Prevalence of Anxiety Symptoms and Associated Clinical and Sociodemographic Factors in Mexican Adults Seeking Psychological Support for Grief During the COVID-19 Pandemic: A Cross-Sectional Study

Psychopathological Symptoms of Individuals Recently Bereaved During COVID-19 Pandemic: Symptom Profiles, Predictive Factors and Correlations With Insomnia

AIMS

This study aimed to identify subgroups of individuals bereaved within the past 1 year during the COVID-19 pandemic based on symptoms of prolonged grief disorder (PGD), depression and post-traumatic stress (PTSD). Additionally, we examined class differences in socio-demographic and loss-related variables and explored the associations between class membership and insomnia.

METHODS

A total of 324 individuals (72.2% female) who experienced bereavement within 12 months (M = 4.01 months, SD = 2.45) completed Inventory of Complicated Grief (ICG), Patient Health Questionnaire (PHQ-9), PTSD Checklist for DSM-5 (PCL-5) and Insomnia Severity Index (ISI). Latent class analysis (LCA) with three-step and BCH procedure was employed.

RESULTS

Three distinct subgroups were identified: a high symptoms class (33.4%), a high PGD, moderate depression and PTSD class (35.2%) and a moderate PGD, low depression and PTSD class (31.4%), especially yearning, preoccupation, emotional pain and loneliness, were predominant. Class membership was influenced by relationship to the deceased and expectancy of death but not by time since loss. Death due to COVID-19 did not significantly differentiate class membership compared to other causes. Additionally, significant differences in insomnia severity were observed across classes (p < 0.001).

CONCLUSION

Distinct psychopathological patterns emerged among recently bereaved individuals during the pandemic, with PGD symptoms being particularly prominent. Tailored strategies may help address distinct symptom profiles and co-morbid symptoms within bereavement care.

Prolonged grief in relatives of deceased patients due to COVID-19 is associated with anxiety and depressive symptoms: A survey-based study in Peru

Objective

Funeral practices have undergone significant changes during the COVID-19 pandemic. Thus, the death of a family member from this disease has altered the typical course of the bereavement process. Therefore, this study seeks to determine the relationship between the levels of grief, anxiety, and depression in relatives of patients who died from COVID-19 in Peru.

Methods

A total of 250 volunteers were obtained, but after applying the inclusion criteria and not being able to contact five of them, the sample consisted of 115 participants over 18 years of age who lost a family member to COVID-19 between 2020 and 2021. They developed the Prolonged Grief Questionnaire-13 and the Zung Anxiety and Depression Questionnaires, in virtual surveys using Google FormTM (Google, CA).

Results

Our analysis revealed that all cases of anxiety (18.3%) were present in individuals experiencing prolonged grief (76.5%), while 49.5% (57/115) of participants exhibited symptoms of depression. Furthermore, we identified a significant association between prolonged grief and both anxiety (p = 0.005) and depression (p < 0.001). Prolonged grief predominantly affected females (45.2%) and individuals aged 31-40 years (28.7%) (p < 0.001). Regarding predictors of anxiety symptoms, we found that both age group (p = 0.035) and grief (p < 0.001) played significant roles. Gender (p = 0.019) and grief (p < 0.001) emerged as predictors of depression, while gender alone predicted grief in relatives of individuals who succumbed to COVID-19 (p = 0.019).

Conclusion

Our results suggest a clear association between prolonged grief and mental health issues among relatives of COVID-19 patients who have passed away. Consequently, it is imperative to provide comprehensive psychological and spiritual support throughout the grieving process, aiming to mitigate the negative impact of traumatic events.

Complicated grief and its relationship with anxiety, depression, and suicidal ideation in older adults in the context of the COVID-19 pandemic in Peru: a cross-sectional analysis

BACKGROUND

Complicated grief (CG) resulting from poor adaptation to the death of a close person may have been related with the presence of other mental health problems in older adults in Peru during the COVID-19 pandemic. Our study aimed to assess the association between CG and anxiety, depression, and suicidal ideation in older adults in Peru in the context of the COVID-19 pandemic.

METHODS

We conducted a cross-sectional analysis using data from the "Socioemotional evaluation form" applied in 2020 to mental health problems in older adults attending the Peruvian Social Security (EsSalud). For our study, we included older adults who reported the death of a close person during the last six months when this assessment was performed. CG, depression, anxiety, and suicidal ideation were initially evaluated using validated questionnaires. The association between CG and the presence of mental health problems was calculated through multivariate analysis, where prevalence ratios (PR) were estimated with 95% confidence intervals (CI).

RESULTS

Of the 249 older adults included, 175 (70.3%) were female with a median age of 71 years (interquartile range: 9), and 35 (14.1%) reported the presence of CG. It was found that CG in this population was associated with the presence of anxiety (PR: 1.35, 95% CI: 0.98 to 1.85), depression (PR: 1.44, 95% CI: 1.06 to 1.95), and suicidal ideation (PR: 2.84, 95% CI: 1.06 to 7.59).

CONCLUSIONS

CG is related to the presence of mental health problems in older adults in Peru. It is essential to implement measures that facilitate the prevention and proper management of this condition in this population, especially in the context of high population mortality such as the COVID-19 pandemic.

Coping Strategies Used by Health Care Workers in Ecuador During the COVID-19 Pandemic: Observational Study to Enhance Resilience and Develop Training Tools

BACKGROUND

The COVID-19 pandemic has generated immense health care pressure, forcing critical decisions to be made in a socially alarmed environment. Adverse conditions have led to acute stress reactions, affective pathologies, and psychosomatic reactions among health personnel, which have been exacerbated by the successive waves of the pandemic. The recovery of the entire health system and its professionals has been hindered, making it essential to increase their resilience.

OBJECTIVE

This study aimed to achieve 2 primary objectives. First, it sought to identify coping strategies, both individual and organizational, used by health care workers in Ecuador to navigate the acute stress during the early waves of the pandemic. Second, it aimed to develop training materials to enhance team leaders' capabilities in effectively managing high-stress situations.

METHODS

The study used qualitative research techniques to collect information on institutional and personal coping strategies, as well as consensus-building techniques to develop a multimedia psychological tool that reinforces the resilience of professionals and teams in facing future crises.

RESULTS

The findings from the actions taken by health care workers in Ecuador were categorized into 4 types of coping strategies based on Lazarus' theories on coping strategies. As a result of this study, a new audiovisual tool was created, comprising a series of podcasts, designed to disseminate these strategies globally within the Spanish-speaking world. The tool features testimonials from health care professionals in Ecuador, narrating their experiences under the pressures of providing care during the pandemic, with a particular emphasis on the coping strategies used.

CONCLUSIONS

Ensuring the preparedness of health professionals for potential future outbreaks is imperative to maintain quality and patient safety. Interventions such as this one offer valuable insights and generate new tools for health professionals, serving as a case study approach to train leaders and improve the resilience capacity and skills of their teams.

Variables Associated with Emotional Symptom Severity in Primary Care Patients: The Usefulness of a Logistic Regression Equation to Help Clinical Assessment and Treatment Decisions

The aim of this study is to contribute to the evidence regarding variables related to emotional symptom severity and to use them to exemplify the potential usefulness of logistic regression for clinical assessment at primary care, where most of these disorders are treated. Cross-sectional data related to depression and anxiety symptoms, sociodemographic characteristics, quality of life (QoL), and emotion-regulation processes were collected from 1,704 primary care patients. Correlation and analysis of variance (ANOVA) tests were conducted to identify those variables associated with both depression and anxiety. Participants were then divided into severe and nonsevere emotional symptoms, and binomial logistic regression was used to identify the variables that contributed the most to classify the severity. The final adjusted model included psychological QoL (p < .001, odds ratio [OR] = .426, 95% CI [.318, .569]), negative metacognitions (p < .001, OR = 1.083, 95% CI [1.045, 1.122]), physical QoL (p < .001, OR = .870, 95% CI [.841, .900]), brooding rumination (p < .001, OR = 1.087, 95% CI [1.042, 1.133]), worry (p < .001, OR = 1.047, 95% CI [1.025, 1.070]), and employment status (p = .022, OR [.397, 2.039]) as independent variables, ρ2 = .326, area under the curve (AUC) = .857. Moreover, rumination and psychological QoL emerged as the best predictors to form a simplified equation to determine the emotional symptom severity (ρ2 = .259, AUC = .822). The use of statistical models like this could accelerate the assessment and treatment-decision process, depending less on the subjective point of view of clinicians and optimizing health care resources.

Diabetes is associated with increased risk of death in COVID-19 hospitalizations in Mexico 2020: A retrospective cohort study

Background and Aim

The COVID-19 disease course can be thought of as a function of prior risk factors consisting of comorbidities and outcomes. Survival analysis data for diabetic patients with COVID-19 from an up to date and representative sample can increase efficiency in resource allocation. The study aimed to quantify mortality in Mexico for individuals with diabetes in the setting of COVID-19 hospitalization.

Methods

This retrospective cohort study utilized publicly available data from the Mexican Federal Government, covering the period from April 14, 2020, to December 20, 2020 (last accessed). Survival analysis techniques were applied, including Kaplan-Meier curves to estimate survival probabilities, log-rank tests to compare survival between groups, Cox proportional hazard models to assess the association between diabetes and mortality risk, and restricted mean survival time (RMST) analyses to measure the average survival time.

Results

A total of 402,388 adults age greater than 18 with COVID-19 were used in the analysis. Mean age = 16.16 (SD = 15.55), 214,161 males (53%). Twenty-day Kaplan-Meier estimates of mortality were 32% for COVID-19 patients with diabetes and 10.2% for those without diabetes with log-rank p < 0.01. Univariable analysis showed increased mortality in diabetic patients (hazard ratio [HR]: 3.61, 95% confidence interval [CI]: 3.54-3.67, p < 0.01) showing a 254% increase in death. After controlling for confounding variables, multivariate analysis continued to show increased mortality in diabetics (HR: 1.37, 95% CI: 1.29-1.44, p < 0.01) indicating a 37% increase in death. Multivariable RMST at Day 20 showed in Mexico, hospitalized COVID-19 patients were associated with less mean survival time by 2.01 days (p < 0.01) and a 10% increased mortality (p < 0.01).

Conclusions

In the present analysis, COVID-19 patients with diabetes in Mexico had shorter survival times. Further interventions aimed at improving comorbidities in the population, particularly in individuals with diabetes, may contribute to better outcomes in COVID-19 patients.

International students' collective resilience in crisis: Sense of community reduced anxiety via social contact and social support during lockdown

Objectives

The role of community in individuals' well-being has been extensively examined in the Western context. However, little is known about how the host community is related to sojourners' well-being in a crisis in an Asian context. The current study aims at exploring international students' sense of community in the Chinese context under the direct threat of a global health crisis.

Methods

Using a cross-sectional sample of 102 international students staying in Wuhan during the 76-day lockdown at the earliest stage of the COVID-19 pandemic, the current study explored the relationship between international students' sense of community and anxiety, and the mediating role of social contact, social support from three key sources in the host community (host university, international students, and Chinese friends).

Results

Results showed that participants' stronger sense of community indirectly reduced anxiety via the role of sources of contact and support from the host community.

Conclusions

This study provided further evidence to support the nurturance of the sense of community in community resilience and provided implications on how the host community can help to enhance sojourners' psychological well-being in a global crisis.

The efficacy and usability of an unguided web-based grief intervention for adults who lost a loved one during the COVID-19 pandemic: A Randomized Controlled Trial

BACKGROUND

The death of a loved one was a challenge many people faced during the COVID-19 pandemic within a context of extraordinary circumstances and great uncertainty. Grief is an unavoidable part of life and for most people, feelings of grief decrease naturally over time. However, for some people, grieving can become a particularly painful process with clinical symptoms which may require professional help to resolve. To provide psychological support to people who had lost a loved one during the COVID-19 pandemic, an unguided web-based psychological intervention was developed.

OBJECTIVE

The main objective of this study was to evaluate the efficacy of the web-based treatment, Grief COVID (Duelo COVID in Spanish), in reducing clinical symptoms of complicated grief, depression, post-traumatic stress, hopelessness, anxiety, and suicidal risk in adults. A secondary aim was to validate the usability of the self-applied intervention system.

METHODS

We used a randomized controlled trial (RCT) with an intervention group (IG) and a waitlist control group (CG). The groups were assessed three times (prior to beginning the intervention, upon completing the intervention, and three months post-intervention). The intervention was delivered online in an asynchronous format through the webpage Duelo COVID-19. Participants created an account that could be used on their computers, smartphones, or tablets. The evaluation process was automated as part of the intervention.

RESULTS

A total of 114 participants were randomly assigned to the IG or CG and met criteria for inclusion in the study (n=45 finished the intervention and n=69 completed the waitlist time period). The majority of participants were women (n=103, 90.4%). Results indicated that the treatment significantly reduced baseline clinical symptoms in the IG for all variables, with larger effect sizes for depression, hopelessness, grief, anxiety, and risk of suicide (all effect sizes ≥0.5). The follow-up evaluation showed that symptom reduction was maintained at three months post-intervention. Results from the CG showed that participants experienced significantly decreased levels of hopelessness after completing the time on the waitlist, but their suicidal risk scores increased. Regarding the usability of the self-applied intervention system, results indicated a high level of satisfaction with Grief COVID.

CONCLUSIONS

The self-applied web-based intervention Grief COVID was effective in reducing symptoms of anxiety, depression, hopelessness, risk of suicide, post-traumatic stress disorder, and complicated grief disorder. Grief COVID was evaluated by the participants, who reported that the system was easy to use. These results affirm the importance of developing additional online psychological tools to help reduce clinical symptoms in people experiencing grief due to the loss of a loved one during a pandemic.

CLINICALTRIAL

The study is registered in Clinical trials (NCT04638842).

Potential risk factors for acute grief during the COVID-19 pandemic: The mediating role of avoidance processes

Bereavement during the COVID-19 pandemic may have some unique characteristics that become potential risk factors (e.g., absence of grief rituals, no opportunity to say goodbye to the deceased and loneliness caused by social distancing) for acute grief. Avoidance processes could be significant mediators in the context of the pandemic. The current study aimed to investigate whether and how these COVID-19-related risk factors were related to acute grief severity. Bereaved adults (n = 319) who lost significant others during the COVID-19 pandemic completed a self-report questionnaire package measuring COVID-19-related factors, grief severity and depressive and anxious avoidance. Regression analyses suggested that among the three potential risk factors (loneliness, grief rituals and opportunity to say goodbye), loneliness was significantly associated with acute grief after controlling for basic demographic and loss-related information. Structural equation models suggested that depressive avoidance and anxious avoidance partially mediated the associations of loneliness with acute grief severity. The findings indicate that dealing with loss during the COVID-19 pandemic warrants further exploration concerning how potential environmental risk factors may impede adaptation to loss. Depressive and anxious avoidance processes may play important roles in grief interventions for isolated and lonely bereaved people.

Mental Health Impact of the COVID-19 Pandemic on Mexican Population: A Systematic Review

The COVID-19 pandemic has had an impact on mental health in the general population, but no systematic synthesis of evidence of this effect has been undertaken for the Mexican population. Relevant studies were identified through the systematic search in five databases until December, 2021. The selection of studies and the evaluation of their methodological quality were performed in pairs. The Newcastle-Ottawa Scale (NOS) was used for study quality appraisal. The protocol of this systematic review was registered with PROSPERO (protocol ID: CRD42021278868). This review included 15 studies, which ranged from 252 to 9361 participants, with a total of 26,799 participants. The findings show that COVID-19 has an impact on the Mexican population's mental health and is particularly associated with anxiety, depression, stress and distress. Females and younger age are risk factors for development mental health symptoms. Mitigating the negative effects of COVID-19 on mental health should be a public health priority in Mexico.