Depressive and Anxiety Symptoms Among People Under Quarantine During the COVID-19 Epidemic in China: A Cross-Sectional Study

Investigating the Associations Between COVID-19, Long COVID, and Sleep Disturbances: Cross-Sectional Study

Background

COVID-19 has not only resulted in acute health issues but also led to persistent symptoms known as long COVID, which have been linked to disruptions in sleep quality.

Objective

This study aims to investigate the associations between COVID-19, long COVID, and sleep disturbances, focusing on demographic, socioeconomic, and psychological factors among a Chinese population.

Methods

This cross-sectional study included 1062 participants from China. Demographic, socioeconomic, and clinical data were collected through web-based questionnaires. Participants were divided into 2 groups based on COVID-19 infection status: infected and noninfected. Within the infected group, participants were further categorized into those with long COVID and those without long COVID. Noninfected participants were included in the non-long COVID group for comparison. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while depression and anxiety were evaluated using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) scales, respectively. Multivariable linear regression was conducted to examine the associations between COVID-19, long COVID, and sleep quality, adjusting for demographic and psychosocial factors.

Results

COVID-19 infection was confirmed in 857 participants, with 273 of them developing long COVID. No significant sex disparities were observed in infection rates (P=.63). However, a marginal statistical difference was noted in the prevalence of long COVID among females (P=.051). Age was significantly associated with both infection rates (P<.001) and long COVID (P=.001). Participants aged 60-70 years were particularly vulnerable to both outcomes. Sleep latency was significantly longer in the infected group (mean 1.73, SD 0.83) compared to the uninfected group (mean 1.57, SD 0.78; P=.01), and PSQI scores were higher (mean 8.52, SD 4.10 vs. 7.76, SD 4.31; P=.02). Long COVID participants had significantly worse sleep outcomes across all metrics (P<.001), except for sleep medication use (P=.17).

Conclusions

Our findings indicate that long COVID is strongly associated with significant sleep disturbances, while initial COVID-19 infection shows a more moderate association with sleep issues. Long COVID-related sleep disturbances were exacerbated by factors such as age, income, and chronic health conditions. The study highlights the need for targeted interventions that address the multifaceted impacts of long COVID on sleep, especially among vulnerable groups such as older adults and those with lower socioeconomic status. Future research should use longitudinal designs to better establish the temporal relationships and causal pathways between COVID-19 and sleep disturbances.

The Association of Sleep Duration and Sleep Quality With Depression and Anxiety Among Chinese Commercial Pilots

Background: Sleep problems are known as risk factors for depression and anxiety, but research on this subject with commercial pilots is limited. This study aimed to explore the effects of sleep problems on depressive and anxiety symptoms among Chinese commercial pilots. Methods: Adults who participated in the baseline assessment of the Civil Aviation Health Cohort of China between December 2022 and March 2023 formed the study sample. Depressive and anxiety symptoms and sleep quality were assessed using standardized scales. Sleep duration was measured with standardized questions. Logistic regression and restricted cubic splines (RCSs) were used to analyze the association between sleep problems and depression/anxiety symptoms. Results: A total of 7055 pilots were included in this study. The overall prevalence of depression and anxiety among pilots was 23.3% (n = 1642; 95% confidence interval [CI] = 22.3%-24.3%) and 17.0% (n = 1196; 95% CI = 16.1-17.8%), respectively. Logistic regression analyses revealed that short sleep duration (<7 h) was significantly associated with a higher risk of depression (odds ratio [OR] = 2.491; p  < 0.001) and anxiety (OR = 2.555; p  < 0.001), while poor sleep quality was also associated with a higher risk of depression (OR = 7.297; p  < 0.001) and anxiety (OR = 7.469; p  < 0.001). After adjusting for confounders, there was an inverse, J-shaped nonlinear relationship between sleep duration and both depression (inflection point: 7.64 h) and anxiety (inflection point: 7.48 h). Similarly, a J-shaped nonlinear relationship was found between sleep quality and depression/anxiety with an inflection point of Pittsburgh Sleep Quality Index (PSQI) = 4 points for both. The major limitation of the study was that causal relationships between variables could not be inferred due to the cross-sectional study design. Conclusion: This study found that depression and anxiety were common among Chinese commercial pilots. Insufficient length and poor quality of sleep were associated with an increased risk of depression and anxiety. Implementing targeted strategies to improve sleep patterns is crucial for reducing the risk of depression and anxiety in this population.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Prevalence of depression, anxiety in China during the COVID-19 pandemic: an updated systematic review and meta-analysis

Background

Mental health risks associated with the aftermath of the COVID-19 pandemic are often overlooked by the public. The aim of this study was to investigate the effects of the COVID-19 pandemic on depression and anxiety disorders in China.

Methods

Studies were analyzed and extracted in accordance with the PRISMA 2020 flowchart. The studies were screened and extracted using electronic databases including PubMed, Web of Science, Embase, Cochrane Library, and ClinicalTrials.gov according to the predefined eligibility criteria. The Cochrane Review Manager software 5.3.1 was used for data analysis and the risk of bias assessment.

Results

As of 2023, a total of 9,212,751 Chinese have been diagnosed with COVID-19 infection. A total of 913,036 participants in 44 studies were selected following the eligibility criteria, the statistical information of which was collected for meta-analysis. The pooled prevalence of depression and anxiety were 0.31 (95% CI: 0.28, 0.35; I2 = 100.0%, p < 0.001) and 0.29 (95% CI: 0.23, 0.36; I2 = 100.0%, p < 0.001), respectively. After performing a subgroup analysis, the prevalence of depression among women, healthcare workers, students, and adolescents was 0.31 (95% CI: 0.22, 0.41), 0.33 (95% CI: 0.26, 0.44), 0.32 (95% CI: 0.26, 0.39), and 0.37 (95% CI: 0.31, 0.44), respectively.

Conclusion

The prevalence of depression and anxiety among the Chinese was overall high. Monitoring and surveillance of the mental health status of the population during crises such as sudden global pandemics are imperative.

Systematic review registration

https://clinicaltrials.gov/, identifier [CRD42023402190].

Association of gastrointestinal symptoms and skipping breakfast with anxiety and depressive symptoms in quarantined Chinese college students during the Shanghai 2022 lockdown: a cross sectional survey

BACKGROUND

This study aimed to evaluate the prevalence of anxiety and depressive symptoms among quarantined college students at school in Shanghai 2022 lockdown during the COVID-19 pandemic and investigate the association of gastrointestinal discomfort related-factors and skipping breakfast with anxiety and depressive symptoms.

METHODS

384 quarantined college students in Shanghai China were recruited in this cross-sectional study from April 5th to May 29th, 2022. Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) were used to assess anxiety and depressive symptoms, respectively.

RESULTS

The prevalence of anxiety and depressive symptoms were 56.8% and 62.8%, respectively. Longer quarantine duration, higher education level, skipping breakfast, stomachache or abdominal pain, and nausea or dyspepsia were significantly associated with anxiety symptoms. Moreover, longer quarantine duration, being woman, skipping breakfast, stomachache or abdominal pain, and nausea or dyspepsia were markedly related to depressive symptoms. Notably, regularly physical exercising and taking positive attitude towards COVID-19 were negatively correlated with anxiety and depressive symptoms.

CONCLUSIONS

More attention should be paid to anxiety and depressive symptoms of quarantined college students and universities should provide timely psychological monitoring and intervention services to mitigate the impact of negative emotions on students. Effectively relieving gastrointestinal symptoms, insisting on eat breakfast, regularly exercising, and taking a positive attitude towards to COVID-19 might contribute to preventing the anxiety and depressive symptoms for those college students experiencing a long-term quarantine.

Predicting the impact of the COVID-19 pandemic on globalization

The COVID-19 pandemic has significantly influenced the global economy, international travel, global supply chains, and how people interact, and subsequently affect globalization in coming years. In order to understand the impact of COVID-19 on globalization and provide potential guidance to policymakers, the present study predicted the globalization level of the world average and 14 specific countries in scenarios with and without COVID-19 based on a new Composite Indicator method which contains 15 indicators. Our results revealed that the world average globalization level is expected to decrease from 2017 to 2025 under the scenario without COVID-19 by -5.99%, while the decrease of globalization under the COVID-19 scenario is predicted to reach -4.76% in 2025. This finding implies that the impact of COVID-19 on globalization will not be as severe as expected in 2025. Nevertheless, the downward trend of globalization without COVID-19 is due to the decline of the Environmental indicators, whereas the decline under the COVID-19 scenario is attributed to Economic aspects (almost -50%). The impact of COVID-19 on globalization varies across individual countries. Among the countries investigated, COVID-19 had a positive impact on the globalization of Japan, Australia, the United States, the Russian Federation, Brazil, India and Togo. In contrast, the globalization in the United Kingdom, Switzerland, Qatar, Egypt, China and Gabon are expected to decrease. The variation of impact induced by COVID-19 on those countries is attributed to the weighting of economic, environmental and political aspects of globalization is different across these countries. Our results can help governments take suitable measures to balance economic, environmental and political policies, which may better support their decision-making.

Prevalence of anxiety during the COVID-19 pandemic: A systematic review and meta-analysis of over 2 million people

INTRODUCTION

Uncertainty, disruptions in daily routines, and concerns for the health and well-being during the COVID-19 pandemic are likely associated with increases in generalized anxiety. The present study aimed to systematically review the literature in order to identify the update prevalence of anxiety in the general population during the COVID-19 pandemic.

METHODS

A systematic review and meta-analysis. It included studies that assessed the prevalence of anxiety among the general population during the COVID-19 pandemic.

RESULTS

In total, we included 194 studies. The general prevalence of anxiety was 35.1 %, affecting approximately 851,000 participants. The prevalence in low and middle-income countries (35.1 %; 95%CI: 29.5 % to 41.0 %) was similar compared to high-income countries (34.7 %; 95%CI: 29.6 % to 40.1 %). In studies that provided the proportion of cases in each level of anxiety disorder, mild-to-moderate anxiety affected one quarter of the participants. One in ten cases with anxiety during the COVID-19 may be living with severe or extremely anxiety disorder. Most instruments estimated similar prevalence of anxiety disorders with notable difference in the prevalence estimated by the Generalized Anxiety Disorder 2-item (GAD-2), Zung Self-Rating Anxiety Scale (SAS), and State-Trait Anxiety Inventory (STAI).

CONCLUSION

One in three adults were living with anxiety disorder during the COVID-19 pandemic worldwide.

Personality, Defenses, Mentalization, and Epistemic Trust Related to Pandemic Containment Strategies and the COVID-19 Vaccine: A Sequential Mediation Model

BACKGROUND

The COVID-19 pandemic has considerably influenced all domains of people's lives worldwide, determining a high increase in overall psychological distress and several clinical conditions. The study attempted to shed light on the relationship between the strategies adopted to manage the pandemic, vaccine hesitancy, and distinct features of personality and mental functioning.

METHODS

The sample consisted of 367 Italian individuals (68.1% women, 31.9% men; M age = 37, SD = 12.79) who completed an online survey, including an instrument assessing four response styles to the pandemic and lockdown(s), the Personality Inventory for DSM-5-Brief Form, the Defense Mechanisms Rating Scales-Self-Report-30, the Reflective Functioning Questionnaire, and the Epistemic Trust, Mistrust, Credulity Questionnaire.

RESULTS

Maladaptive response patterns to pandemic restrictions were related to dysfunctional personality traits, immature defense mechanisms, poor mentalization, and epistemic mistrust or credulity. Moreover, more severe levels of personality pathology were predictive of an extraverted-maladaptive response style to health emergency through the full mediation of low overall defensive functioning, poor certainty of others' mental states, and high epistemic credulity.

CONCLUSIONS

Recognizing and understanding dysfunctional psychological pathways associated with individuals' difficulties in dealing with the pandemic are crucial for developing tailored mental-health interventions and promoting best practices in healthcare services.

Medical students' perceptions and performance in an online regional anatomy course during the Covid-19 pandemic

The present study evaluated the students' psychological well-being, experiences, performance, and perception of learning regional anatomy remotely. A regional anatomy remote learning curriculum was designed and learning materials were delivered virtually to 120 undergraduate medical students at Jinan University, China. All the students consented and voluntarily participated in this study by completing self-administered online questionnaires including the Zung's Self-Rating Anxiety and Depression Scales at the beginning and end of the learning session. A subset participated in focus group discussions. Most of the students (90.0%) positively evaluated the current distance learning model. More than 80% were satisfied with the content arrangement and coverage. Many students preferred virtual lectures (68.2%) and videos showing dissections (70.6%) during the distance learning sessions. However, writing laboratory reports and case-based learning were the least preferred modes of learning as they were only preferred by 23.2% and 14.1% of the students, respectively. There was no significant lockdown-related anxiety or depression reported by students using depression and anxiety scales as well as feedback from focus group discussions. The surveyed students' confidence scores in distance learning were significantly higher after 5 weeks than at the beginning of the session (3.05 ± 0.83 vs. 3.70 ± 0.71, P < 0.05). Furthermore, the present results showed no significant differences between the current group's academic performance in the unit tests as well as the final overall evaluation for different parts of the course compared to that of the previous year's cohort. The findings above were congruent with focus group discussion data that the use of the online teaching platform for regional anatomy significantly improved the students' confidence in virtual and self-directed learning and did not negatively affect their academic performance.

Mental Health Problems, Burnout and Resilience in Community Pharmacists during the COVID-19 Pandemic: a Cross-Sectional Study

Background

Methods

Results

Conclusions

Compliance with COVID-19-preventive behaviours among employees returning to work in the post-epidemic period

BACKGROUND

The COVID-19 pandemic has underscored the importance of behaviours such as social distancing in controlling pandemics. Currently, the epidemic is under control in China and production has resumed in various industries. This study investigates the behavioural compliance and related factors for COVID-19 prevention among employees returning to the workplace and provide strategic recommendations for improving individual-level preventive behaviour to prevent a new outbreak.

METHODS

A cross-sectional study design was used. Data were gathered from returning employees in China using an online questionnaire survey, from March to May, 2020. The questionnaire covered participants' COVID-19-related knowledge, compliance with recommended preventive behaviours, and levels of depression and anxiety. Univariate and multi-factor methods were used to analyse the data and identify factors influencing behaviour compliance.

RESULTS

Of the 1300 participants completing the full survey, more than half were male (71.92%) and 61% were aged between 31 and 50 years. Six hundred and ninety-eight (53.7%) participants showed high compliance, while 602 (46.3%) showed low compliance. In models adjusted for demographic and socio-economic factors, high education level (odds ratio [OR] = 0.23, 95% confidence interval [CI]: 0.07-0.70), office staff (OR = 0.51, 95% CI: 0.33-0.78), higher knowledge of COVID-19 (OR = 0.74, 95% CI: 0.67-0.81), and quarantining (OR = 0.74, 95% CI: 0.57-0.96) predicted better compliance with preventive behaviours (P <  0.05), while high anxiety levels (OR = 1.55, 95% CI: 1.10-2.18) predicted lower compliance with preventive behaviours (P <  0.05).

CONCLUSION

For employees returning to work during the post-COVID-19-epidemic period, compliance with recommended preventive behaviours requires improvement. Consequently, comprehensive intervention measures, including the provision of health education and psychological counselling, as well as the continuance of a strict isolation policy, could enhance such compliance.

COVID-19 depression and its risk factors in Asia Pacific - A systematic review and meta-analysis

BACKGROUND

This systematic review and meta-analysis aim to synthesize the extant literature reporting the effects of COVID-19 pandemic based on the pooled prevalence of depression among affected populations in Asia Pacific, as well as its risk factors.

METHOD

A systematic review and meta-analysis approach was adopted as per the PRISMA guidelines, targeting articles published in PubMed, Google Scholar and Scopus from January 2021 to March 30, 2021. The screening resulted in 82 papers.

RESULTS

The overall pooled depression prevalence among 201,953 respondents was 34% (95%CI, 29-38, 99.7%), with no significant differences observed between the cohorts, timelines, and regions (p > 0.05). Dominant risk factors found were fear of COVID-19 infection (13%), gender (i.e., females; 12%) and deterioration of underlying medical conditions (8.3%), regardless of the sub-groups. Specifically, fear of COVID-19 infection was the most reported risk factor among general population (k = 14) and healthcare workers (k = 8). Gender (k = 7) and increased workload (k = 7) were reported among healthcare workers whereas education disruption among students (k = 7).

LIMITATION

The review is limited to articles published in three electronic databases. Conclusion The pandemic has caused depression among the populations across Asia Pacific, specifically among the general population, healthcare workers and students. Immediate attention and interventions from the concerned authorities are needed in addressing this issue.

An Oppositional Tolerance Account for Potential Cognitive Deficits Caused by the Discontinuation of Antidepressant Drugs

Depression is the leading cause of disability worldwide, making antidepressant drugs the most used psychiatric drugs in the USA. Withdrawal effects and rebound symptoms frequently occur after the reduction and/or discontinuation of these drugs. Although these phenomena have been investigated with respect to the clinical symptomatology, no studies have systematically investigated the effects of withdrawal/rebound on general cognition. We present a novel framework based on the idea of allostatic adaptation, which allows to predict how different antidepressants likely impair different cognitive processes as a result of withdrawal and rebound effects. This framework relies on the assumptions that the type of cognitive impairments evoked by an antidepressant is determined by the targeted neurotransmitter systems, while the severity of deficits depends on its half-life. Our model predicts that the severity of detrimental cognitive withdrawal and rebound effects increases with a shorter half-life of the discontinued antidepressant drug. It further proposes drug-specific effects: antidepressants mainly targeting serotonin should primarily impair aversive and emotional processing, those targeting norepinephrine should impair the processing of alerting signals, those targeting dopamine should impair motivational processes and reward processing, and those targeting acetylcholine should impair spatial learning and memory. We hope that this framework will motivate further research to better understand and explain cognitive changes as a consequence of antidepressant discontinuation.

Psychological Distress and Trust in University Management Among International Students During the COVID-19 Pandemic

Since the end of 2019, the outbreak of the COVID-19 pandemic has engendered widespread fear and anxiety across China. Nearly half a million international students pursuing their studies in Chinese universities have also been exposed to the psychological distress triggered by the unfolding crisis. In addition to government and medical institutions' efforts, universities have also endeavored to mitigate concerns among these students under quarantine on campus by providing reliable information as well as medical, monetary, and emotional support. In this study, international students' trust in university management teams and its role in remediating their anxieties were evaluated using an online survey conducted after 10 days of the lockdown of Wuhan, China. The empirical analysis incorporates quantitative data from 180 international students. Ordinary least squares regression and probit regression were used in the analysis with the non-robust and robust models. The study found students' perception of trust in university management to be negatively associated with their anxiety levels. Additionally, having trust in university management was found to positively influence students' commitment to the self-quarantine guidelines. These results reinforce the important role of universities and their relationship with international students during public health emergencies.

Prevalence and Factors for Anxiety during the COVID-19 Pandemic among College Students in China

Background: Knowledge of the impact of COVID-19 on the mental health of college students remains limited. Our aim is to investigate the prevalence of anxiety and explore the potential risk and protective factors of anxiety. Methods: A cross-sectional survey was adopted and a total of 24,678 college students were included from Zhengzhou, Henan Province, China, during February, 2020. Anxiety was assessed by using the Generalized Anxiety Disorder tool (GAD-7). Multiple logistic regression models were established for exploring potential factors of anxiety. Results: The overall prevalence of anxiety was 7.3%. After adjusting for potential confounders, sex, place of residence, worried level, fear level, cognitive levels, and behavior status were found to be associated with anxiety (p < 0.05). Students with positive preventive behaviors showed a protective effect against the anxiety symptoms compared to those with negative preventive behaviors. In contrast to the high-cognition category, participants at a low cognitive level were 14.9% more likely to present anxiety symptoms. Conclusion: This large-scale study assessed the prevalence of anxiety and its potential influencing factors among college students. It suggests that the government could strengthen health education related to COVID-19 and supervise the performance of preventive behaviors to handle anxiety.