Mitigating COVID-19 Impact on the Portuguese Population Mental Health: The Opportunity That Lies in Digital Mental Health

COVID-19 fear and anxiety as mediators in the relationship between repetitive negative thinking and psychopathology: a community-based study during the 2nd confinement in Portugal

Repetitive negative thinking is a cognitive dimension of the onset and maintenance of psychopathology, and increased levels of psychopathology have been observed during COVID-19 lockdowns. The role of fear of COVID-19 and COVID-19 anxiety has been poorly explored in terms of psychopathology during lockdowns due to the pandemic crisis. This study examines the mediating role of fear of COVID-19 and COVID-19 anxiety in the relationship between repetitive negative thinking and psychopathology during the second lockdown in Portugal. Participants completed a web survey that included a sociodemographic questionnaire, the Fear of COVID-19 Scale, the COVID-19 Anxiety Scale, the Persistent and Intrusive Negative Thoughts Scale, and the Depression, Anxiety, and Stress Scale - 21. The results showed a positive and significant correlation between all variables and identified fear of COVID-19 and COVID-19 anxiety as significant mediators in the relationship between repetitive negative thinking and psychopathology during the second lockdown in Portugal, after controlling for being isolated, being infected, and working in first line response of COVID-19. Overall, the current findings highlight the role of cognitive dimensions such as anxiety and fear in the context of COVID-19, nearly a year after the pandemic outbreak and after the release of a vaccine. Mental health programs should consider improving coping strategies for emotion regulation, particularly fear and anxiety, during major catastrophic health-related events.

Adjusting to a new reality: Consensual qualitative research on therapists' experiences with teletherapy

OBJECTIVE

In the wake of the COVID-19 pandemic, the use of teletherapy has become more pervasive than ever. Many therapists faced this move to a remote setting with little experience or training. We aimed to qualitatively examine therapists' subjective experience of providing teletherapy, including changes in technique, the therapeutic relationship, and the therapeutic process.

METHODS

Thirty-one psychotherapists participated in semistructured interviews. Interviews were recorded, then transcribed and analyzed using the Consensual Qualitative Research method.

RESULTS

Therapists typically reported a change in the therapeutic relationship in terms of an increased sense of disconnection as well as shifts in various aspects of the relational dynamics, and they also typically experienced differences in the therapy process due to changes in patient and therapist engagement in the therapeutic work. Additionally, some therapists also reported that they became more active and directive in sessions, took a more informal, personal, or relaxed approach to interacting with patients, and while the emotional connection changed and they missed the energy and intimacy of in-person sessions, the relationship in telesessions felt more authentic and human for some, and teletherapy also provided a way to discuss new dimensions in the process.

CONCLUSION

Overall, these results suggest great variability in therapists' subjective experiences with teletherapy, and present teletherapy as a distinct therapy format in many aspects. Further process-level research and subsequent training is needed to better equip therapists to navigate teletherapy's challenges and harness its unique opportunities.

COVID-19-related mental health difficulties among marginalised populations: A literature review

The COVID-19 pandemic has had negative consequences on the mental health of the population, which has been documented. Marginalised groups that are at risk of poor mental health overall have been particularly impacted. The purpose of this review is to describe the mental health impact of the COVID-19 pandemic on marginalised group (i.e. persons who are socio-economically disadvantaged, migrants and members of ethno-racial minorities, experience homelessness) and identified interventions which could be well-suited to prevent and address mental health difficulties. We conducted a literature review of systematic reviews on mental health difficulties since the beginning of the COVID-19 epidemic and appropriate interventions among marginalised groups published from January 1, 2020 to May 2, 2022, using Google Scholar and PubMed (MEDLINE). Among 792 studies on mental health difficulties among members of marginalised groups identified by keywords, 17 studies met our eligibility criteria. Twelve systematic reviews examining mental health difficulties in one or several marginalised groups during the COVID-19 pandemic and five systematic reviews on interventions that can mitigate the mental health impact of the COVID-19 pandemic were retained in our literature review. The mental health of marginalised groups was severely affected during the COVID-19 pandemic. Most frequently reported mental health difficulties included symptoms of anxiety and depression. Additionally, there are interventions that appear effective and well-suited for marginalised populations, which should be disseminated on a large scale to mitigate the psychiatric burden in these groups and at the population level.

The 'Covid-Trigger': New Light on Urban Agriculture and Systemic Approach to Urbanism to Co-Create a Sustainable Lisbon

In 2018, Lisbon won the title of Green capital of Europe 2020. It was described by the Expert Panel as an inspirational city which had started its journey towards sustainability during a period of economic crisis. A year later, Covid-19 had become a global pandemic. Imposed confinements highlighted the extent to which globalisation has spread the virus, as well as the particular fragility of places like cities where people, living together, were asked to not physically interact anymore. Exploring further that very particular global crisis can help to identify the faults in our economic systems and to ask why Lisbon was neither resilient nor sustainable in the face of that adversity. In addition to highlighting how weak our health is, Covid-19 has exacerbated vulnerabilities in Lisbon such as job losses (especially in the touristic sector), food supply (Portugal imports 70% of its food) and food waste. This paper explores how the activity which, 'par excellence', meets the most basic of our needs (food), through the example of Urban Agriculture (UA), could contribute to discussions on what makes a city sustainable. A literature review on UA in Lisbon highlights its various benefits, complemented by a broader literature review which converges to showing how UA can help to address the vulnerabilities generated or exacerbated by Covid. Having shown its potential contribution to addressing crises, this article then suggests to examine how systems approaches could help to incorporate UA further in a new type of more participatory urbanism aimed at creating sustainable cities.

At-distance neurocognitive rehabilitation during COVID-19 pandemic: A first glance of patients' perspectives about the process and an online platform

Despite the use of digital communication technologies in neurocognitive rehabilitation has been widely used in face-to-face interventions, the difficulties of using ICT-based tools to provide rehabilitation services and the unfamiliarity of the neuropsychologists with internet interventions limited the use of these kinds of interventions in their clinical practices. The lockdown and mitigating measures associated with the COVID-19 pandemic, on the other hand, forced the use of at-distance and online interventions as a means to mitigate the impact of those measures on the mental health and rehabilitation processes of people with neurological disorders. Overall, little is known about the perspectives of patients with acquired neurological conditions about rehabilitation services delivered at distance. Therefore, the main goal of this study was to explore the perceptions that patients with neurological disorders have on at-distance online neurocognitive rehabilitation, namely during the COVID-19 pandemic. Sixteen patients with acquired neurological conditions attending an online neurocognitive rehabilitation program in a Portuguese rehabilitation center filled in an online questionnaire during the mandatory lockdown. The results of this study highlight the potential of delivering rehabilitation services at distance, presenting its advantages and limitations from patients' perspectives, as well as suggestions for improving both neurorehabilitation processes and the online rehabilitation platform used.

Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review

BACKGROUND

The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions.

OBJECTIVE

To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions.

METHODS

We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care.

RESULTS

Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence.

CONCLUSIONS

Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions.

Understanding Mental Health Professionals' Perspectives and Practices Regarding the Implementation of Digital Mental Health: Qualitative Study

BACKGROUND

Despite the potential of digital mental health to provide cost-effective mental health care, its adoption in clinical settings is limited, and little is known about the perspectives and practices of mental health professionals regarding its implementation or the factors influencing these perspectives and practices.

OBJECTIVE

This study aims to characterize in depth the perspectives and practices of mental health professionals regarding the implementation of digital mental health and explore the factors affecting such perspectives and practices.

METHODS

A qualitative study using in-depth semistructured interviews with Portuguese mental health professionals (N=13)-psychologists and psychiatrists-was conducted. The transcribed interviews were thematically analyzed.

RESULTS

Mental health professionals deemed important or engaged in the following practices during the implementation of digital mental health: indication evaluation, therapeutic contract negotiation, digital psychological assessment, technology setup and management, and intervention delivery and follow-up. Low-threshold accessibility and professionals' perceived duty to provide support to their clients facilitated the implementation of digital mental health. Conversely, the lack of structured intervention frameworks; the unavailability of usable, validated, and affordable technology; and the absence of structured training programs inhibited digital mental health implementation by mental health professionals.

CONCLUSIONS

The publication of practice frameworks, development of evidence-based technology, and delivery of structured training seem key to expediting implementation and encouraging the sustained adoption of digital mental health by mental health professionals.

The modulatory role of internet-supported mindfulness-based cognitive therapy on extracellular vesicles and psychological distress in people who have had cancer: a protocol for a two-armed randomized controlled study

Background

Mindfulness-based interventions (MBIs) have been used in oncology contexts as a promising tool with numerous benefits for various health-related and psychosocial outcomes. Despite the increasing popularity of MBIs, few randomized controlled trials (RCTs) have examined their effects upon biological parameters. Specifically, no previous study has examined the effects of MBIs on extracellular vesicles (EVs), which are potentially important markers of health, disease, and stress. Moreover, the lack of RCTs is even more limited within the context of technology-mediated MBIs and long-term effects.

Methods

The current study protocol presents a two-arm, parallel, randomized controlled study investigating the effects of internet-supported mindfulness-based cognitive therapy (MBCT) compared with treatment as usual (TAU). Primary outcomes are psychological distress and EV cargo of distressed participants with previous breast, colorectal, or prostate cancer diagnoses. Secondary outcomes are self-reported psychosocial and health-related measures, and additional biological markers. Outcomes will be assessed at baseline, 4 weeks after baseline (mid-point of the intervention), 8 weeks after baseline (immediately post-intervention), 24 weeks after baseline (after booster sessions), and 52 weeks after baseline. Our goal is to recruit at least 111 participants who have been diagnosed with breast, prostate, or colorectal cancer (cancer stage I to III), are between 18 and 65 years old, and have had primary cancer treatments completed between 3 months and 5 years ago. Half of the participants will be randomized to the TAU group, and the other half will participate in an 8-week online MBCT intervention with weekly group sessions via videoconference. The intervention also includes asynchronous homework, an online retreat after the fifth week, and 4 monthly booster sessions after completion of the 8-week programme.

Discussion

This study will allow characterizing the effects of internet-based MBCT on psychosocial and biological indicators in the context of cancer. The effects on circulating EVs will also be investigated, as a possible neurobiological pathway underlying mind-body intervention effects.

Trial registration

ClinicalTrials.govNCT04727593 (date of registration: 27 January 2021; date of record verification: 6 October 2021).

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06045-x.

A Hybrid Spherical Fuzzy MCDM Approach to Prioritize Governmental Intervention Strategies against the COVID-19 Pandemic: A Case Study from Vietnam

The unprecedented coronavirus pandemic (COVID-19) is fluctuating worldwide. Since the COVID-19 epidemic has a negative impact on all countries and has become a significant threat, it is necessary to determine the most effective strategy for governments by considering a variety of criteria; however, few studies in the literature can assist governments in this topic. Selective governmental intervention during the COVID-19 outbreak is considered a Multi-Criteria Decision-Making (MCDM) problem under a vague and uncertain environment when governments and medical communities adjust their priorities in response to rising issues and the efficacy of interventions applied in various nations. In this study, a novel hybrid Spherical Fuzzy Analytic Hierarchy Process (SF-AHP) and Fuzzy Weighted Aggregated Sum Product Assessment (WASPAS-F) model is proposed to help stakeholders such as governors and policymakers to prioritize governmental interventions for dealing with the COVID-19 outbreak. The SF-AHP is implemented to measure the significance of the criteria, while the WASPAS-F approach is deployed to rank intervention alternatives. An empirical case study is conducted in Vietnam. From the SF-AHP findings, the criteria of “effectiveness in preventing the spread of COVID-19”, “ease of implementation”, and “high acceptability to citizens” were recognized as the most important criteria. As for the ranking of strategies, “vaccinations”, “enhanced control of the country’s health resources”, “common health testing”, “formation of an emergency response team”, and “quarantining patients and those suspected of infection” are the top five strategies. Aside from that, the robustness of the approach was tested by performing a comparative analysis. The results illustrate that the applied methods reach the general best strategy rankings. The applied methodology and its analysis will provide insight to authorities for fighting against the severe pandemic in the long run. It may aid in solving many complicated challenges in government strategy selection and assessment. It is also a flexible design model for considering the evaluation criteria. Finally, this research provides valuable guidance for policymakers in other nations.

COVID-19 Lockdown in Portugal: Challenges, Strategies and Effects on Mental Health

Identified in China at the end of 2019, the COVID-19 infection has increased exponentially worldwide. Together with the threat of physical illness, this pandemic brought negative impacts on mental health. Additionally, the pandemic also interfered with other life domains: closings of schools and companies, restricted access to public places, changes in work and home routines and increased uncertainty due to the economic repercussions. This study examines people’s experiences and mental health in the 6th consecutive lockdown week in Portugal and compares with the pre-confinement population’s mental health. Specifically, we explore the difficulties experienced by the general population while in lockdown, their strategies to cope with it, and its impact on mental health. One thousand five hundred and two participants undergoing the 6th lockdown week answered a web-based cross-sectional survey. Demographic information, living conditions, confinement-related difficulties or challenges, strategies to cope with lockdown and mental health dimensions were assessed. Some difficult confined related experiences and sociodemographic variables were associated with poor mental health. When compared to our findings, the general population’ mental health was better before the pandemic. Lockdown challenges experienced by participants and their strategies to cope with confinement predicted 10 to 42% of the variance in mental health dimensions. This study identified several mental health-protective and risk factors related to long-term compulsory confinement. Individual strategies to prevent mental health problems are discussed. Additionally, our findings may inform national health agencies and governments on measures to enhance mental health among the quarantined general population.

The Impact of Psycho-Social Interventions on the Wellbeing of Individuals With Acquired Brain Injury During the COVID-19 Pandemic

Individuals with Acquired Brain Injury (ABI) suffer chronic impairment across cognitive, physical and psycho-social domains, and the experience of anxiety, isolation and apathy has been amplified by the COVID-19 pandemic. A qualitative evaluation was conducted of 14 individuals with ABI who had participated in series of COVID adapted group-based intervention(s) that had been designed to improve wellbeing. Eight themes were identified: Facilitating Safety, Fostering Positive Emotion, Managing and Accepting Difficult Emotions, Promoting Meaning, Finding Purpose and Accomplishment, Facilitating Social Ties, (Re)Connecting to Nature, and Barriers to Efficacy. Findings are discussed with respects to recent theoretical developments in positive psychology and wellbeing science and support the use of online and outdoor interventions to enhance wellbeing in individuals living with ABI during the COVID-19 pandemic. This paper makes a unique contribution to second wave positive psychology (PP2.0) through the application of recent advances in wellbeing science to an ABI population during the COVID-19 pandemic. In doing so, this paper lays the foundation for new interventions that not only reduce impairment and distress, but also create opportunities for meaning and enhanced wellbeing in people living with chronic conditions and those individuals living with ABI in particular.

Exercise and Use of Enhancement Drugs at the Time of the COVID-19 Pandemic: A Multicultural Study on Coping Strategies During Self-Isolation and Related Risks

Introduction: Little is known about the impact of restrictive measures during the COVID-19 pandemic on self-image and engagement in exercise and other coping strategies alongside the use of image and performance-enhancing drugs (IPEDs) to boost performance and appearance. Objectives: To assess the role of anxiety about appearance and self-compassion on the practice of physical exercise and use of IPEDs during lockdown. Methods: An international online questionnaire was carried out using the Exercise Addiction Inventory (EAI), the Appearance Anxiety Inventory (AAI), and the Self-Compassion Scale (SCS) in addition to questions on the use of IPEDs. Results: The sample consisted of 3,161 (65% female) adults from Italy (41.1%), Spain (15.7%), the United Kingdom (UK) (12.0%), Lithuania (11.6%), Portugal (10.5%), Japan (5.5%), and Hungary (3.5%). The mean age was 35.05 years (SD = 12.10). Overall, 4.3% of the participants were found to engage in excessive or problematic exercise with peaks registered in the UK (11.0%) and Spain (5.4%). The sample reported the use of a wide range of drugs and medicines to boost image and performance (28%) and maintained use during the lockdown, mostly in Hungary (56.6%), Japan (46.8%), and the UK (33.8%), with 6.4% who started to use a new drug. Significant appearance anxiety levels were found across the sample, with 18.1% in Italy, 16.9% in Japan, and 16.7% in Portugal. Logistic regression models revealed a strong association between physical exercise and IPED use. Anxiety about appearance also significantly increased the probability of using IPEDs. However, self-compassion did not significantly predict such behavior. Anxiety about appearance and self-compassion were non-significant predictors associated with engaging in physical exercise. Discussion and Conclusion: This study identified risks of problematic exercising and appearance anxiety among the general population during the COVID-19 lockdown period across all the participating countries with significant gender differences. Such behaviors were positively associated with the unsupervised use of IPEDs, although no interaction between physical exercise and appearance anxiety was observed. Further considerations are needed to explore the impact of socially restrictive measures among vulnerable groups, and the implementation of more targeted responses.

Changes of Gambling Patterns during COVID-19 in Sweden, and Potential for Preventive Policy Changes. A Second Look Nine Months into the Pandemic

Gambling has been suggested as one of the potential mental health consequences of the COVID-19 pandemic. In earlier self-report studies, increased gambling has been reported by a limited proportion of respondents characterized with a high degree of problem gambling. The present study, carried out with the same methodology and in the same geographical setting, around seven months later in the pandemic, aimed to repeat and to extend the understanding of potential gambling changes in the population during COVID-19. An anonymous sample of web panel members was assessed, altogether 2029 individuals (52% women, 10% moderate-risk or problem gamblers). Results indicated that 6% reported increased gambling, and 4% reported decreased gambling during the pandemic. Having increased gambling was associated with more severe gambling problems (OR 2.78, 95% confidence interval 2.27–3.40), increased alcohol consumption (OR 2.92, 1.71–4.98), and psychological distress (OR 3.38, 1.83–6.23). In the group reporting increased gambling during COVID-19, moderate-risk/problem gambling was very common (62%). Recent governmental policy interventions in the area were known to a minority (30%) of respondents, but awareness of the regulations was markedly more common in individuals with at least moderate-risk gambling (56%) and in self-excluders (78%). Reporting of any perceived influence from policy changes was low (3%), and divided between those reporting an increasing and decreasing effect, respectively. Increased gambling may be a consequence of COVID-19-related changes in everyday lives of individuals with problematic gambling patterns. Thus, a vulnerable group demonstrates higher rates of gambling migration and psychosocial problems, and may require particular attention in screening and treatment contexts, and further scientific evaluations.