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Cowlishaw S, O'Dwyer C, Bowd C, Sadler N, O'Donnell M, Forbes D, Howard A. Pandemic impacts and experiences after disaster in Australia: qualitative study of compound impacts following the Black Summer bushfires. BJPsych Open 2024; 10:e43. [PMID: 38305026 PMCID: PMC10897690 DOI: 10.1192/bjo.2023.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 12/07/2023] [Accepted: 12/14/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND The first cases of the COVID-19 pandemic in Australia were recorded in January 2020, which was during the 'Black Summer' bushfires of 2019-20 and prior to additional disasters in some regions. Few studies have considered the compound impact of disasters and the pandemic. AIMS To improve understanding of the impact on mental health and well-being of the pandemic in disaster-affected communities. METHOD We conducted semi-structured interviews (n = 18) with community members and online focus groups (n = 31) with help providers from three regions of rural Australia affected by bushfires and the pandemic. RESULTS Six themes were produced: (a) 'Pulling together, pulling apart', describing experiences after bushfires and prior to impacts of the pandemic; (b) 'Disruption of the 'normal response', encompassing changes to post-disaster recovery processes attributed to the pandemic; (c) 'Escalating tensions and division in the community', describing impacts on relationships; (d) 'Everywhere you turn you get a slap in the face', acknowledging impacts of bureaucratic 'red tape'; (e) 'There are layers of trauma', highlighting intersecting traumas and pre-existing vulnerabilities; and (f) 'Where does the help come from when we can't do it?', encompassing difficulties accessing services and impacts on the helping workforce. CONCLUSIONS This study furthers our understanding of compound disasters and situates pandemic impacts in relation to processes of adjustment and recovery from bushfires. It highlights the need for long-term approaches to resilience and recovery, investment in social infrastructure, multi-component approaches to workforce issues, and strategies to increase mental health support and pathways across services.
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Affiliation(s)
- S. Cowlishaw
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - C. O'Dwyer
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - C. Bowd
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - N. Sadler
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - M. O'Donnell
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - D. Forbes
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
| | - A. Howard
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Australia
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Blendermann M, Ebalu TI, Obisie-Orlu IC, Fried EI, Hallion LS. A narrative systematic review of changes in mental health symptoms from before to during the COVID-19 pandemic. Psychol Med 2024; 54:43-66. [PMID: 37615061 DOI: 10.1017/s0033291723002295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
The onset of the COVID-19 pandemic raised concerns regarding population-wide impacts on mental health. Existing work on the psychological impacts of disaster has identified the potential for multiple response trajectories, with resilience as likely as the development of chronic psychopathology. Early reviews of mental health during the pandemic suggested elevated prevalence rates of multiple forms of psychopathology, but were limited by largely cross-sectional approaches. We conducted a systematic review of studies that prospectively assessed pre- to peri-pandemic changes in symptoms of psychopathology to investigate potential mental health changes associated with the onset of the pandemic (PROSPERO #CRD42021255042). A total of 97 studies were included, covering symptom clusters including obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), fear, anxiety, depression, and general distress. Changes in psychopathology symptoms varied by symptom dimension and sample characteristics. OCD, anxiety, depression, and general distress symptoms tended to increase from pre- to peri-pandemic. An increase in fear was limited to medically vulnerable participants, and findings for PTSD were mixed. Pre-existing mental health diagnoses unexpectedly were not associated with symptom exacerbation, except in the case of OCD. Young people generally showed the most marked symptom increases, although this pattern was reversed in some samples. Women in middle adulthood in particular demonstrated a considerable increase in anxiety and depression. We conclude that mental health responding during the pandemic varied as a function of both symptom cluster and sample characteristics. Variability in responding should therefore be a key consideration guiding future research and intervention.
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Affiliation(s)
- Mary Blendermann
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tracie I Ebalu
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Eiko I Fried
- Department of Psychology, Leiden University, Leiden, The Netherlands
| | - Lauren S Hallion
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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Beames JR, Huckvale K, Fujimoto H, Maston K, Batterham PJ, Calear AL, Mackinnon A, Werner-Seidler A, Christensen H. The impact of COVID-19 and bushfires on the mental health of Australian adolescents: a cross-sectional study. Child Adolesc Psychiatry Ment Health 2023; 17:34. [PMID: 36895004 PMCID: PMC9998012 DOI: 10.1186/s13034-023-00583-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND When COVID-19 spread to Australia in January 2020, many communities were already in a state of emergency from the Black Summer bushfires. Studies of adolescent mental health have typically focused on the effects of COVID-19 in isolation. Few studies have examined the impact of COVID-19 and other co-occurring disasters, such as the Black Summer bushfires in Australia, on adolescent mental health. METHODS We conducted a cross-sectional survey to examine the impact of COVID-19 and the Black Summer bushfires on the mental health of Australian adolescents. Participants (N = 5866; mean age 13.61 years) answered self-report questionnaires about COVID-19 diagnosis/quarantine (being diagnosed with and/or quarantined because of COVID-19) and personal exposure to bushfire harm (being physically injured, evacuated from home and/or having possessions destroyed). Validated standardised scales were used to assess depression, psychological distress, anxiety, insomnia, and suicidal ideation. Trauma related to COVID-19 and the bushfires was also assessed. The survey was completed in two large school-based cohorts between October 2020 and November 2021. RESULTS Exposure to COVID-19 diagnosis/quarantine was associated with increased probability of elevated trauma. Exposure to personal harm by the bushfires was associated with increased probability of elevated insomnia, suicidal ideation, and trauma. There were no interactive effects between disasters on adolescent mental health. Effects between personal risk factors and disasters were generally additive or sub-additive. CONCLUSIONS Adolescent mental health responses to community-level disasters are multi-faceted. Complex psychosocial factors associated with mental ill health may be relevant irrespective of disaster. Future research is needed to investigate synergistic effects of disasters on young mental health.
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Affiliation(s)
- Joanne R Beames
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Kit Huckvale
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, VIC, Australia
| | - Hiroko Fujimoto
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Kate Maston
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Andrew Mackinnon
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Helen Christensen
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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The impact of prolonged landscape fire smoke exposure on women with asthma in Australia. BMC Pregnancy Childbirth 2022; 22:919. [PMID: 36482359 PMCID: PMC9733231 DOI: 10.1186/s12884-022-05231-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Little is known about the physical and mental health impact of exposure to landscape fire smoke in women with asthma. This study examined the health impacts and information-seeking behaviours of women with asthma exposed to the 2019/2020 Australian fires, including women who were pregnant. METHODS Women with asthma were recruited from the Breathing for Life Trial in Australia. Following the landscape fire exposure period, self-reported data were collected regarding symptoms (respiratory and non-respiratory), asthma exacerbations, wellbeing, quality of life, information seeking, and landscape fire smoke exposure mitigation strategies. Participants' primary residential location and fixed site monitoring was used to geolocate and estimate exposure to landscape fire-related fine Particulate Matter (PM2.5). RESULTS The survey was completed by 81 pregnant, 70 breastfeeding and 232 non-pregnant and non-breastfeeding women with asthma. Participants had a median daily average of 17 μg/m3 PM2.5 and 105 μg/m3 peak PM2.5 exposure over the fire period (October 2019 to February 2020). Over 80% of participants reported non-respiratory and respiratory symptoms during the fire period and 41% reported persistent symptoms. Over 82% reported asthma symptoms and exacerbations of asthma during the fire period. Half the participants sought advice from a health professional for their symptoms. Most (97%) kept windows/doors shut when inside and 94% stayed indoors to minimise exposure to landscape fire smoke. Over two in five (43%) participants reported that their capacity to participate in usual activities was reduced due to prolonged smoke exposure during the fire period. Participants reported greater anxiety during the fire period than after the fire period (mean (SD) = 53(13) versus 39 (13); p < 0.001). Two in five (38%) pregnant participants reported having concerns about the effect of fire events on their pregnancy. CONCLUSION Prolonged landscape fire smoke exposure during the 2019/2020 Australian fire period had a significant impact on the health and wellbeing of women with asthma, including pregnant women with asthma. This was despite most women taking actions to minimise exposure to landscape fire smoke. Effective and consistent public health messaging is needed during landscape fire events to guard the health of women with asthma.
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Halcomb E, Thompson C, Morris D, James S, Dilworth T, Haynes K, Batterham M. Impacts of the 2019/20 bushfires and COVID-19 pandemic on the physical and mental health of older Australians: a cross-sectional survey. Fam Pract 2022; 40:449-457. [PMID: 36462177 DOI: 10.1093/fampra/cmac138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND In 2019/20 major bushfires devastated Australia's East Coast. Shortly afterward the COVID-19 pandemic was declared. Older people are disproportionately affected by disasters and are at high risk from respiratory pandemics. However, little is known about how these events impact on older peoples' health and well-being and engagement with services such as primary care. OBJECTIVE To explore the health impacts of the 2019/20 bushfires and the COVID-19 pandemic on older Australians' health and well-being. METHODS One hundred and fifty-five people aged over 65 years living in South-eastern New South Wales, Australia participated in an online survey. The survey measured the impacts of the bushfires and COVID-19 on physical and mental health and the capacity of older people to manage these impacts. RESULTS Most respondents felt that the bushfires caused them to feel anxious/worried (86.2%) and negatively affected their physical (59.9%) and mental (57.2%) health. While many participants had similar feelings about COVID-19, significantly fewer felt these physical and mental health impacts than from the bushfires. A significantly greater perceived level of impact was observed for females and those with health problems. More respondents described negative mental health than physical health effects. Those who felt more impacted by the events had lower levels of resilience, social connection and support, and self-rated health. CONCLUSION The health impacts identified in this study represent an opportunity for primary care to intervene to both ensure that people with support needs are identified and provided timely support and that older people are prepared for future disasters.
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Affiliation(s)
| | - Cristina Thompson
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| | - Darcy Morris
- Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| | - Sharon James
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tasmin Dilworth
- Centre for Environmental Risk Management of Bushfires, University of Wollongong, Wollongong, Australia
| | - Katharine Haynes
- Centre for Environmental Risk Management of Bushfires, University of Wollongong, Wollongong, Australia.,Natural Hazards Research Australia, Melbourne, Australia
| | - Marijka Batterham
- National Institute for Applied Statistics Research Australia, University of Wollongong, Wollongong, Australia
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Ong T, Wilczewski H, Soni H, Nisbet Q, Paige SR, Barrera JF, Welch BM, Bunnell BE. The Symbiosis of Virtual Reality Exposure Therapy and Telemental Health: A Review. FRONTIERS IN VIRTUAL REALITY 2022; 3:848066. [PMID: 37483657 PMCID: PMC10361704 DOI: 10.3389/frvir.2022.848066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Phobias and related anxiety are common and costly mental health disorders. Experts anticipate the prevalence of phobias will increase due to the COVID-19 pandemic. Exposure therapies have been established as effective and reliable treatments for anxiety, including recent innovations in virtual reality-based exposure therapy (VRET). With the recent advent of telemental health (TMH), VRET is poised to become mainstream. The combination of VRET and TMH has the potential to extend provider treatment options and improve patient care experiences. In this narrative review, we describe how recent events have accelerated VRET + TMH, identify barriers to VRET + TMH implementation, and discuss strategies to navigate those barriers.
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Affiliation(s)
- Triton Ong
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
| | | | - Hiral Soni
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
| | - Quinn Nisbet
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
| | | | - Janelle F. Barrera
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
- Biomedical Informatics Center, Public Health and Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Brandon M. Welch
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
- Innovation in Mental Health Lab, Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
| | - Brian E. Bunnell
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
- Biomedical Informatics Center, Public Health and Sciences, Medical University of South Carolina, Charleston, SC, United States
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Beggs PJ, Zhang Y, McGushin A, Trueck S, Linnenluecke MK, Bambrick H, Berry HL, Jay O, Rychetnik L, Hanigan IC, Morgan GG, Guo Y, Malik A, Stevenson M, Green D, Johnston FH, McMichael C, Hamilton I, Capon AG. The 2021 report of the MJA-Lancet Countdown on health and climate change: Australia increasingly out on a limb. Med J Aust 2021; 215:390-392.e22. [PMID: 34670328 DOI: 10.5694/mja2.51302] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/29/2021] [Accepted: 08/10/2021] [Indexed: 01/07/2023]
Abstract
The MJA-Lancet Countdown on health and climate change in Australia was established in 2017, and produced its first national assessment in 2018, its first annual update in 2019, and its second annual update in 2020. It examines indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. Our special report in 2020 focused on the unprecedented and catastrophic 2019-20 Australian bushfire season, highlighting indicators that explore the relationships between health, climate change and bushfires. For 2021, we return to reporting on the full suite of indicators across each of the five domains and have added some new indicators. We find that Australians are increasingly exposed to and vulnerable to excess heat and that this is already limiting our way of life, increasing the risk of heat stress during outdoor sports, and decreasing work productivity across a range of sectors. Other weather extremes are also on the rise, resulting in escalating social, economic and health impacts. Climate change disproportionately threatens Indigenous Australians' wellbeing in multiple and complex ways. In response to these threats, we find positive action at the individual, local, state and territory levels, with growing uptake of rooftop solar and electric vehicles, and the beginnings of appropriate adaptation planning. However, this is severely undermined by national policies and actions that are contrary and increasingly place Australia out on a limb. Australia has responded well to the COVID-19 public health crisis (while still emerging from the bushfire crisis that preceded it) and it now needs to respond to and prepare for the health crises resulting from climate change.
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Affiliation(s)
| | | | - Alice McGushin
- Institute for Global Health, University College London, London, UK
| | | | | | | | - Helen L Berry
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | | | | | - Ivan C Hanigan
- University Centre for Rural Health, University of Sydney, Sydney, NSW
| | - Geoffrey G Morgan
- University Centre for Rural Health, University of Sydney, Lismore, NSW
| | | | - Arunima Malik
- Integrated Sustainability Analysis, University of Sydney, Sydney, NSW
| | | | - Donna Green
- Climate Change Research Centre and ARC Centre of Excellence for Climate Extremes, University of New South Wales, Sydney, NSW
| | - Fay H Johnston
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS
| | | | - Ian Hamilton
- UCL Energy Institute, University College London, London, UK
| | - Anthony G Capon
- Monash Sustainable Development Institute, Monash University, Melbourne, VIC
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Isaac F, Toukhsati SR, Di Benedetto M, Kennedy GA. A Systematic Review of the Impact of Wildfires on Sleep Disturbances. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910152. [PMID: 34639453 PMCID: PMC8508521 DOI: 10.3390/ijerph181910152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 11/21/2022]
Abstract
Wildfires present a serious risk to humans as well as to the environment. Wildfires cause loss of lives, economic losses, expose people to personal as well as collective trauma, and compromise the mental health of survivors. Sleep disturbances are highly prevalent following a traumatic event; however, their prevalence is not well established amongst those confronted by natural disasters such as wildfires. The aim of this systematic review is to synthesise the empirical findings pertaining to wildfires and the prevalence of sleep disturbances in the general community affected by this natural disaster. We searched EBSCO, PsychINFO, Medline, SpringerLink, CINAHL Complete, EMBASE, PubMed, Scopus and Cochrane Library between January 2012 and March 2021. Five studies met the inclusion criteria. Findings from this systematic review suggest that sleep disturbances, assessed one to ten months following the fires, are highly prevalent in wildfire survivors, with insomnia (ranging between 63–72.5%) and nightmares (ranging between 33.3–46.5%), being the most prevalent sleep disturbances reported in this cohort. Results also highlight the significant associations between sleep disturbances and post-traumatic symptoms following the trauma of wildfires. There is a possible link between sleep disturbance prevalence, severity of, and proximity to fires.
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Affiliation(s)
- Fadia Isaac
- School of Science, Psychology and Sport, Federation University, Ballarat, VIC 3350, Australia; (S.R.T.); (G.A.K.)
- Correspondence: ; Tel.: +61-3-5327-6651
| | - Samia R. Toukhsati
- School of Science, Psychology and Sport, Federation University, Ballarat, VIC 3350, Australia; (S.R.T.); (G.A.K.)
| | | | - Gerard A. Kennedy
- School of Science, Psychology and Sport, Federation University, Ballarat, VIC 3350, Australia; (S.R.T.); (G.A.K.)
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3083, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Melbourne, VIC 3084, Australia
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Yang H, Xian X, Hu J, Millis JM, Zhao H, Lu X, Sang X, Zhong S, Zhang H, Yin P, Mao Y. Public Psychosocial and Behavioral Responses in the First Wave of COVID-19 Pandemic: A Large Survey in China. Front Psychiatry 2021; 12:676914. [PMID: 34393844 PMCID: PMC8355736 DOI: 10.3389/fpsyt.2021.676914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The COVID-19 has grown into a global pandemic. This study investigated the public psychosocial and behavioral responses through different time periods of the pandemic, and assessed whether these changes are different in age, gender, and region. Methods: A three-phase survey was conducted through the DaDui Social Q&A Software for COVID-19. A total of 13,214 effective responses of COVID-19 were collected. Statistical analysis was performed based on their basic information and psychosocial responses. Results: The degree of attention, understanding, and cooperation with preventive and control measures of the disease increased and then decreased. The panic level gradually increased with the epidemic process. The degree of satisfaction with management measures and of confidence in defeating COVID-19 increased throughout the survey. Compared with residents in other areas, respondents from the COVID-19 epicenter (Wuhan) reported a higher degree of self-protection during the outbreak and a significantly lower degree of satisfaction with respect to government prevention and control measures during all phases. Shortages of medical supplies and low testing capacity were reported as the biggest shortcoming in the prevention and control strategies during COVID-19, and an abundance of disorderly and inaccurate information from different sources was the primary cause of panic. Conclusions and Relevance: Major public health events elicit psychosocial and behavioral changes that reflect the different phases of the biologic curve. Sufficient medical supplies and improved organization and accurate information during epidemics may reduce panic and improve compliance with requested changes in behavior. We need to recognize this natural phenomenon and our public policy preparedness should attempt to move the social/psychological curve to the left in order to minimize and flatten the biologic curve.
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Affiliation(s)
- Huayu Yang
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences (CAMS), Beijing, China
| | - Xiaomeng Xian
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences (CAMS), Beijing, China
| | - Jing Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - J Michael Millis
- Department of Surgery, Global Surgery, University of Chicago, Chicago, IL, United States
| | - Haitao Zhao
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences (CAMS), Beijing, China
| | - Xin Lu
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences (CAMS), Beijing, China
| | - Xinting Sang
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences (CAMS), Beijing, China
| | - Shouxian Zhong
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences (CAMS), Beijing, China
| | - Hui Zhang
- International Relations and Social Development Division, Horizon iDataWay, Beijing, China
| | - Ping Yin
- Department of Epidemiology and Health Statistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yilei Mao
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences (CAMS), Beijing, China
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