and social support represent important predictors for mental health and that strengthening these resources, could potentially promote Brazilians' mental health.

Impact of closed management on gastrointestinal function and mental health of Chinese university students during COVID-19

BACKGROUND

The innovative closed management of universities may have influenced the physical and mental health of students during the fourth stage of the COVID-19 pandemic in China. The study aimed to assess the gastrointestinal and mental health status of students in this stage and to explore the possible risk factors and mechanisms to provide a reference for future school responses to similar stressful events.

METHOD

A multicenter, cross-sectional survey was administered to 598 college students from 10 Chinese universities. The study used the 7-item Generalized Anxiety Disorder Scale (GAD-7), 9-item Patient Health Questionnaire (PHQ-9), Fear of COVID-19 Scale (FCV-19 S), and the Diagnostic Tendency of Functional Bowel Disease Scale (DT-FBD) to evaluate anxiety, depression, fear of COVID-19 and likelihood of being diagnose diagnosed with functional bowel disease (FBD), respectively.

RESULTS

A total of 516 college students completed the questionnaire. The proportions of students with more severe anxiety, more severe depression, greater fear of COVID-19, and a greater likelihood of being diagnosed with FBD were 49.8%, 57.0%, 49%, and 49%, respectively. These symptoms were significantly and positively correlated with the frequency of irregular sleep and eating (p < 0.05). Students in high-risk areas were more likely to experience anxiety and depression than students in areas with low/medium risk (odds ratio [OR] = 1.90, 95% confidence interval [CI]: 1.12-3.24, p = 0.017; OR = 2.14, 95% CI: 1.11-4.11, p = 0.022). A high likelihood of being diagnosed with FBD was positively associated with the severity of anxiety and depression symptoms and fear of COVID-19 (all p < 0.001). Moreover, mediation analysis revealed the following pathway in college students: fear of COVID-19 → depression and anxiety → poor diet → likelihood of being diagnosed with FBD.

CONCLUSION

College students generally exhibited higher more severe anxiety and depression symptoms and psychological symptoms with a greater higher propensity likelihood of being to be diagnosed with FBD. Good lifestyle habits, especially adequate sleep and a regular diet, can alleviate these problems. In addition, appropriate psychological intervention is very important.

Human social isolation and stress: a systematic review of different contexts and recommendations for future studies

OBJECTIVES

The emergence of the coronavirus disease 2019 (COVID-19) pandemic and subsequent lockdowns and social distancing measures adopted worldwide raised questions about the possible health effects of human social isolation.

METHODS

We conducted a systematic review on PubMed, Scopus, and Embase electronic databases using terms related to human social isolation - defined as the isolation of an individual from regular routines and usual social contact - and psychological stress, searching for simulated or naturalistic isolation environments. We present the main results, as well as the validity and limitations of each model. PROSPERO registry number: CRD42021241880.

RESULTS

Despite the diversity of contexts reviewed, some outcomes almost ubiquitously relate to psychological stress, i.e., longer periods, expectation of a longer period, confinement, lack of social interaction, and support. Based on the results, and considering that most studies were not designed for the purpose of understanding isolation itself, we propose a group of recommendations for future experimental or naturalistic research on the topic.

CONCLUSION

Evidence on the impact of different situations in which individuals are subjected to social isolation can assist in development of directed preventive strategies to support people under similar circumstances. Such strategies might increase the general public's compliance with social distancing as a non-pharmacological intervention for emerging infectious diseases.