Perceived Risk and Protection From Infection and Depressive Symptoms Among Healthcare Workers in Mainland China and Hong Kong During COVID-19

Perceived risk of COVID-19 hurts mental health: the mediating role of fear of COVID-19 and the moderating role of resilience

BACKGROUND

Depression and anxiety have been found prevalent during all phases of the COVID-19 pandemic. In late December 2022, almost all COVID-19 control measures were lifted in China, leading to a surge in COVID-19 infections. The public's perceived risk and fear of COVID-19 would be increased. This study aims to examine the prevalence of depression and anxiety in the Chinese general population and explores the mediating role of fear of COVID-19 between COVID-19 perceived risk and depression/anxiety and the moderating role of resilience between fear of COVID-19 and depression/anxiety.

METHODS

A cross-sectional online survey was conducted in Wenzhou, China, immediately following almost all COVID-19 control measures lifted. The 9-item Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), the COVID-19 Risk Perception Scale, the Fear of COVID-19 Scale, and the Connor-Davidson Resilience Scale (CD-RISC) were used to evaluate depression, anxiety, COVID-19 perceived risk, fear of COVID-19, and resilience, respectively. Structural Equation Modeling (SEM) with Maximum Likelihood (ML) estimator and adjusted for significant background factors was performed to test the moderated mediation. Data obtained from 935 participants were analyzed.

RESULTS

The prevalence of moderate to severe depression and anxiety was 23.7% and 9.5%, respectively. The present study revealed positive associations among COVID-19 perceived risk, fear of COVID-19 and depression/anxiety, and negative associations between resilience and fear of COVID-19/depression/anxiety. Fear of COVID-19 partially mediated the association between COVID-19 perceived risk and depression/anxiety. Furthermore, resilience significantly moderated the association between fear of COVID-19 and depression/anxiety. Two moderated mediation models were constructed.

CONCLUSION

Depression and anxiety were prevalent among Chinese adults during the final phase of the pandemic in China. The significant mediation role of fear of COVID-19 implies that reducing fear of COVID-19 may effectively alleviate depression and anxiety symptoms. Moreover, enhancing public resilience during an epidemic crisis is crucial for promoting mental health.

Navigating the crisis: A review of COVID-19 research and the importance of academic publications - The case of a private university in Lebanon

Objectives

The threat of the Corona virus has had a profound global impact, prompting extensive discussions among academicians and medical researchers seeking to understand its implications across various fields. Consequently this review aims to explore the COVID-19 research approaches adopted at the Lebanese American University (LAU) between 2019 and 2022 and, to eventually shed light on the importance of the academic publications during this crisis period in the context of Lebanon.

Design Data sources Eligibility criteria

Studies related to "Coronavirus", "SARS-CoV-2," or "COVID-19″ were extracted from the SciVal database spanning the period 2019 to 2022. The identified studies, totaling 97 publications, were indexed in Scopus and Web of Science and underwent narrative analysis along with an evaluation using a predefined scale to determine their eligibility. The majority of the studies were literature reviews, followed by observational studies, modeling studies, systematic reviews, and meta-analyses.

Results

The majority of the identified studies (31 %) were focused on the medical field, primarily the impact of SARS-CoV-2 infection. Additionally, 22 % of studies discussed updates related to global finance and economic markets, while 18 % addressed the psychological burden of the pandemic. Other areas covered in the literature included the impact on performance, nutrition, tourism, politics, and telecommunication.

Conclusion

This study marks a pioneering endeavor that sparks a crucial dialogue regarding peer-reviewed scientific literature during a period of immense need for accurate information. The prevalence of literature reviews can be attributed to the demand for swift dissemination of preliminary findings and the increased call for COVID-19-related research. However, despite the abundance of publications in this specific domain, it is imperative for future research to shift its focus towards the development of novel therapies, preventive measures, psychological insights, and strategies to address the socioeconomic and financial burdens stemming from the pandemic. This study has the potential to establish a standardized framework for addressing similar crises across diverse fields and at various levels.

Limitations

The review readily acknowledges certain limitations. By solely relying on specific databases like Scopus and WoS, there is a possibility of inadvertently overlooking relevant studies. Although the study provides insights into the impact of COVID-19 across different fields and their respective publications, it is important to recognize that the continuous updates to databases and potential exclusions of related studies may have imposed constraints on the findings. Moreover, the urgency for expeditious peer-review during the pandemic may have heightened the chances of errors and diminished transparency. This urgency has unfortunately increased the risk of fraudulent activities and misconduct.

Quarantine experience of healthcare workers in close contact with COVID-19 patients in China: a qualitative study

BACKGROUND

This study investigated the experiences of front-line healthcare workers who had been in close contact with COVID-19 patients and had been quarantined in order to provide guidance on quarantine measures with more humanistic care when dealing with future public health emergencies.

METHODS

We conducted a qualitative study using semistructured, qualitative, in-depth interviews between April and June 2022. The interviews were recorded and transcribed, followed by a thematic analysis. The study followed the Standards for Reporting Qualitative Research.

RESULTS

This study identified the following four themes: (1) personal psychological changes, (2) increased reflection on life and work during quarantine, (3) the important role of others' support and (4) different types of demands during quarantine and isolation. Each theme is supported by several subthemes that further illustrate the participants' experiences.

CONCLUSIONS

Quarantine of close contacts is necessary to prevent outbreaks. Front-line doctors and nurses are at a greater risk of COVID-19 infection than others. The results showed the psychological reactions of ordinary close contacts, and the unique feelings and experiences of doctors and nurses during the epidemic. Therefore, future research should cooperate with multiple departments to assess their needs, provide them with individualised care and love and give them incentives in order to reduce their psychological burden, improve their quality of life and allow them to engage in healthcare with a healthy mind.

Comparison of depressive symptoms among healthcare workers in high-risk versus low-risk areas during the first month of the COVID-19 pandemic in China

Introduction

The psychological health of healthcare workers (HCWs) has become a significant concern, particularly during the initial stage of a pandemic. This study compared the depressive symptoms among HCWs in high-risk areas (HRAs) and low-risk areas (LRAs) with matching demographics.

Methods

A cross-sectional study was employed to compare the depressive symptoms (Patient Health Questionnaire score ≥ 10), workplace environment characteristics, the Health Belief Model (HBM) and socio-demographics of the HCWs working in HRAs and LRAs in several accessible regions (mainly Hubei Province and Guangdong-Hong Kong-Macao Greater-Bay-Area) in China. Eight hundred eighty-five HCWs were recruited for unmatched analysis between March 6 and April 2, 2020. After matching with occupation and years of service using a 1:2 ratio, 146 HCWs in HRAs and 290 HCWs in LRAs were selected for matched analysis. Subgroup analyzes were performed using two individual logistic regressions to delineate the associated factors in LRAs and HRAs, respectively.

Results

HCWs in LRAs (Prevalence = 23.7%) had 1.96 times higher odds of depressive symptoms than those in HRAs (Prevalence = 15.1%) after adjusting for occupation and years of service (p < 0.001). Significant differences in workplace environment characteristics (p < 0.001) and the 5-dimension of the HBM of HCWs (p < 0.001 to p = 0.025) were found between HRAs and LRAs.Logistic regression showed that workers with years of service between 10 and 20  years (OR:6.27), ever had contact with COVID-19 patients (OR:14.33) and had higher scores of "perceived barrier" of HBM (OR:4.48) predicted depressive symptoms in HRAs while working in pneumology departments and infectious disease units (OR:0.06), and high "self-efficacy" in the HBM (OR:0.13) was a protective factor against depressive symptoms.Contrarily, in LRAs, those HCWs who worked in ICUs (OR:2.59), had higher scores of "perceived susceptibility toward the COVID-19 outbreak" (OR:1.41), "perceived severity of the pandemic" (OR:1.25), and "perceived barriers of wearing masks" (OR:1.43) in the HBM predicted depressive symptoms. High "cues to action" (OR:0.79), and better "knowledge" (OR:0.79) in the HBM were protective factors against depressive symptoms.

Conclusion

The risk of depressive symptoms of HCWS was double in LRAs than in HRAs in the first month of the COVID-19 pandemic. Furthermore, salient predictors for depressive symptoms among HCWs in HRAs and LRAs were very different.

Identifying health research in the era of COVID-19: A scoping review

Background

Health improvements are considered one of the most important fields of research. Since the coronavirus disease 2019 was declared a pandemic, it might have impacted clinical and public health research in various forms.

Objectives

The goal of this study is to explore health research approaches in the era of coronavirus disease 2019.

Methods

In this scoping review, we reviewed published medical full-text studies and identified potential areas of interest of health research in the era the coronavirus disease 2019 pandemic during the last 3 years within a higher educational setting. A bibliometric analysis was used to compare among published works.

Results

Among the 93 studies that met the inclusion criteria, most focused on mental health (n = 23; 24.7%). Twenty-one publications targeted coronavirus disease 2019 and its consequences on general health. Other studies have described hemato-oncological, cardiovascular, respiratory, and endocrinological diseases. 42 studies were cross-sectional or cohort studies and most of them published in Q1 journals. Almost half of them belonged to the Faculty of Medicine (49.5%) followed by the School of Arts, Sciences, and Psychology (26.9%).

Conclusions

Health research has been demonstrated to be important, at all times, especially during crises. Therefore, researchers need to invest more efforts into seeking new medical updates in various health-related fields, regardless of their correlation with coronavirus disease 2019.

Passengers' self-protective intentions while using ride-hailing services during the COVID-19 pandemic

In the transport context, there has been limited research examining passengers' health-protective behaviour while travelling during a health-related crisis such as COVID-19. This study develops a conceptual model aiming to explore determinants associated with passengers' self-protective intentions using the context of ride-hailing services in Vietnam. Ride-hailing services are popular in countries where public transport is underdeveloped. The conceptual model is based on perceived risk and self-efficacy as the main predictor of self-protective intentions when using ride-hailing services. In addition, the proposed conceptual model explores the direct and indirect impact of subjective knowledge and the perceived effectiveness of preventive measures on self-protective intentions. The proposed conceptual model was tested on a large sample of ride-hailing users in Vietnam (n = 527). The structural equation modelling (SEM) analysis results indicate that self-efficacy has the highest total impact on self-protective behaviour, followed by subject knowledge and perceived effectiveness of preventive measures. Self-efficacy also plays a fully mediating role in the linkage between the perceived effectiveness of preventive measures implemented by ride-hailing organisations and the intention to engage in self-protective behaviour. The results of this study expand the current understanding of ride-hailing passengers' health-protective behaviour and contribute to the transport and public health literature.

Risk Perception Related to COVID-19 and Future Affective Responses Among Healthcare Workers in Switzerland: A Mixed-Methods Longitudinal Study

Objectives: Whereas early findings suggest that risk perceptions related to COVID-19 affect psychological well-being in healthcare workers (HCWs), the temporal associations between these variables need to be clarified and HCWs lived experience further explored. This study proposes a mixed evaluation of COVID-19-related risk perception and affective responses among HCWs.

Methods: A longitudinal mixed-method study was conducted. HCWs (N = 138) completed measures of COVID-19 risk perceptions, depression, anxiety, burnout and secondary traumatic stress (STS) at baseline and 6 months later. A subsample (n = 20) participated in semi-structured interviews exploring both risk perceptions and affective responses.

Results: Main quantitative findings showed positive associations between worry to contaminate others and depression (IRR = 1.04, p < 0.05), anxiety (IRR = 1.03, p < 0.01), STS (b = 0.3, p < 0.05), and perceptions of lacking protection (IRR = 1.04, p < 0.05) with anxiety scores. Four themes emerged from the thematic content analysis: 1) life was turned upside down; 2) skills were put in quarantine; 3) dealing with patient discomfort; 4) balance to be found between protection and restrictions.

Conclusion: These findings emphasize the importance to develop tailored interventions, such as group discussion sessions, to optimize risk perception and help manage uncertainty.

Perceived risk of contracting COVID-19 among healthcare workers in Ghana: A cross-sectional study

Background and Aims

The COVID-19 pandemic has stretched many healthcare systems, and it is having detrimental impacts on healthcare workers at the forefront, fighting to save lives. This study sought to assess the relationship between job factors and the perceived risk of contracting COVID-19 at the workplace among healthcare workers and how the relationships are augmented when sociodemographic characteristics are taken into consideration in a limited resource setting (Ghana).

Methods

A cross-sectional survey of 455 respondents was conducted.

Results

Overall, 5.93% of the respondents perceived low risk of contracting COVID-19 while 69.45% and 24.62% perceived medium and high risks of contracting COVID-19 at the workplace, respectively. The odds of a high perceived risk versus the combined medium and low perceived risk of contracting COVID-19 at the workplace was 0.461 times lower for healthcare workers who rated their workplace safety systems as good and 0.515 and 0.170 times lower for healthcare workers who indicated occasional and frequent work environment situational assessment (situational awareness), respectively. The odds of high perceived risk were 2.239 times higher for workers who are always emotionally fatigued and 1.829 times higher for healthcare workers who frequently contribute personally to workplace decision-making. The perceived risk of contracting COVID-19 at the workplace was also 1.780 times higher for healthcare workers with tertiary education.

Conclusion

In terms of health and safety at work, this study recommends that there should be an improvement in implementing safety protocols at health facilities to increase the confidence of healthcare workers. Furthermore, social and psychological support and work environment situational assessment, which can reduce stress and anxiety levels among the healthcare workers, should be implemented if contributing factors such as working outside their area of expertise or job scope cannot be eliminated.

Frontline healthcare workers' experiences of providing care during the COVID-19 pandemic at a COVID-19 centre in Bulawayo, Zimbabwe: A phenomenological study

Background

The coronavirus disease 2019 (COVID-19) pandemic has had a far-reaching, negative impact on healthcare systems worldwide. Healthcare workers play a critical role in the country’s healthcare delivery system, as they facilitate a continuum of care and containment of diseases such as the COVID-19 pandemic.

Objectives

The aim of this study was to explore and describe the experiences of healthcare workers who provided care to COVID-19 patients at a central hospital in Zimbabwe.

Method

The researchers used an interpretative phenomenological analysis design. In-depth interviews were conducted virtually with 10 frontline healthcare workers working at a COVID-19 centre in Zimbabwe. Data collection was guided by an interview guide. All audio-recorded interview data were transcribed verbatim into written text. Data analysis was conducted using an interpretative phenomenological analysis framework. An expert in qualitative research acted as an independent co-coder and conducted the open coding of each transcript.

Results

Findings reveal inadequate preparation and training of healthcare providers before the commencement of duty, resources-related challenges and a lack of support as significant experiences of healthcare providers. Moreover, healthcare providers have been subjected to stigma and discrimination attached to COVID-19, resulting in psychological effects on frontline healthcare providers.

Conclusion

The COVID-19 pandemic brings unique and challenging experiences for frontline healthcare workers, resulting in a physically and emotionally drained workforce. This study calls for comprehensive support in the form of counselling, reasonable work schedules, training and adequate provision of personal protective equipment.

The Work Environment during Coronavirus Epidemics and Pandemics: A Systematic Review of Studies Using Quantitative, Qualitative, and Mixed-Methods Designs

We aimed to provide an overview of how work environment and occupational health are affected, and describe interventions designed to improve the work environment during epidemics and pandemics. The guidelines on Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) were followed. The databases Cinahl, Medline, PsycInfo, and Web of Science were searched for population: working population; exposure: coronavirus epidemic or pandemic; and outcome: work environment, in articles published until October 2020. Quality assessment was based on a modified version of the Mixed Methods Appraisal Tool (MMAT). After deduplication 3711 articles remained, of which 530 were selected for full-text screening and 119 for quality assessment. After the exclusion of studies that were low quality, 95 remained, of which 85 focused on healthcare personnel and 10 on employees in other industries; 73 used quantitative methods and 22 used qualitative or mixed methods; the majority were based on cross-sectional data. Healthcare staff experienced increased job demands, poor leadership, and lack of resources (personal protective equipment, personnel, and competence). High demands and work with infected patients were associated with negative mental health outcomes. There was a lack of studies assessing interventions, studies from industries other than healthcare, and studies of high quality.

The workplace and psychosocial experiences of Australian junior doctors during the COVID-19 pandemic

Background

Junior doctors experience high levels of psychological distress and emotional exhaustion. The current Coronavirus disease 2019 (COVID‐19) pandemic has resulted in significant changes to healthcare globally, with quantitative studies demonstrating increased fatigue, depression and burnout in junior doctors. However, there has been limited qualitative research to examine junior doctors' experiences, challenges and beliefs regarding management of future crises.

Aims

To investigate the workplace and psychosocial experiences of Australian junior doctors working during the second wave of the COVID‐19 pandemic.

Methods

Australian healthcare workers were invited to participate in a nationwide, voluntary, anonymous, single time point, online survey between 27 August and 23 October 2020. A qualitative descriptive study of responses to four free‐text questions from 621 junior doctors was undertaken, with responses analysed using inductive content analysis.

Results

Participants were predominantly female (73.2%), aged 31–40 years (48.0%) and most frequently reported working in medical specialties (48.4%), emergency medicine (21.7%) or intensive care medicine (11.4%). Most (51.9%) participants had 0–5 years of clinical experience since medical graduation. Junior doctors described experiences related to four key themes: a hierarchical, difficult workplace culture; challenging working conditions; disrupted training and career trajectories; and broader psychosocial impacts. The COVID‐19 pandemic exacerbated longstanding, workplace issues and stressors for junior doctors and highlighted the threat that crises pose to medical workforce retention. There is an urgent need for authentic, positive workplace cultural interventions to engage, validate and empower junior doctors.

Conclusions

Challenging workplace cultures and conditions, which have worsened during the COVID‐19 pandemic, are associated with poor psychological well‐being in junior doctors. There exists a need for long‐term, widespread improvements in workplace culture and working conditions to ensure junior doctors' well‐being, facilitate workforce retention and enhance the safety and quality of patient care in Australia.

Family caregiving during the COVID-19 pandemic: factors associated with anxiety and depression of carers for community-dwelling older adults in Hong Kong

Background

The COVID-19 pandemic disrupts the daily routine and increases the caregiving load of the family carers of older adults. This study examined how the pandemic may impact mental health and investigated the prevalence of anxiety and depressive symptoms in family carers of older people.

Methods

Two hundred and thirty-six family carers of older adults participated in this cross-sectional survey study. Outcome measures included their symptoms of anxiety and depression, pandemic-related psychosocial factors, external factors, and the practice of preventive behaviours.

Results

Caseness prevalence of anxiety and depression among family carers was 25 and 56% respectively. Working carers were more depressed than non-working, while younger carers reported more anxiety and depression symptoms than older. Hand hygiene and getting drugs from the hospital positively predicted depression while healthy lifestyle negatively predicted depression. These variables, together with perceived risk and severity and the worry of getting infected, predicted anxiety.

Conclusions

The prevalence of mental health symptoms was alarming. Telemedicine practice, including online pharmaceutical services and the Internet Hospital plus Drug Delivery platform, could be a solution in alleviating the burden and worry of infection of family carers. Tailored-made interventions by age and working status of the family carers are recommended.

Depression prevention in healthcare workers during the COVID-19 pandemic

BACKGROUND

Few studies have assessed depression in healthcare workers (HCWs) in Japan owing to the coronavirus disease 2019 (COVID-19) pandemic, and no studies have proposed effective interventions to help support their mental health.

AIMS

To test the hypothesis that enhancing access to mental healthcare professionals helps to improve HCWs' mental health.

METHODS

This cross-sectional study assessed depressive symptoms in HCWs at three hospitals in Osaka prefecture between May and July, 2020. The survey obtained information on HCWs' mental state and related situations/perceptions. Multivariable logistic regression analysis was performed to identify factors associated with depressive symptoms.

RESULTS

Of the 3291 eligible HCWs, 1269 (39%) completed the survey. Of all HCWs, 87 (7%) were physicians, and 700 (55%) were nurses. A total of 181 (14%) HCWs had moderate-to-severe symptoms of depression. Being a frontline worker was not significantly associated with depressive symptoms (odds ratio: 0.86 [95% confidence intervals: 0.54-1.37], P = 0.50). The unwillingness to consult with anyone was significantly associated with more severe depressive symptoms (1.70 [1.10-2.63], P < 0.01). HCWs who had no opportunity to confide in family/friends (1.66 [1.10-2.52], P < 0.01) or colleagues/supervisors (3.19 [2.22-4.58], P < 0.001) were significantly more likely to have depressive symptoms.

CONCLUSIONS

Being a frontline HCW in a Japanese hospital treating patients with COVID-19 was not significantly associated with having depressive symptoms. The study highlights that encouraging daily communication with close persons (family, friends, colleagues and supervisors), rather than improving access to mental health professionals, might help to prevent depression in HCWs during the COVID-19 pandemic.

Finding the positives from the COVID-19 pandemic: factors associated with posttraumatic growth among nurses in Hong Kong

BACKGROUND

Due to active involvement with patients for COVID-19 treatments, nurses are susceptible to adverse psychological outcomes amid the COVID-19 pandemic. Despite the distress, studies have suggested that nurses are able to experience positive changes (i.e. posttraumatic growth; PTG) during the pandemic. Research on other populations has also indicated that COVID-19-specific worries and work-related coping resources are associated with people's positive changes during the pandemic.

OBJECTIVE

This study examined how socio-demographic characteristics, COVID-19-related worries, and work-related variables (satisfaction with work and workplace pandemic guidelines) were associated with PTG among nurses in Hong Kong.

METHODS

Nurses (N = 1510) working in hospitals and community settings were recruited through nursing associations in Hong Kong between 8 August 2020 and 22 September 2020. They were invited to complete a cross-sectional survey measuring their sociodemographic characteristics, COVID-19 worries, and satisfaction with work and workplace pandemic-control measures.

RESULTS

Results from hierarchical regressions found that those working non-full-time (β = -0.06), affiliating with a religion (β = 0.24), having higher COVID-19-related worries and psychological distress (βs ranging from 0.12-0.15), and having higher work satisfaction (β = 0.14) were associated with higher PTG (ps < .05). Moreover, a significant interaction between psychological distress and satisfaction with workplace pandemic control guidelines emerged in explaining PTG (β = 0.08, p < .05), such that guideline satisfaction was only associated with higher PTG among those with higher distress (β = 0.09, p = .03), but not those with lower distress (β = -0.05, p > .05).

CONCLUSIONS

Nurses in Hong Kong did report positive changes amid the COVID-19 pandemic. Future studies could focus on the contributing factors of PTG to design for effective strategies to enhance resources for nurses to promote positive psychosocial outcomes.

Psychological outcomes and associated factors amongst healthcare workers during a single wave, deeper into the COVID-19 pandemic in China

BACKGROUND

To date, the repeated breakout of the novel coronavirus disease 2019 (COVID-19) pandemic across many regions in China has caused continuous physical and mental harm to health care workers. This study investigates the psychological burden of the pandemic and its associated risk factors among Chinese healthcare workers (HCWs) during a single wave of COVID-19.

METHODS

For this cross-sectional web-based survey conducted from January 16, 2022 to February 5, 2022, a total of 412 HCWs from Northwestern China were recruited. Their socio-demographic data and COVID-19 related survey variables were then collected using online self-rating questionnaires. In addition, the Chinese versions of well-validated instruments, including the 12-item General Health Questionnaire for psychiatric morbidity, the Generalized Anxiety Disorder Scale-7 for anxiety, the Patient Health Questionnaire-9 for depression and the Insomnia Severity Index-7 for insomnia, were used to assess the participants' mental health status. Multivariate logistic regression analysis was eventually performed to identify the risk factors associated with the psychological outcomes.

RESULTS

Of the 388 participants who were included in the final study (94.17% response rate), the prevalence of anxiety, depression, and insomnia symptoms were 25.3% (95% CI: 20.9-29.6%), 40.7% (95% CI: 35.8-45.6%), and 30.9% (95% CI: 26.3-35.5%), respectively. Multivariate logistic regression analysis revealed that being a woman and having a perceived need for psychological support were risk factors for all psychological outcomes, while poor disease cognition and perceived susceptibility were risk factors for anxiety. Poor disease cognition and being unvaccinated against COVID-19 were risk factors for depression, with the latter also being an independent risk factor for insomnia.

CONCLUSION

This study has identified a relatively lower prevalence rate of psychological disorders among Chinese HCWs during a single wave, deeper into the COVID-19 pandemic. Female HCWs, and those who had a perceived need for psychological support, had poor disease cognition, were perceived as susceptible to COVID-19 and had not been vaccinated against COVID-19 deserve more attention.

COVID-19-Related Variables and Its Association with Anxiety and Suicidal Ideation: Differences Between International and Local University Students in Taiwan

Purpose

The present study examined the differences between international and local university students in Taiwan regarding COVID-19-related variables, anxiety, and suicidal ideation.

Participants and Methods

An online cross-sectional survey (sent via an online link in an email) was carried out comprising university students (n=529). The students were assessed on measures (including validated psychometric instruments) of perceived susceptibility to COVID-19, perceived sufficiency of resources, sources of COVID-19 information, perceived satisfaction with support, anxiety and suicidal ideation.

Results

Local students had higher susceptibility to COVID-19 (p<0.001) but decreased sufficiency with resources (p<0.001) and anxiety (p<0.001) compared with international students. Staying with family members, satisfaction with support, and information seeking were the factors that predicted anxiety among international students (all p-values<0.05), while information seeking predicted local students’ anxiety (p<0.001). Furthermore, staying with family members, susceptibility to COVID-19, and sufficiency with resources were the factors that predicted suicidal ideation among international students (all p-values<0.05), while being a male and satisfaction with support predicted suicidal ideation among local students (all p-values<0.05).

Conclusion

International students displayed different COVID-19-related challenges compared with local students. More specifically, international students as compared with local students had lower susceptibility to COVID-19 and higher anxiety. Therefore, healthcare providers should pay more attention to international students’ psychological health and awareness regarding impacts of COVID-19 on health.

Healthcare worker stress, anxiety and burnout during the COVID-19 pandemic in Singapore: A 6-month multi-centre prospective study

Aim

The long-term stress, anxiety and job burnout experienced by healthcare workers (HCWs) are important to consider as the novel coronavirus disease (COVID-19) pandemic stresses healthcare systems globally. The primary objective was to examine the changes in the proportion of HCWs reporting stress, anxiety, and job burnout over six months during the peak of the pandemic in Singapore. The secondary objective was to examine the extent that objective job characteristics, HCW-perceived job factors, and HCW personal resources were associated with stress, anxiety, and job burnout.

Method

A sample of HCWs (doctors, nurses, allied health professionals, administrative and operations staff; N = 2744) was recruited via invitation to participate in an online survey from four tertiary hospitals. Data were gathered between March-August 2020, which included a 2-month lockdown period. HCWs completed monthly web-based self-reported assessments of stress (Perceived Stress Scale-4), anxiety (Generalized Anxiety Disorder-7), and job burnout (Physician Work Life Scale).

Results

The majority of the sample consisted of female HCWs (81%) and nurses (60%). Using random-intercept logistic regression models, elevated perceived stress, anxiety and job burnout were reported by 33%, 13%, and 24% of the overall sample at baseline respectively. The proportion of HCWs reporting stress and job burnout increased by approximately 1·0% and 1·2% respectively per month. Anxiety did not significantly increase. Working long hours was associated with higher odds, while teamwork and feeling appreciated at work were associated with lower odds, of stress, anxiety, and job burnout.

Conclusions

Perceived stress and job burnout showed a mild increase over six months, even after exiting the lockdown. Teamwork and feeling appreciated at work were protective and are targets for developing organizational interventions to mitigate expected poor outcomes among frontline HCWs.

The Psychological Experience of Frontline Perioperative Health Care Staff in Responding to COVID-19: Qualitative Study

BACKGROUND

The rapid spread of the novel coronavirus (COVID-19) has presented immeasurable challenges to health care workers who remain at the frontline of the pandemic. A rapidly evolving body of literature has quantitatively demonstrated significant psychological impacts of the pandemic on health care workers. However, little is known about the lived experience of the pandemic for frontline medical staff.

OBJECTIVE

This study aimed to explore the qualitative experience of perioperative staff from a large trauma hospital in Melbourne, Australia.

METHODS

Inductive thematic analysis using a critical realist approach was used to analyze data from 9 semistructured interviews.

RESULTS

Four key themes were identified. Hospital preparedness related to the perceived readiness of the hospital to respond to the pandemic and encompassed key subthemes around communication of policy changes, team leadership, and resource availability. Perceptions of readiness contributed to the perceived psychological impacts of the pandemic, which were highly varied and ranged from anger to anxiety. A number of coping strategies were identified in response to psychological impacts which incorporated both internal and external coping mechanisms. Finally, adaptation with time reflected change and growth over time, and encompassed all other themes.

CONCLUSIONS

While frontline staff and hospitals have rapidly marshalled a response to managing the virus, relatively less consideration was seen regarding staff mental health in our study. Findings highlight the vulnerability of health care workers in response to the pandemic and reinforce the need for a coordinated approach to managing mental health.

Associations between Personality Traits, Intolerance of Uncertainty, Coping Strategies, and Stress in Italian Frontline and Non-Frontline HCWs during the COVID-19 Pandemic-A Multi-Group Path-Analysis

The COVID-19 pandemic represented a very difficult physical and psychological challenge for the general population and even more for healthcare workers (HCWs). The main aim of the present study is to test whether there were significant differences between frontline and non-frontline Italian HCWs concerning (a) personality traits, intolerance of uncertainty, coping strategies and perceived stress, and (b) the models of their associations. A total of 682 Italian HCWs completed a self-report questionnaire: 280 employed in COVID-19 wards and 402 in other wards. The analysis of variance omnibus test revealed significant differences between the two groups only for perceived stress, which was higher among the frontline. The multi-group path analysis revealed significant differences in the structure of the associations between the two groups of HCWs, specifically concerning the relations between: personality traits and intolerance of uncertainty; intolerance of uncertainty and coping strategies. Regarding the relation between coping strategies and stress no difference was identified between the two groups. In both of them, emotionally focused coping was negatively related with perceived stress, whereas dysfunctional coping was positively related with stress. These results could be useful in planning actions aiming to reduce stress and improve the effectiveness of HCWs' interventions. Training programs aimed to provide HCWs with a skillset to tackle uncertain and stressful circumstances could represent an appropriate support to develop a preventive approach during outbreaks.

Long-Term Impact of COVID-19 on Mental Health among the General Public: A Nationwide Longitudinal Study in China

COVID-19 might have long-term mental health impacts. We aim to investigate the longitudinal changes in mental problems from initial COVID-19 peak to its aftermath among general public in China. Depression, anxiety and insomnia were assessed among a large-sample nationwide cohort of 10,492 adults during the initial COVID-19 peak (28 February 2020 to 11 March 2020) and its aftermath (8 July 2020 to 8 August 2020) using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Insomnia Severity Index. We used generalized estimating equations and linear mixed models to explore factors associated with long-term mental health symptoms during COVID-19. During the five months, mental health symptoms remained consistently elevated (baseline 46.4%; follow-up 45.1%). Long-term depression, anxiety and insomnia were associated with several personal and work-related factors including quarantine (adjusted OR for any mental health symptoms 1.31, 95%CI 1.22–1.41, p < 0.001), increases in work burden after resuming work (1.77, 1.65–1.90, p < 0.001), occupational exposure risk to COVID-19 (1.26, 1.14–1.40, p < 0.001) and living in places severely affected by initial COVID-19 peak (1.21, 1.04–1.41, p = 0.01) or by a COVID-19 resurgence (1.38, 1.26–1.50, p < 0.001). Compliance with self-protection measures, such as wearing face masks (0.74, 0.61–0.90, p = 0.003), was associated with lower long-term risk of mental problems. The findings reveal a pronounced and prolonged mental health burden from the initial COVID-19 peak through to its aftermath in China. We should regularly monitor the mental health status of vulnerable populations throughout COVID-19.

The role of fortitude, loneliness, and depression in the association between risk perception of contracting COVID-19 and life satisfaction: serial mediation analysis

Recently, the COVID-19 pandemic has been found to have a negative impact on both physical wellbeing and mental health. Increased risk perception of contracting the virus has been associated with adverse psychological outcomes and reduced life satisfaction. However, susceptibility to psychological distress is influenced by personality-related characteristics. This study focuses on fortitude as a potential protective factor. The aim of this study is to investigate the parallel and serial mediating roles of fortitude, loneliness, and depression in the relationship between risk perception and life satisfaction. The participants were young adults ( N = 337) who have completed five self-report questionnaires: University of California Los Angeles Loneliness Scale, Centre for Epidemiological Studies Depression Scale, Fortitude Questionnaire, Satisfaction with Life Scale, and COVID-19 Risk Perception Scale. Descriptive statistics were generated, and structural equation modelling was used to examine the parallel and serial mediating roles of loneliness, depression, and fortitude. Positive associations were found between risk perception and loneliness and depression, and fortitude was found to mediate the relationship between risk perception and life satisfaction, between loneliness and life satisfaction, and between depression and life satisfaction. The overall serial mediation was also found to be significant, thereby supporting the hypothesis that those who perceive themselves to be at a risk of contracting COVID-19 have higher loneliness scores, which in turn is associated with higher depression scores. These findings confirm that fortitude is a salient protective factor and suggest that improving the perception of the ability to manage the risk of infection can enhance psychological wellbeing.

Prevalence of Depression among Healthcare Workers during the COVID-19 Outbreak: A Systematic Review and Meta-Analysis

Background: There is evidence of a high psychological toll from the COVID-19 pandemic in healthcare workers. This paper was aimed at conducting a systematic review and meta-analysis of studies reporting levels of depression among healthcare workers during the COVID-19 and estimating the pooled prevalence of depression. Methods: We searched for cross-sectional studies listed on PubMed from 1 December 2019 to 15 September 2020 that reported prevalence of depression in healthcare workers, nurses, medical doctors, and COVID-19 frontline professionals. The pooled proportions of depression were calculated with random effects models. Results: We identified 57 studies from seventeen countries. The pooled prevalence of depression in healthcare workers was 24% (95% CI: 20–28%), 25% for nurses (95% CI: 18–33%), 24% for medical doctors (95% CI: 16–31%), and 43% for frontline professionals (95% CI: 28–59%). Conclusions: The proportion of depression in nurses and medical doctors during the COVID-19 pandemic was similar to that found in the general population as previously reported in other meta-analyses conducted with smaller numbers of studies. Importantly, almost half of the frontline healthcare workers showed increased levels of depression. There is need for a comprehensive, international response to prevent and treat common mental health problems in healthcare workers.

The Combined Effect of Safety Specific Transformational Leadership and Safety Consciousness on Psychological Well-Being of Healthcare Workers

Occupational health researchers have begun to realize that the psychological well-being of healthcare workers who are providing treatment against COVID-19 is deteriorating. However, there is minimal research conducted on it, particularly in the context of leadership. The current study aims to fill this important gap by identifying critical factors that can enhance the psychological well-being of healthcare workers. We proposed that safety specific transformational leadership enhances psychological well-being among healthcare workers, and COVID-19 perceived risk mediates this relationship. Furthermore, the safety conscientiousness of healthcare workers was proposed to be a boundary condition that enhances the negative relationship between safety-specific transformational leadership and COVID-19 perceived risk. Data were collected from healthcare workers (N = 232) treating COVID-19 patients in the hospitals of Pakistan through well-established adopted questionnaires. The discriminant and convergent validity of the data was tested through confirmatory factor analysis by using AMOS statistical package. The mediation and moderation hypotheses were tested by using PROCESS Macro by Hayes. The results showed that safety specific transformational leadership enhances psychological well-being among healthcare workers, and COVID-19 perceived risk mediates this relationship. Moderation results also confirmed that safety conscientiousness moderates the relationship between safety specific transformational leadership and COVID-19 perceived risk. This study offers implications for both researchers and practitioners.

Associations between the working experiences at frontline of COVID-19 pandemic and mental health of Korean public health doctors

BACKGROUND

Demographic, work environmental, and psychosocial features are associated with mental health of healthcare professionals at pandemic frontline. The current study aimed to find predictors of mental health for public health doctors from working experiences at frontline of COVID-19 pandemic.

METHODS

With first-come and first-served manner, 350 public health doctors with experiences of work at COVID-19 frontline participated online survey on August 2020. Mental health was defined using the total scores of the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Perceived Stress Scale, and the Stanford Presenteeism Scale-6. Multivariate logistic regression models of mental health with lowest Akaike Information Criterion were determined among all combinations of working environments, perceived threats and satisfaction at frontline, and demographics that were significant (P < 0.05) in the univariate logistic regression.

RESULTS

Perceived distress, lowered self-efficacy at work, anxiety, and depressive mood were reported by 45.7, 34.6, 11.4, and 15.1% of respondents, respectively. Predictors of poor mental health found in the multivariate logistic regression analyses were environmental (insufficient personal protective equipment, workplace of screening center, prolonged workhours) and psychosocial (fear of infection and death, social stigma and rejection) aspects of working experiences at frontline. Satisfaction of monetary compensation and proactive coping (acceptance and willingness to volunteer at frontline) were predictive of better mental health.

CONCLUSIONS

Sufficient supply of personal protective equipment and training on infection prevention at frontline, proper workhours and satisfactory monetary compensation, and psychological supports are required for better mental health of public health doctors at frontline of COVID-19 pandemic.

The fear of COVID-19 outbreak among health care professionals in Gaza Strip, Palestine

INTRODUCTION

The emergence of the COVID-19 and its consequences has led to fears, worries, and anxiety among individuals, particularly among healthcare professionals. The present study aimed to assess the fear of COVID-19 among different healthcare professionals in the Gaza Strip, Palestine.

METHODS

A cross-sectional, snowball sampling technique and an online questionnaire were employed among healthcare professionals. A total of 300 participants completed the questionnaire. The validated fear of COVID-19 Scale Arabic version was used. Statistical analysis was performed using SPSS version 22.

RESULTS

The sample fear mean score was 17.53 ± 5.78; more than half of the study participants (54.3%) consider it as low levels of fear and 45.7% of the participants consider it as high levels of fear. Statistically significant differences were found between males and females, and different healthcare professional's disciplines. Females have a higher mean score compared to males. The highest fear mean scores were found among Lab-Technicians (20.19 ± 7.42), followed by X-ray-Technicians (17.95 ± 3.96), Nurses (17.1 ± 5.55), and Physicians (16.25 ± 4.66).

CONCLUSION

The fear of COVID-19 was high among female healthcare professionals compared to males, as well as, among Lab-Technicians compared to Physicians and Nurses. There is a need to establish a strategy to continues measuring the psychological effect of COVID-19 among healthcare professionals especially females.

[Perception of the risk of COVID-19, emotional intelligence and psychological health of caregivers]

COVID-19 which appeared in China in 2019 and spread all over the world causing on its way important damages (WHO, 2020). This pandemic has generated stressful situations and significantly hampered the mental and psychosomatic health of the world population, especially that of the medical and paramedical personnel. That is why, we thought it just to focus on the perception of risk, emotional intelligence and the psychological health of caregivers relatively to this dreadful pandemic. This brought us to collect some data through using a composite questionnaire, which we submitted to 180 participants aged between 26 and 63 years (M = 17.89, ET = 6.56) recruited among health workers. They have selected through the simple random sampling technique. The results of this study permit us to notice that emotional intelligence is correlated to the psychological well being (r(180) = .25; p ≤ .01), while risk perception is correlated to the psychological distress (r(180) = .29; p ≤ .01). This type of results shows the impact of the perception of risk and of emotional intelligence on the psychological health of the health professionals.

Prevalence of depression, anxiety and post-traumatic stress disorder in health care workers during the COVID-19 pandemic: A systematic review and meta-analysis

OBJECTIVE

The COVID-19 pandemic has placed health care workers under psychological stress. Previous reviews show a high prevalence of mental disorders among health care workers, but these need updating and inclusion of studies written in Chinese. The aim of this systematic review and meta-analysis was to provide updated prevalence estimates for depression, anxiety and post-traumatic stress disorder (PTSD) among health care workers during the COVID-19 pandemic, benefitting from the inclusion of studies published in Chinese.

METHODS

Systematic search of EMBASE, MEDLINE, PsycINFO, Global Health, Web of Science, CINAHL, Google Scholar and the Chinese databases SinoMed, WanfangMed, CNKI and CQVIP, for studies conducted between December 2019 and August 2020 on the prevalence of depression, anxiety and PTSD in health care workers during the COVID-19 pandemic. Studies published in both English and Chinese were included.

RESULTS

Data on the prevalence of moderate depression, anxiety and PTSD was pooled across 65 studies involving 97,333 health care workers across 21 countries. The pooled prevalence of depression was 21.7% (95% CI, 18.3%-25.2%), of anxiety 22.1% (95% CI, 18.2%-26.3%), and of PTSD 21.5% (95% CI, 10.5%-34.9%). Prevalence estimates are also provided for a mild classification of each disorder. Pooled prevalence estimates of depression and anxiety were highest in studies conducted in the Middle-East (34.6%; 28.9%). Subgroup and meta-regression analyses were conducted across covariates, including sampling method and outcome measure.

CONCLUSIONS

This systematic review and meta-analysis has identified a high prevalence of moderate depression, anxiety and PTSD among health care workers during the COVID-19 pandemic. Appropriate support is urgently needed. The response would benefit from additional research on which interventions are effective at mitigating these risks.

Face Mask Wearing Behaviors, Depressive Symptoms, and Health Beliefs Among Older People During the COVID-19 Pandemic

The COVID-19 pandemic has affected more than 100 countries. Despite the global shortage of face masks, the public has adopted universal mask wearing as a preventive measure in many Asian countries. The COVID-19 mortality rate is higher among older people, who may find that wearing a face mask protects their physical health but jeopardizes their mental health. This study aimed to explore the associations between depressive symptoms, health beliefs, and face mask wearing behaviors among older people. By means of an online survey conducted between March and April 2020, we assessed depressive symptoms, health beliefs regarding COVID-19, and face mask use and reuse among community-dwelling older people. General linear models were employed to explore the associations among these variables. Of the 355 valid participants, 25.6% experienced depressive symptoms. Health beliefs regarding the perceived severity of disease (p = 0.001) and perceived efficacy of practicing preventive measures (p = 0.005) were positively associated with face mask use. Those who reused face masks (p = 0.008) had a stronger belief in disease severity (p < 0.001), had poorer cues to preventive measures (p = 0.002), and were more likely to experience depressive symptoms. Mask reuse was significantly associated with depression only among those who perceived the disease as serious (p = 0.025) and those who had poorer cues to preventive measures (p = 0.004). In conclusion, health beliefs regarding perceived severity and efficacy contributed to more frequent face mask use, which was unrelated to depressive symptoms. Older people who had a stronger belief in disease severity had less adequate cues to preventive measures and reused face masks experienced greater depressive symptoms. A moderation effect of health beliefs (i.e., disease severity and cues to preventive measures) on face mask reuse and depression was observed.

COVID-19 experience in mainland China: Nursing lessons for the United States of America

COVID-19 emerged in Wuhan, China, and began its worldwide journey. As the severity of the virus became known, the Chinese National Government mobilized resources, and their centralized management was critical to the containment of the epidemic. Healthcare agencies and providers were overwhelmed with patients, many of whom were critically ill and died. Nurses adapted to the work using personal protective equipment, but its initial scarcity contributed to stressful working conditions. Nurses in the United States can take several lessons from the experiences of their Chinese nurse colleagues, including the benefit of centralized management of the epidemic, the need for specialized treatment facilities, and the importance of a national stockpile of critical equipment and supplies. A fully funded United States Department of Health and Human Services Office of Pandemics and Emerging Threats is necessary. A nursing department within the office and a national mobilization plan to send nurses to support local efforts during a pandemic or other threat are likewise essential. Continuous training for nurses, especially caring for patients with infectious diseases in intensive care units, stress management, and how to comfort the dying, are also useful lessons.

Coronavirus Disease Stress Among Italian Healthcare Workers: The Role of Coping Humor

The study aimed to understand how coping strategies in general and humor-based coping strategies in particular modulate the perception of pandemic-related stress in a sample of Italian healthcare workers during the coronavirus disease (COVID-19) outbreak in Italy. A total of 625 healthcare workers anonymously and voluntarily completed a 10-min questionnaire, which included psychometrically valid measurements preceded by a set of questions aimed at determining workers' exposure to COVID-19. The Perceived Stress Scale was used to measure healthcare workers' stress levels, and the Brief COPE Scale and Coping Humor Scale were used to assess participants' avoidant or approach coping style and verify the degree to which they relied on humor to cope with stress. The results show that (1) levels of perceived stress were higher in healthcare workers who were more exposed to COVID-19 (i.e., who came into contact with COVID-19 patients or worked in wards dedicated to COVID-19) in comparison to less-exposed workers; (2) participants who reported a higher use of avoidant coping strategies perceived the situation as more stressful than those who used them less; and (3) healthcare workers who reported higher use of humor-based coping strategies perceived the situation as less stressful in comparison with those who reported less use of coping humor. Such findings expanded other research studies by including coping humor as a potential factor to mitigate the perceived stress related to COVID-19. The paper concludes with a discussion of implications for future research and limitations of the study.

Magnitude and Predictors of Health Care Workers Depression During the COVID-19 Pandemic: Health Facility-Based Study in Eastern Ethiopia

Background: Depression of health care workers was related to work absences, resignations, and poor work performance, affecting the quality of patient care and the health care system. The Coronavirus disease pandemic has had an effect on the mental health of health care workers. Health care workers are facing challenges that can be stressful, overwhelming, and cause strong emotions, may put them at higher risk to develop depression. There is limited evidence that assesses health care workers' depression and its associated factors in the study area during the Coronavirus disease pandemic. Therefore this study aimed to assess depression and associated factors among health care workers in eastern Ethiopia. Method: The cross-sectional study design was conducted from October 26th to November 15, 2020. A total of 265 health care workers from 10 health facilities participated. Patient Health Questionnaire was used for the collection of depressive symptoms. The data were analyzed by using STATA version 14 software. To assess the association between depression and the predictors Adjusted Odds Ratio along with a 95% confidence interval was estimated by using logistic regression analysis. A statistical significance was declared at p-value ≤ 0.05. Results: Of the total 265 study participant, 176 (66.4%) and 95% CI: 60.4%, 71.8% of them reported depressive symptoms. Of 176 reported symptoms of depression 27.9, 24.1, 9.4, 3.7, and 1.1% were had minimal, mild, moderate, moderate-severe, and severe depressive symptoms respectively. The multivariable logistic regression analysis revealed the odds of depression were 2.34 times higher among female participants compared to male participants (AOR: 2.34, 95%CI: 1.09-5.02). In addition, the odds of depression for participants who perceived susceptibility to COVID-19 was 4.05 times higher among their counterpart (AOR: 4.05, 95%CI: 1.12-14.53). Conclusions: Health care workers who experienced depression in the study was high. Health care workers' mental health needs to be protected during the COVID-19 pandemic. Female health care workers and health care workers perceived susceptibility of COVID-19 need attention.

Psychological Distress, Early Behavioral Response, and Perception Toward the COVID-19 Pandemic Among Health Care Workers in North Shoa Zone, Oromiya Region

Background: The coronavirus disease 2019 (COVID-19) pandemic has had a significant psychological impact on health care workers (HCWs). Therefore, this study inspects the mental health status, behavioral response, and perception among HCWs (nurses, physicians, and medical laboratory workers) during the COVID-19 pandemic in public health care facilities. Methods: A facilities-based cross-sectional study was conducted in July 2020. A simple random sampling technique was used to select study participants. Data were collected by self-report administered questionnaires using Patient Health Questionnaire-9 (PHQ-9) for depression, General Anxiety Disorder-7 (GAD-7) for anxiety, Insomnia Severity Index (ISI) for insomnia, Impact of Event Scale-Revised (IES-R) for psychological distress, Perceived Threat Scale for perception, and Behavioral Response Inquiry for the behavioral response. Moreover, bivariable and multivariable logistic regressions analysis was used to identify the association between dependent and independent variables at p-value <0.05. Results: A total of 417 (98.6%) HCWs responded to a self-administered questionnaire. The proportion of HCWs who had moderate to severe symptoms of psychological distress, depression, anxiety, and insomnia during the COVID-19 pandemic were 58, 16.3, 30.7, and 15.9%, respectively. Three-fifth of the nurses, medical laboratory professionals (62.2%), and physicians (59.2%) had reported good behavioral responses toward the COVID-19 pandemic. More than three-fifths of the nurses had reported poor perception toward the COVID-19 pandemic. Conversely, 61.2% of physicians and three-fourths (75.5%) of medical laboratory professionals had reported good perception toward the COVID-19 pandemic. Female and married participants, those working in the emergency unit, those with poor behavioral responses, and those with poor perception toward the COVID-19 pandemic were significantly associated with symptoms of psychological distress, depression, anxiety, and insomnia. Conclusions: Psychological impacts among physicians, nurses, and medical laboratory professionals are high during the COVID-19 pandemic. The Ethiopian Federal Ministry of Health should aim to protect all HCWs' psychological well-being during the COVID-19 pandemic with appropriate interventions and accurate information response.

Face mask exemptions, psychiatric patients, and COVID-19

It has been compulsory to wear face masks in all public spaces, both indoor and outdoor, since May 21, 2020 throughout Spain [1], a measure intended to prevent the spread of coronavirus disease 2019 (COVID-19). However, there are some exceptions to this rule, including "… People for whom the use of a mask is inadvisable for duly justified health reasons, or who, due to their disability or dependency, present behavioural alterations that make its use unviable."

Nurse Reports of Stressful Situations during the COVID-19 Pandemic: Qualitative Analysis of Survey Responses

The coronavirus disease (COVID-19) pandemic has exposed nurses to conditions that threaten their health, well-being, and ability to work. It is therefore critical to study nurses' experiences and well-being during the current crisis in order to identify risk groups for ill health and potential sources of organizational intervention. The aim of this study was to explore perceptions of the most salient sources of stress in the early stages of the coronavirus pandemic in a sample of U.S. nurses. A cross-sectional online survey was conducted among a sample of 695 U.S. nurses in May 2020. Content analysis was conducted on nurses' responses (n = 455) to an open-ended question on the most stressful situations they had experienced during the pandemic. Six distinct themes emerged from the analysis: exposure/infection-self; illness/death-others; workplace; personal protective equipment/supplies; unknowns; opinions/politics. Two sub-themes concerned restrictions associated with the pandemic and feelings of inadequacy/helplessness regarding patients and their treatment. More than half of all comments concerned stress related to problems in workplace response to the pandemic. Healthcare institutions should provide opportunities for nurses to discuss the stress they are experiencing, support one another, and make suggestions for workplace adaptations during this pandemic.

The prevalence of psychological consequences of COVID-19: A systematic review and meta-analysis of observational studies

A systematic review and a meta-analysis were conducted to examine the overall prevalence of psychological health outcomes during COVID-19. Seven databases were systematically searched to include studies reporting on at least one psychological outcome. The pooled prevalence of primary psychological outcomes was 26% (95%CI: 21-32). Pooled prevalence for symptoms of PTSD was 33% (0-86), anxiety 28% (21-36), stress 27% (14-43), and depression 22% (13-33). The prevalence of psychological outcomes was similar in healthcare workers and in the general population (34% [24-44] and 33% [27-40] respectively). High prevalence figures support the importance of ensuring adequate provision of resources for mental health.

Association Between Depression, Health Beliefs, and Face Mask Use During the COVID-19 Pandemic

The 2019 novel coronavirus (COVID-19) pandemic is associated with increases in psychiatric morbidity, including depression. It is unclear if people with depressive symptoms understand or apply COVID-19 information differently to the general population. Therefore, this study aimed to examine associations between depression, health beliefs, and face mask use during the COVID-19 pandemic among the general population in Hong Kong. This study gathered data from 11,072 Hong Kong adults via an online survey. Respondents self-reported their demographic characteristics, depressive symptoms (PHQ-9), face mask use, and health beliefs about COVID-19. Hierarchical logistic regression was used to identify independent variables associated with depression. The point-prevalence of probable depression was 46.5% (n = 5,150). Respondents reporting higher mask reuse (OR = 1.24, 95%CI 1.17-1.34), wearing masks for self-protection (OR = 1.03 95%CI 1.01-1.06), perceived high susceptibility (OR = 1.15, 95%CI 1.09-1.23), and high severity (OR = 1.33, 95%CI 1.28-1.37) were more likely to report depression. Depression was less likely in those with higher scores for cues to action (OR = 0.82, 95%CI 0.80-0.84), knowledge of COVID-19 (OR = 0.95, 95%CI 0.91-0.99), and self-efficacy to wear mask properly (OR = 0.90 95%CI 0.83-0.98). We identified a high point-prevalence of probable major depression and suicidal ideation during the COVID-19 outbreak in Hong Kong, but this should be viewed with caution due to the convenience sampling method employed. Future studies should recruit a representative probability sample in order to draw more reliable conclusions. The findings highlight that COVID-19 health information may be a protective factor of probable depression and suicidal ideation during the pandemic. Accurate and up-to-date health information should be disseminated to distressed and vulnerable subpopulations, perhaps using digital health technology, and social media platforms to prompt professional help-seeking behavior.

A Cross-Sectional Study of Psychological Status in Different Epidemic Areas in China After the COVID-19 Outbreak

Background: The outbreak of coronavirus disease 2019 in Wuhan, Hubei Province, China has seriously affected people's mental health. We aimed to assess the psychological impact of the coronavirus disease 2019 on health care workers and non-health care workers in three different epidemic areas in China and to identify independent risk factors. Methods: We surveyed 1,020 non-health care workers and 480 health care workers in Wuhan, other cities in Hubei except Wuhan and other provinces in China except Hubei. Results: Health care workers in Hubei had higher levels of anxiety and depression than non-health care workers (p < 0.05), but there was no such difference in other provinces in China except Hubei (p > 0.05). Compared with other regions, health care workers in Wuhan was more anxious (p < 0.05), and this anxiety may be caused by concerns about occupational exposure and wearing protective clothing for a long time daily; health care workers in Hubei had more obvious depression (p < 0.05), which may be associated with long days participating in epidemic work and wearing protective clothing for a long time daily. Meanwhile, 62.5% of health care workers were proud of their work. The anxiety and depression of non-health care workers in Wuhan were also the most serious. Conclusions: In Wuhan, where the epidemic is most severe, levels of anxiety and depression seem to be higher, especially among health care workers. This information may help to better prepare for future events.