Discrimination and Social Exclusion in the Outbreak of COVID-19

The Effect of Information Exposure on Stigma Toward the COVID-19 Patient Mediated by Perceived Risk, Attribution of Blame and Protection Norm Conformity

This study employed the model of stigma communication (MSC) to analyze how exposure to COVID-19-related information affected stigma-related information sharing about people who contracted COVID-19 during the pandemic and examined the cognitive process of the MSC in a collectivist culture. Based on a survey of 526 social media users during the COVID-19 pandemic in China, the study found that exposure to contact tracing information and pandemic control information had different impact on stigma-related information sharing through a series of cognitive variables. A dual-path model showed that perceived personal risk influenced stigma-related information sharing through attribution of blame toward the infected (the personal path), while perceived social risk influenced stigma-related information sharing through protection norm conformity (the social path). Compared to the personal path, the social path is more salient in shaping stigmatized attitudes and behaviors. The findings and discussions added to our understanding of the intricate stigma communication process in a collectivist culture.

International students' perceived discrimination and psychological distress during the COVID-19 pandemic

OBJECTIVE

This study examined the relationship between perceived discrimination and psychological distress among international students during the COVID-19 pandemic.

METHODS

A total of 188 international students from two large U.S. universities participated in the study. Perceived discrimination, psychological distress, and demographic information were assessed using self-reported questionnaires.

RESULTS

COVID-related variables and perceived discrimination were significantly associated with international students' psychological distress. Their COVID-related anxiety mediated the relationship between perceived discrimination and psychological distress.

CONCLUSION

Initiatives to mitigate the perceived discrimination experienced by international students may improve their mental health.

Compassion fatigue and the meaning in life as predictors of secondary traumatic stress in nurses during the COVID-19 pandemic

AIM

This study aimed to investigate the relationship among secondary traumatic stress, compassion fatigue, and meaning in life in nurses during the COVID-19 pandemic.

BACKGROUND

Changes in working conditions during the pandemic also changed the needs of nurses. In addition to physical health, the COVID-19 pandemic led to many psychosocial health problems such as sleep disturbances, depression, and traumatic stress. This makes nurses vulnerable to psychological side effects of the pandemic.

DESIGN

A cross-sectional study was conducted.

METHODS

This study was conducted with 166 nurses. Data were collected online at May-June 2021. A Personal Information Form, the Secondary Traumatic Stress Scale, Compassion Fatigue Scale, and Meaning in Life Scale were used. The STROBE reporting checklist was followed.

RESULTS

As secondary traumatic stress levels increase, compassion fatigue increases, meaning in life decreases, and the search for meaning in life increases.

CONCLUSION

Predictors of secondary traumatic stress were shown to be compassion fatigue, change in sleep habits, meaning in life, marital status, and having a chronic illness. This suggested that working during the pandemic posed significant risks in terms of manifesting negative consequences on mental health in the long term.

Perceived Discrimination in Australia During the COVID-19 Pandemic: a Longitudinal Study

OBJECTIVES

There have been global reports of increased discrimination during the COVID-19 pandemic relative to the pre-pandemic era, though this has not been well explored within Australia. The aim of the study was to characterise discriminatory behaviour experienced by groups previously identified as most at risk of experiencing discrimination (i.e. those of Asian descent or healthcare workers) both from pre-pandemic to pandemic and during the pandemic era in Australia.

METHODS

From April 2020 to September 2021, 1479 Australian adults completed the everyday discrimination scale (EDS). Initially, participants were asked to retrospectively consider discrimination experienced pre-COVID-19 pandemic and then to consider experiences in the past month during the pandemic. Participants were invited to repeat the latter every 2 months.

RESULTS

Collectively, there was a reduction in EDS scores from pre-pandemic to pandemic. Within the pandemic era, mean trajectory graphs across time revealed that changes in EDS scores in the 'non-Asian healthcare workers' and 'Asian healthcare workers' subgroups tended to mirror onto fluctuations in Australian COVID-19 case numbers.

CONCLUSION

Our findings suggest social solidarity amongst the general Australian population during the pandemic, but still highlight a need to dedicate resources towards groups with heightened risk of experiencing discrimination during future public health threats.

Discrimination experienced among Asian/Asian American students amid the COVID-19 pandemic

Objective: With the increasing incidents of discrimination toward Asian and Asian Americans (A/AA) in the United States amid the COVID-19 pandemic, this study explored A/AA university students' lived experiences of discrimination during this time and their reactions toward discrimination. Participants: Ten A/AA university students from a major research university in the mid-Atlantic region of the United States participated in the study. Methods: We utilized a phenomenology approach in this study. Results: Two primary structural themes were identified: (1) examples of discrimination and (2) personal reactions to discrimination and microaggression. Conclusion: A/AA university students experienced overt/open discrimination and microaggression amid the COVID-19 pandemic. Their responses to discrimination and microaggressions highlighted the challenges and opportunities presented by the COVID-19-related anti-Asian racism. Implications for university personnel were also discussed.

Automatic detection of health misinformation: a systematic review

The spread of health misinformation has the potential to cause serious harm to public health, from leading to vaccine hesitancy to adoption of unproven disease treatments. In addition, it could have other effects on society such as an increase in hate speech towards ethnic groups or medical experts. To counteract the sheer amount of misinformation, there is a need to use automatic detection methods. In this paper we conduct a systematic review of the computer science literature exploring text mining techniques and machine learning methods to detect health misinformation. To organize the reviewed papers, we propose a taxonomy, examine publicly available datasets, and conduct a content-based analysis to investigate analogies and differences among Covid-19 datasets and datasets related to other health domains. Finally, we describe open challenges and conclude with future directions.

Characteristics of victim blaming related to COVID-19 in South Korea

This study aimed to determine the characteristics of the victim-blaming tendency of patients with coronavirus disease-2019 (COVID-19) and the worry of being blamed because of COVID-19 infection. This study utilized two methodologies based on the theory of defensive attribution and information processing. First, a media analysis was conducted to determine the characteristics of the two representative COVID-19 victim blaming cases (the Itaewon Club case and the Omicron-infected pastor case). The results show that from the viewpoint of defensive attribution theory, the victim blaming of patients infected with COVID-19 is related to social identity and moral violations committed by the patients. The Korean public emphasized their social identity and believed that the patients were different from them from an ego-defensive viewpoint. Second, we conducted three longitudinal online panel surveys (N1 = 1569; N2 = 1037; N3 = 833). The samples were selected by stratified random sampling based on sex, age, and 17 metropolitan regions in Korea. The results showed that as the number of COVID-19 cases increased, the respondents' level of risk perception decreased significantly. As the information processing theory explains, people who are familiar with the frequent risks of COVID-19 are less worried about being blamed by others. Meanwhile, the regression analysis found that victim blaming of the pastor was significantly related to the respondent's religion. We can conclude that the Korean people may blame the victims of COVID-19 because they believe that the victims are very different from an ego-defensive viewpoint. Furthermore, the trust variable appeared to be important: the more the respondents trusted the government, the more they blamed the victims of COVID-19. We term this phenomenon the "trust paradox."

Tough Talks COVID-19 Digital Health Intervention for Vaccine Hesitancy Among Black Young Adults: Protocol for a Hybrid Type 1 Effectiveness Implementation Randomized Controlled Trial

BACKGROUND

Interventions for increasing the uptake of COVID-19 vaccination among Black young adults are central to ending the pandemic. Black young adults experience harms from structural forces, such as racism and stigma, that reduce receptivity to traditional public health messaging due to skepticism and distrust. As such, Black young adults continue to represent a priority population on which to focus efforts for promoting COVID-19 vaccine uptake.

OBJECTIVE

In aims 1 and 2, the Tough Talks digital health intervention for HIV disclosure will be adapted to address COVID-19 vaccine hesitancy and tailored to the experiences of Black young adults in the southern United States (Tough Talks for COVID-19). In aim 3, the newly adapted Tough Talks for COVID-19 digital health intervention will be tested across the following three southern states: Alabama, Georgia, and North Carolina.

METHODS

Our innovative digital health intervention study will include qualitative and quantitative assessments. A unique combination of methodological techniques, including web-based surveys, choose-your-own-adventures, digital storytelling, user acceptability testing, and community-based participatory approaches, will culminate in a 2-arm hybrid type 1 effectiveness implementation randomized controlled trial, wherein participants will be randomized to the Tough Talks for COVID-19 intervention arm or a standard-of-care control condition (N=360). Logistic regression will be used to determine the effect of the treatment arm on the probability of vaccination uptake (primary COVID-19 vaccine series or recommended boosters). Concurrently, the inner and outer contexts of implementation will be ascertained and catalogued to inform future scale-up. Florida State University's institutional review board approved the study (STUDY00003617).

RESULTS

Our study was funded at the end of April 2021. Aim 1 data collection concluded in early 2022. The entire study is expected to conclude in January 2025.

CONCLUSIONS

If effective, our digital health intervention will be poised for broad, rapid dissemination to reduce COVID-19 mortality among unvaccinated Black young adults in the southern United States. Our findings will have the potential to inform efforts that seek to address medical mistrust through participatory approaches. The lessons learned from the conduct of our study could be instrumental in improving health care engagement among Black young adults for several critical areas that disproportionately harm this community, such as tobacco control and diabetes prevention.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05490329; https://clinicaltrials.gov/ct2/show/NCT05490329.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41240.

A qualitative study on health stigma and discrimination in the first year of the COVID-19 pandemic: Lessons learnt from a public health perspective

Background

Stigmatisation, misinformation and discrimination have been magnified globally due to the COVID-19 pandemic. The healthcare sector was not spared from this. We conducted a transnational study, using the Health Stigma and Discrimination framework (HSDF) to explore public perception and reactions to the COVID-19 pandemic in a multicultural context. Findings from the Asian arm of the study, sited in Singapore, are reported in this paper.

Methods

This phenomenological research deployed semi-structured informant interviews using non-probability sampling approaches to recruit members of the public. Interviews were coded independently by two researchers and thematic analysis was used to analyse the responses.

Results

Twenty-nine members of the public (23-80 years old) were interviewed between Oct 2020 to Feb 2021. Five major themes were identified: (i) perception of stigma amongst respondents, (ii) experiences of stigma amongst respondents, (iii) views on what drove stigma and misinformation, (iv) facilitators in preventing and reducing stigma and misinformation, and (v) ageist attitudes towards older adults. Overall, construction workers living in dormitories, healthcare workers, and to some extent tourists from China, were perceived to have been stigmatised and shunned by the public. Place-based stigmatisation was common; participants responded by avoiding places that had confirmed cases of COVID-19. Perceived stigma was temporary and not enduring, driven at the outset by fear of being infected. This study also identified the role played by trust in reducing stigmatisation. The relative absence of politicising of issues and high-quality information readily disseminated to the public were reported as factors that could have reduced and prevented stigma and misinformation on the various groups. Ageist attitudes were observed in some participants with older adults being labelled as vulnerable, susceptible to misinformation and being less able to cope during the pandemic.

Conclusion

Through the lens of the HSDF, this study provided an exploratory account of the nature of stigma that resulted from the COVID-19 pandemic in an Asian context. It also shed light on facilitators in preventing and reducing stigma during an outbreak especially the role of trust and communications during a public health crisis.

Belief in just deserts regarding individuals infected with COVID-19 in Japan and its associations with demographic factors and infection-related and socio-psychological characteristics: a cross-sectional study

Prejudice related to the coronavirus disease 2019 (COVID-19) is a social issue worldwide. A possible psychological factor that promotes prejudice is the belief in just deserts (BJD) regarding individuals infected with COVID-19 (i.e., the belief that the infected individual deserves to be infected). The BJD is based on the belief in immanent justice. It is reportedly higher in Japan than in other countries. Therefore, we conducted a cross-sectional study to investigate the BJD among Japanese individuals and clarify its associations with demographic factors or infection-related and socio-psychological characteristics. To this end, we conducted an online questionnaire survey in Japan from August 7-8, 2020, with 1,207 respondents aged 20-69 years. We performed screening to exclude inappropriate responses. We investigated the association between the BJD and demographic factors such as gender and age. We also investigated the association between the BJD and infection-related and socio-psychological characteristics, including risk perception of COVID-19 infection and human rights restrictions (i.e., the degree of agreement with government restrictions on individuals' behavior during emergencies). Among the surveyed items, human rights restrictions showed a strong association with BJD, followed by risk perception of COVID-19 infection. Men had a slightly higher BJD than women. Our study is significant in that it is the first to investigate the items associated with the BJD, thereby providing foundational information for revising individual perceptions of justice related to COVID-19 and solving prejudice-related issues.

The scar that takes time to heal: A systematic review of COVID-19-related stigma targets, antecedents, and outcomes

COVID-19, as a crucial public health crisis, has affected our lives in nearly every aspect. Besides its major health threats, COVID-19 brings severe secondary impacts, one of which is the rise of social stigma. Although numerous studies have examined the antecedents and outcomes of COVID-19-related stigma, we still lack a systematic understanding of who is being stigmatized during the COVID-19 pandemic, what exacerbates COVID-19-related stigma, and what impacts COVID-19-related stigma has on victims. Therefore, this review aims to provide a systematic overview of COVID-19-related stigma. With 93 papers conducted with 126,371 individuals in more than 150 countries and territories spanning five continents, we identify three targets that have received the most research: Chinese/Asian people, (suspected) patients and survivors, and healthcare workers. Furthermore, we find that for each stigma target, characteristics of the stigmatized, stigmatizer, and context contribute to COVID-19-related stigma and that this stigma negatively influences victims' health and non-health outcomes. We call for future research to provide a more integrative, balanced, and rigorous picture of COVID-19-related stigma via conducting research on neglected topics (e.g., contextual factors that contribute to stigma toward HCWs) and stigma interventions and using a longitudinal design. In practice, we urge governments and institutions (e.g., ministries of public health, hospitals) to pay close attention to stigma issues and to promote safe and inclusive societies.

Effect of ontological insecurity on vaccination behavior against COVID-19: a hospital-based cross-sectional study

OBJECTIVE

Coronavirus disease 2019 (COVID-19) has brought great uncertainty to our society and it may have disrupted people's ontological security. Consequently, this hospital-based study concerns the impact of ontological insecurity on vaccination behavior against COVID-19.

STUDY DESIGN

This cross-sectional study was conducted among hospital inpatients.

METHODS

A questionnaire survey addressing inpatient ontological insecurity and vaccination behavior against COVID-19 was administered in Taizhou, China. A total of 1223 questionnaires were collected; specifically, 1185 of them were credible, for a validity rate of 96.9%.

RESULTS

The score of ontological insecurity was 13.27 ± 7.84, which was higher in participants who did not recommend vaccination for others than those who did (12.95 ± 8.25 vs 14.00 ± 6.78, P = 0.022). There was no difference between the vaccinated and unvaccinated groups (13.22 ± 7.96 vs 13.35 ± 7.67, P = 0.779). Lower ontological insecurity (odds ratio [OR] = 1.40, 95% confidence interval [CI]: 1.08-1.81) and being inoculated with COVID-19 vaccines (OR = 2.17, 95% CI: 1.67-2.82) were significantly associated with recommendation of COVID-19 vaccines to others after adjusting for sex, age, education, and occupation. Associations between low ontological insecurity and recommendations for COVID-19 vaccines were observed in men, adults aged 18-59 years, non-farmers, and vaccine recipients.

CONCLUSIONS

This study suggests that the ontological insecurity of participants affects their behavior of recommending the COVID-19 vaccination to others rather than getting vaccinated themselves. This promotion of vaccination can be considered from the perspective of improving ontological security in China.

Survey of German medical students during the COVID-19 pandemic: attitudes toward volunteering versus compulsory service and associated factors

Due to the spread of COVID-19, a key challenge was to reduce potential staff shortages in the healthcare sector. Besides recruiting retired healthcare workers, medical students were considered to support this task. Commitment of medical students in Germany during the COVID-19 pandemic was evaluated using an online survey, with particular focus on their burdens and anxieties. This survey was distributed to students within a 2-week period in April and May 2020. Ultimately, 1241 participants were included in the analysis. During the pandemic, 67.9% (65.3% to 70.5%) of the participants reported that they had volunteered. Furthermore, 88.9% (86.9% to 90.5%) stated that they were against compulsory recruitment in this context. Students who volunteered (committed students) had a significantly lower anxiety index than non-committed students. Additionally, students were more concerned about infecting other patients and relatives than themselves. Higher levels of anxiety were related to lower levels of commitment. A mandatory assignment during the pandemic was rejected by the students and does not seem to be necessary due to the large number of volunteers.

Experienced stigma and applied coping strategies during the COVID-19 pandemic in Germany: a mixed-methods study

OBJECTIVE

Health-related stigma is considered a social determinant of health equity and a hidden burden of disease. This study aimed to assess the level and dimensions of stigma and respective coping mechanisms in COVID-19 survivors.

METHODS

A mixed-methods study with sequential explanatory design was conducted at the University Hospital of Ulm, Germany. Stigma was assessed using the Social Impact Scale (SIS) including adult COVID-19 survivors with mild-to-severe disease. Subsequently, 14 participants were sampled with regard to gender, age and severity of disease for in-depth interviews to understand how stigma was experienced and coping strategies were applied. The questionnaire was analysed using descriptive statistics, t-test and analysis of variance. Content analysis was used for qualitative data.

RESULTS

From 61 participants, 58% were men and mean age was 51 years. The quantitative analysis of the SIS indicated an intermediate level of experienced stigma. Participants experienced stigma mainly as 'social rejection' (M=14.22, SD=4.91), followed by 'social isolation' (M=10.17, SD=4.16) and 'internalised shame' (M=8.39, SD=3.32). There was no significant difference in experienced stigma regarding gender, education, occupational status or residual symptoms. However, participants between 30 and 39 years of age experienced higher levels of stigma than other age groups (p=0.034). The qualitative analysis revealed how stigma seemed to arise from misconceptions creating irrational fear of infection, leading to stereotyping, vilification, discrimination and social exclusion of COVID-19 survivors, leaving them feeling vulnerable. Stigma cut through all social levels, from the individual level at the bottom to the institutional and societal level at the top. Social networks protected from experiencing stigma.

CONCLUSION

COVID-19-related stigma is a relevant burden in the ongoing pandemic. Providing accurate information and exposing misinformation on disease prevention and treatment seems key to end COVID-19-related stigma.

Social Exclusion and Depression among undergraduate students: the mediating roles of rejection sensitivity and social self-efficacy

Nowadays, depression has been a prominent mental health problem throughout the world. A common but negative social experience, social exclusion (also known as ostracism) is a great risk factor for individuals' health and adaptation. Undergraduate students are in a development period of challenges and transitions, so they are vulnerable to suffering from depression and negative social experiences. Against this background, the present study aimed to examine the association between social exclusion and undergraduate students' depression as well as the underlying mechanism - the mediating roles of rejection sensitivity and social self-efficacy. Seven hundred sixty-two undergraduate students were recruited to participate in this study, who were asked to complete a set of questionnaires measuring social exclusion, depression, rejection sensitivity, and social self-efficacy. After controlling for gender, social exclusion was positively associated with undergraduate students' depression. And rejection sensitivity and social self-efficacy could significantly mediate this relation through three mediating paths - the separate mediating effects of rejection sensitivity and social self-efficacy, as well as the serial mediating effect of rejection sensitivity and social self-efficacy. These results could not only deepen our understanding of this theme, but also have several practical implications for the intervention of depression, for example, relevant social skill training and cognitive therapy could be adopted to intervene the rejection sensitivity and social self-efficacy.

The impact of perceived racism on walking behavior during the COVID-19 lockdown

The COVID-19 pandemic lockdown has had a significant impact on people's travel behavior. The level of this impact has been unevenly distributed among different population groups. The recent rise in anti-Asian racism implies that Asians have faced increased stress during the pandemic. As a result, the impact on their travel behavior is likely to differ from other ethnic groups. We examined this hypothesis by focusing on the impact of the pandemic on walking behavior. We collected survey data in Melbourne, Australia, during the pandemic lockdown, and analyzed the data using a Structural Equation Model approach. The results suggest that Asians experienced a significantly higher level of discrimination than other racial groups and were less likely to increase walking than White people. We also found that neighborhood cohesion helped alleviate perceived discrimination and promote walking. This study offers new insights into the role of racism in travel behavior.

Age Differences in Psychological Antecedents and Behavioral Consequences of Stigmatization Associated with COVID-19 among Koreans

The first goal of this study is to develop a conceptual model of the causal relationship between psychological antecedents (internal attribution, anger, dangerousness, fear) of stigmatization, stigmatization (public stigma, anticipated stigma), and the behavioral consequences (compliance with COVID-19 prevention guidelines, COVID-19 testing intention) of stigmatization associated with COVID-19. The second goal of the study is to investigate the age differences in the conceptual model between younger and older adults unconfirmed with COVID-19 in Korea. After building the model based on previous studies, an online survey was conducted with Koreans in their 20s (n = 300, females: 50%) and 60s (n = 300, females: 50%) who had not been confirmed with COVID-19. The results revealed that for participants in their 20s and 60s, their internal attribution of COVID-19 infection to individuals confirmed with COVID-19 enhanced their anger at the individuals. Afterward, their anger increased their anticipated stigma of being confirmed with COVID-19 through enhancing the public stigma of the individuals confirmed with COVID-19. Unexpectedly, the fear of individuals confirmed with COVID-19 elicited by the dangerousness of the individuals had no effect on the public stigma of the individuals among participants in their 20s and 60s. The fear directly enhanced their compliance with the COVID-19 prevention guidelines. Next, for participants in their 20s, their anticipated stigma increased their compliance with COVID-19 prevention guidelines, but not their COVID-19 testing intention. However, the anticipated stigma did not affect both the compliance with the COVID-19 prevention guidelines and COVID-19 testing intention among participants in their 60s. The implications and limitations of these findings are discussed.

Decision-making framework for identifying regions vulnerable to transmission of COVID-19 pandemic

At the beginning of 2020, the World Health Organization (WHO) identified an unusual coronavirus and declared the associated COVID-19 disease as a global pandemic. We proposed a novel hybrid fuzzy decision-making framework to identify and analyze these transmission factors and conduct proactive decision-making in this context. We identified thirty factors from the extant literature and classified them into six major clusters (climate, hygiene and safety, responsiveness to decision-making, social and demographic, economic, and psychological) with the help of domain experts. We chose the most relevant twenty-five factors using the Fuzzy Delphi Method (FDM) screening from the initial thirty. We computed the weights of those clusters and their constituting factors and ranked them based on their criticality, applying the Fuzzy Analytic Hierarchy Process (FAHP). We found that the top five factors were global travel, delay in travel restriction, close contact, social cohesiveness, and asymptomatic. To evaluate our framework, we chose ten different geographically located cities and analyzed their exposure to COVID-19 pandemic by ranking them based on their vulnerability of transmission using Fuzzy Technique for Order of Preference by Similarity To Ideal Solution (FTOPSIS). Our study contributes to the disciplines of decision analytics and healthcare risk management during a pandemic through these novel findings. Policymakers and healthcare officials will benefit from our study by formulating and improving existing preventive measures to mitigate future global pandemics. Finally, we performed a sequence of sensitivity analyses to check for the robustness and generalizability of our proposed hybrid decision-making framework.

Association between Social Integration, Social Exclusion, and Vaccination Behavior among Internal Migrants in China: A Cross-Sectional Study

Cross-sectional studies about the association between social integration, social exclusion, and vaccination behavior among internal migrants in China are lacking. In this study, we aimed to explore the association between the influenza vaccination behavior and social integration as well as social exclusion in China based on a cross-sectional study. We included 12,467 participants aged 15 years old or above from the 2017 Migrant Population Dynamic Monitoring Survey (MDMS). We used univariate analysis and logistic regression models to access the association between social integration, exclusion status, and influenza vaccination rates. Results suggested that the association between social integration and the vaccination rate was significantly positive. Moving between different districts impact on people’s mental health and their health performance. Significant association between influenza vaccination behavior and education attainment, income status, health record, and awareness of basic public health services program was reported. Therefore, in order to reduce the incidence of influenza disease and increase the vaccination rate, policymakers and the public should promote social integration for internal migrants. Meanwhile, our finding also implies possible strategies to promote COVID-19 vaccination.

Development and psychometric validation of new questionnaires assessing experienced discrimination and internalised stigma among people with Covid-19

AIMS

To develop and validate two new standardised measures assessing, respectively, experienced discrimination (Covid-19 Experienced DISCrimination scale, CEDISC) and internalised stigma (COvid-19 INternalised Stigma scale, COINS) in people who had been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or had developed coronavirus disease 2019 (Covid-19) disease.

METHODS

Both the CEDISC and the COINS were developed in Italian and tested for ease of use, comprehension, acceptability, the relevance of items and response options within a focus group session. Online cross-sectional validation survey was conducted among adults infected with SARS-CoV-2 or who developed Covid-19 disease, members of a closed Facebook discussion group in Italy. Exploratory factor analysis (EFA) with Promax oblique rotation; the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and the Bartlett's test of sphericity were used to assess the suitability of the sample for factor analysis. Reliability was assessed as internal consistency using Cronbach's alpha and as test-retest reliability using weighted kappa and intraclass correlation coefficient (ICC). Precision was examined by Kendall's tau-b coefficient.

RESULTS

Overall, 579 participants completed the CEDISC, 519 also completed the COINS, 155 completed the retest for both scales after two weeks. The 12 items of the CEDISC converged over a 2-factor solution ('social life' and 'close relations') accounting for 49.2% of the variance (KMO = 0.894; Bartlett's test p < 0.001); the 13 items of the COINS converged over a 3-factor solution ('self-perception', 'close relations' and 'social life') accounting for 67.7% (KMO = 0.827; Bartlett's test p < 0.001). Cronbach's α was 0.848 for the CEDISC, and 0.837 for the COINS. The CEDISC showed three items (25%) with kappa between 0.61 and 0.80 and seven (58.4%) between 0.41 and 0.60, with only two items scoring 0.21 and 0.40; the COINS had ten items (76.9%) with kappa ranging from 0.41 to 0.60, and three items below 0.31. ICC was 0.906 (95% CI, 0.871-0.932) for the, CEDISC and 0.860 (95% CI, 0.808-0.898) for the COINS. Kendall's tau-b ranged from 0.360 to 0.556 (p < 0.001) for the CEDISC and from 0.290 to 0.606 (p < 0.001) for the COINS.

CONCLUSIONS

Both the CEDISC and the COINS are two valid and reliable scales to be used in studies examining the role of stigma and discrimination of people infected with SARS-CoV-2 and Covid-19 patients, and in research evaluating interventions designed to mitigate stigma in this population.

Patients' Responses to COVID-19 Pandemic: The Relationship Between Potential Pandemic-Induced Disruptions, Ontological Security, and Adaptive Responses in Taizhou, China

Background

The COVID-19 pandemic has changed the social environment of most individuals around the world and has profoundly impacted people's lives, ontological security, and behavior. Among them, the patients are one of the groups most influenced by the pandemic.

Objective

The present research aimed to study the relationship of COVID-19 pandemic-induced disruption to patients' daily lives, ontological security, and patients' responses to prevent the spread of COVID-19, and explore the role of ontological security.

Methods

This article was based on an online structured questionnaire study conducted among hospitalized patients in Taizhou Hospital of Zhejiang Province, Taizhou, China, from 8 July to 11 August 2021. We analyzed the data using the multivariate regression model and mediation analysis method.

Results

The results showed that the higher the pandemic-induced disruption to inpatients' lives, the better behavior would be taken by hospitalized patients to prevent the spread of COVID-19, and the perceived scarcity of ontological security played a mediating role in this process. Higher pandemic-induced disruption to patients' lives increased the ontological insecurity which further, in turn, reduced patients' good practice toward measures to prevent the novel coronavirus.

Conclusion

These findings provided direct evidence for the relationship between pandemic-induced disruption, scarcity of ontological security, and patients' prevention behavior. It suggested that there was a need to emphasize patients' ontological security. Overall, these findings suggested that it is important to emphasize the mental health among patients during the COVID-19 pandemic, and implement strategies to offer psychological support when needed.

Types of Racism and Twitter Users' Responses Amid the COVID-19 Outbreak: Content Analysis

BACKGROUND

When the first COVID-19 cases were noticed in China, many racist comments against Chinese individuals spread. As there is a huge need to better comprehend why all of these targeted comments and opinions developed specifically at the start of the outbreak, we sought to carefully examine racism and advocacy efforts on Twitter in the first quarter of 2020 (January 15 to March 3, 2020).

OBJECTIVE

The first research question aimed to understand the main type of racism displayed on Twitter during the first quarter of 2020. The second research question focused on evaluating Twitter users' positive and negative responses regarding racism toward Chinese individuals.

METHODS

Content analysis of tweets was utilized to address the two research questions. Using the NCapture browser link and NVivo software, tweets in English and Spanish were pulled from the Twitter data stream from January 15 to March 3, 2020. A total of 19,150 tweets were captured using the advanced Twitter search engine with the keywords and hashtags #nosoyunvirus, #imNotAVirus, #ChineseDon'tComeToJapan, #racism, "No soy un virus," and "Racismo Coronavirus." After cleaning the data, a total of 402 tweets were codified and analyzed.

RESULTS

The data confirmed clear sentiments of racism against Chinese individuals during the first quarter of 2020. The tweets displayed individual, cultural, and institutional racism. Individual racism was the most commonly reported form of racism, specifically displaying physical and verbal aggression. As a form of resistance, Twitter users created spaces for advocacy and activism. The hashtag "I am not a virus" helped to break stereotypes, prejudice, and discrimination on Twitter.

CONCLUSIONS

Advocacy efforts were enormous both inside and outside the Chinese community; an allyship sentiment was fostered by some white users, and an identification with the oppression experienced by the Chinese population was expressed in the Black and Muslim worldwide communities. Activism through social media manifested through art, food sharing, and community support.

Antecedents and consequences of COVID-19 conspiracy beliefs: A systematic review

RATIONALE

Belief in COVID-19 conspiracy theories can have severe consequences; it is therefore crucial to understand this phenomenon, in its similarities with general conspiracy belief, but also in how it is context-dependent.

OBJECTIVE

The aim of this systematic review is to provide a comprehensive overview of the available research on COVID-19 conspiracy beliefs and to synthesise this research to make it widely accessible.

METHODS

We present a synthesis of COVID-19 conspiracy belief research from 85 international articles, identified and appraised through a systematic review, in line with contemporary protocols and guidelines for systematic reviews.

RESULTS

We identify a number of potential antecedents of COVID-19 conspiracy beliefs (individual differences, personality traits, demographic variables, attitudes, thinking styles and biases, group identity, trust in authorities, and social media use), their consequences (protective behaviours, self-centred and misguided behaviours such as hoarding and pseudoscientific health practices, vaccination intentions, psychological wellbeing, and other negative social consequences such as discrimination and violence), and the effect sizes of their relations with the conspiracy beliefs.

CONCLUSIONS

We conclude that understanding both the potential antecedents and consequences of conspiracy beliefs and how they are context-dependent is highly important to tackle them, whether in the COVID-19 pandemic or future threats, such as that of climate change.

Comparisons Between COVID-19 Stigma and Other Stigmas: Distinct in Explicit Attitudes and Similar in Implicit Process

Since the outbreak of COVID-19, the public stigma associated with COVID-19 has emerged. To better understand the COVID-19 stigma, the present research conducted three studies on 1,493 Chinese participants from the outbreak to the recovery period of the COVID-19 pandemic to examine the psychological mechanisms of COVID-19 stigma by comparing it with other disease-related stigmas in terms of their explicit and implicit processes. Study 1 and Study 2 jointly demonstrated that the public endorsed more stigma toward the COVID-19 related people (i.e., the COVID-19 patients) relative to the other disease-related people (i.e., the SARS patients, people with flu) in multiple explicit aspects, including emotional, motivational, cognitive, and social processing. Using the implicit association test (IAT), Study 3 found no significant difference in the implicit measures of the COVID-19 vs. the SARS groups, which further revealed that the pandemic stigmas (i.e., COVID-19 and SARS) were similar at the implicit level. These findings suggest common (implicit level) but distinct (explicit level) psychological processes of the pandemic-related stigmas, which provide reference to policymakers in formulating suitable interventions to deal with COVID-19 stigma and a newly generated potential stigma and provide psychological support for the public in the future.

"Responsible" or "Strange?" Differences in Face Mask Attitudes and Use Between Chinese and Non-East Asian Canadians During COVID-19's First Wave

Early in the COVID-19 pandemic, journalists and scholars noted differences between Asians and North Americans in their support for public mask use. These differences were primarily assumed to be due d to variations in ethnocultural norms and practices. To better ascertain people's motives for wearing masks and potential cultural differences in these rationales, this comparative, mixed-methods research examines Chinese and non-East Asian Canadians' mask use attitudes utilizing online group interviews (Study 1) and a nation-wide survey (Study 2) Study 1, conducted in the early stages of the pandemic, captured an ambivalent, yet evolving attitude toward public mask use among the non-East Asian Canadians, which differed from their Chinese counterparts who more uniformly perceived mask use favorably. Study 2, conducted 2 months later, suggests that both groups primarily wore masks for disease protection- and prevention-related reasons. However, age and education appeared to influence the mask wearing frequency of the non-East Asian Canadians, for whom public mask use was less prevalent and normative. The attitudinal differences in public mask use call for targeted strategies to support mask wearing for different ethnocultural groups, which may be achieved partially through enhancing interethnic understanding on the diversified use of and opinions about masks. The findings suggest that favorable social norms, along with evidence-based information campaigns involving personal appeals may encourage greater mask use by the non-East Asian population.

Internet of Things Framework for Oxygen Saturation Monitoring in COVID-19 Environment

The pandemic/epidemic of COVID-19 has affected people worldwide. A huge number of lives succumbed to death due to the sudden outbreak of this corona virus infection. The specified symptoms of COVID-19 detection are very common like normal flu; asymptomatic version of COVID-19 has become a critical issue. Therefore, as a precautionary measurement, the oxygen level needs to be monitored by every individual if no other critical condition is found. It is not the only parameter for COVID-19 detection but, as per the suggestions by different medical organizations such as the World Health Organization, it is better to use oximeter to monitor the oxygen level in probable patients as a precaution. People are using the oximeters personally; however, not having any clue or guidance regarding the measurements obtained. Therefore, in this article, we have shown a framework of oxygen level monitoring and severity calculation and probabilistic decision of being a COVID-19 patient. This framework is also able to maintain the privacy of patient information and uses probabilistic classification to measure the severity. Results are measured based on latency of blockchain creation and overall response, throughput, detection, and severity accuracy. The analysis finds the solution efficient and significant in the Internet of Things framework for the present health hazard in our world.

Immigrants in Norway: Resilience, challenges and vulnerabilities in times of COVID-19

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Immigrants experience social, economic and structural challenges during the pandemic.

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Pre-existing vulnerabilities may be further exacerbated during crisis.

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Need for better support in navigating healthcare and welfare services during COVID-19.

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Important to consider both short-term and long-term impacts of the pandemic.

Immigrants have been found to be disproportionately impacted during the COVID-19 pandemic across the world. Our study, exploring the experiences of immigrants in Norway during the pandemic, is based on interviews and focus group discussions with 10 and 21 immigrants, respectively. Our analysis showed that participants perceived the circumstances induced by the pandemic to be difficult and voiced the challenges experienced. Their experiences encompassed social, economic, and the public sphere, where immigrants felt themselves to be in more vulnerable positions than before the pandemic. Our analysis identified four main themes: 1) Feeling stagnated, 2) Perceptions towards government and health authorities, 3) Boundaries of us vs them, and 4) Coping. We conclude our paper by stating that government and health authorities should consider both short-term and long-term consequence of the pandemic to mitigate impact on communities at risk.

Educators' Psychosocial Burdens Due to the COVID-19 Pandemic and Predictive Factors: A Cross-Sectional Survey of the Relationship with Sense of Coherence and Social Capital

This study aims to identify the social and psychological burdens placed on educators during the third wave of the COVID-19 pandemic in Japan and to propose an optimal form of support. We investigated educators' perceptions of psychological and socioeconomic anxieties and burdens, sense of coherence, and social capital using a questionnaire survey of 1000 educators in January 2021. Multivariate regression analyses were conducted to analyze the associations between the variables. Results: Approximately 80% of the respondents considered COVID-19 a formidable, life-threatening illness. Our results revealed that the higher the social capital, the greater the fear of COVID-19, and the higher the sense of coherence, the lower this fear. Conclusions: The anxiety burden of implementing infection prevention was higher than the anxiety burden associated with distance learning. The predictive factors for educators' perceptions of burden included sense of coherence, gender, and age. Our findings suggest the importance of having the government and educational institutions provide multidimensional assistance that matches educators' individual characteristics.

Accuracy and Timeliness of Knowledge Dissemination on COVID-19 Among People in Rural and Remote Regions of China at the Early Stage of Outbreak

Coronavirus disease 2019 (COVID-19) spread throughout China in January 2020. To contain the virus outbreak, the Chinese government took extraordinary measures in terms of public policy, wherein accurate and timely dissemination of information plays a crucial role. Despite all of the efforts toward studying this health emergency, little is known about the effectiveness of public policies that support health communication during such a crisis to disseminate knowledge for self-protection. Particularly, we focus on the accuracy and timeliness of knowledge dissemination on COVID-19 among people in remote regions—a topic largely omitted in existing research. In February 2020, at the early-stages of the COVID-19 outbreak, a questionnaire survey was carried out. In total, 8,520 participants from seven less economically developed provinces situated in the borderlands of China with large ethnic minority groups responded. We analyzed the data through poisson regression and logistic regression analyses. We found that (1) people in remote regions of China obtained accurate information on COVID-19. Further, they were able to take appropriate measures to protect themselves. (2) Result from both descriptive analysis and multivariable regression analysis revealed that there is no large difference in the accuracy of information among groups. (3) Older, less educated, and rural respondents received information with a significant delay, whereas highly educated, younger, urban residents and those who obtained information through online media were more likely to have received the news of the outbreak sooner and to be up to date on the information. This research provides evidence that disadvantage people in remote regions obtained accurate and essential information required to act in an appropriate manner in responses to the COVID-19 outbreak. However, they obtained knowledge on COVID-19 at a slower pace than other people; thus, further improvement in the timely dissemination of information among disadvantage people in remote regions is warranted.

Impact of infectious disease epidemics on xenophobia: a systematic review

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Xenophobia has a significant impact on the health of international migrants.

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During an infectious disease outbreak, stigma and prejudice are highly pronounced.

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Migrants, often seen as disease carriers, are socially rejected during epidemics.

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Ensure an equal treatment and healthcare assistance for migrants is imperative.

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Educational interventions are urgently needed to prevent xenophobic tendencies.

Background Globally, xenophobia towards out-groups is frequently increased in times of economic and political instability, such as in infectious disease outbreaks. This systematic review aims to: (1) assess the xenophobic attitudes and behaviors towards migrants during disease outbreaks; and (2) identify adverse health outcomes linked to xenophobia. Methods We searched nine scientific databases to identify studies measuring xenophobic tendencies towards international migrants during disease outbreaks and evaluated the resulting adverse health effects. Results Eighteen articles were included in the review. The findings were grouped into: (1) xenophobia-related outcomes, including social exclusion, out-group avoidance, support for exclusionary health policies, othering, and germ aversion; and (2) mental health problems, such as anxiety and fear. Depending on the disease outbreak, different migrant populations were negatively affected, particularly Asians, Africans, and Latino people. Factors such as perceived vulnerability to disease, disgust sensitivity, medical mistrust individualism, collectivism, disease salience, social representation of disease and beliefs in different origins of disease were associated with xenophobia. Conclusions Overall, migrants can be a vulnerable population frequently blamed for spreading disease, promoting irrational fear, worry and stigma in various forms, thus leading to health inequities worldwide. It is urgent that societies adopt effective support strategies to combat xenophobia and structural forms of discrimination against migrants.

Evolution of intersectional perceived discrimination and internalized stigma during COVID-19 lockdown among the general population in Spain

BACKGROUND

Stigma and discrimination have been associated with different diseases and pandemics, with negative consequences for the people who suffered them and for their communities. Currently, COVID-19 has become a new source of stigmatization.

AIMS

The aim of the present study is to analyze longitudinally the evolution of intersectional perceived discrimination and internalized stigma among the general population of Spain, at three points in time throughout the confinement.

METHOD

Participants completed an online survey.

RESULTS

Results show an increase in both variables from the first to the second evaluation, and a slight decrease from the second to the third evaluation. Moreover, these changes are explained by depression, anxiety and family support.

CONCLUSIONS

These findings indicate the factors that need to be considered to reduce the perception of discrimination and the internalization of stigma, and their detrimental consequences, during an especially stressful event such as the current pandemic outbreak.

Relationship between social exclusion and anxiety in older people during the COVID-19 pandemic

AIM

This study aims to determine the relationship between social exclusion and anxiety in older people during the COVID-19 pandemic.

METHODS

This descriptive research was conducted with individuals aged ≥65 years who were registered with Family Health Centers between July and September 2021. The sample size was calculated using a sampling method with an unknown population and was determined as 400 individuals; a random sampling method was utilized for selecting the participants. Data were collected using the Personal Information Form, Social Exclusion Scale in the Elderly and the Geriatric Anxiety Inventory.

RESULTS

Social exclusion level was found to be significantly higher in those who were illiterate who were single/widowed, who lived in rural areas, who reportedly had a low income, who had a chronic disease, who used an assistive device and who perceived their health as bad (P < 0.05). The geriatric anxiety level was found to be significantly higher in those who had an education level of university and above, who were married, who lived with their spouse and children, who worked, who had a good income, who lived in urban areas, who did not use an assistive device, who were dependent in their daily activities, who did not have a chronic disease, who perceived their health condition as good, and who did exercises regularly (P < 0.05).

CONCLUSIONS

This study found a negative and significant relationship between the Geriatric Anxiety Inventory and the Social Exclusion Scale. Geriatr Gerontol Int 2022; ••: ••-••.

Assessment of Impact of Containment During the COVID-19 Epidemic and Coping Behaviours Using Newly Developed Assessment Tools

Background: The confinement measures during COVID-19 had a massive effect on physical and psychological health in public. This study assessed the impact of containment and coping behaviour among the Malaysia public during the COVID-19 pandemic. Questions assessing the impact of containment and coping behaviours were developed and psychometrically tested. Methods: Exploratory factor analysis (EFA) was conducted with the items using principal component analysis extraction and Varimax rotation. Partial least squares structural equation modelling was used to determine the relationship between coping and impact. Results: The 13-item of impact and 10-item coping instruments were developed with three dimensions identified through EFA. Both scales demonstrated excellent composite reliability and good convergent validity. The survey findings revealed that the impact on individual psychological aspects was prominent, followed by well-being and lifestyle. Mindfulness and physical coping strategies were most commonly reported. Coping through seeking help from health professionals and hotlines had a positive direct effect on well-being and lifestyle (b = 0.231, p < 0.001), psychological (B = 0.132, p < 0.001), and employment-related (0.194, p < 0.001) impacts. Coping through mindfulness practise had a negative effect on well-being and lifestyle-related impact (B = -0.180, p < 0.001) and employment-related impact (B = -0.096, p = 0.008). Conclusions: Despite some limitation, the scales for measuring impact and coping behaviours have the potential to be used as a measurement tool in future studies. Findings highlight the enormous impact of the pandemic on psychological well-being and lifestyles. Health authorities should support individual coping as it was found to be an important resilience-related factor to mitigate the impacts of containment during the pandemic.

A systematic review and meta-analysis on the prevalence of stigma in infectious diseases, including COVID-19: a call to action

Infectious diseases, including COVID-19, are crucial public health issues and may lead to considerable fear among the general public and stigmatization of, and discrimination against, specific populations. This meta-analysis aimed to estimate the pooled prevalence of stigma in infectious disease epidemics. We systematically searched PubMed, PsycINFO, Embase, MEDLINE, Web of Science, and Cochrane databases since inception to June 08, 2021, and reported the prevalence of stigma towards people with infectious diseases including SARS, H1N1, MERS, Zika, Ebola, and COVID-19. A total of 50 eligible articles were included that contributed 51 estimates of prevalence in 92722 participants. The overall pooled prevalence of stigma across all populations was 34% [95% CI: 28-40%], including enacted stigma (36% [95% CI: 28-44%]) and perceived stigma (31% [95% CI: 22-40%]). The prevalence of stigma in patients, community population, and health care workers, was 38% [95% CI: 12- 65%], 36% [95% CI: 28-45%], and 30% [95% CI: 20-40%], respectively. The prevalence of stigma in participants from low- and middle-income countries was 37% [95% CI: 29-45%], which is higher than that from high-income countries (27% [95% CI: 18-36%]) though this difference was not statistically significant. A similar trend of prevalence of stigma was also observed in individuals with lower education (47% [95% CI: 23-71%]) compared to higher education level (33% [95% CI: 23-4%]). These findings indicate that stigma is a significant public health concern, and effective and comprehensive interventions are needed to counteract the damaging effects of the infodemics during infectious disease epidemics, including COVID-19, and reduce infectious disease-related stigma.

Perceived Discrimination and Mental Health: The Role of Immigrant Social Connectedness during the COVID-19 Pandemic

The COVID-19 public health emergency has led to changes in people's attitudes towards minority groups, increasing prejudice and discriminatory behaviors, especially towards migrants. These prejudicial attitudes and discrimination negatively influence migrants’ mental health increasing anxiety and depression and loneliness. However, the sense of belonging can be beneficial in mitigating these mental health issues especially in adverse social situations. Within this context, the aim of the study was to examine to what extent overall social connectedness plays a role in immigrant mental health during the COVID-19 crisis, hypothesizing that reduced sense of belonging to the social world will be part of the pathway from the negative effects of perceived discrimination on mental health during the pandemic. We recruited 104 immigrants from Greece who completed online self-report measures of perceived discrimination, social connectedness, depression, anxiety, paranoia, and loneliness, and conducted mediation analyses to test our predictions. Mediation models indicated that perceived discrimination has a negative impact on sense of belonging, which in turn increases anxiety and paranoia symptoms. Findings suggest that while perceived discrimination has a negative impact on mental health, this effect is less severe if participants remain socially connected. Results are discussed with regard to the need for social inclusion practices.

A study on COVID-19-related stigmatization, quality of professional life and professional identity in a sample of HCWs in Italy

BACKGROUND AND AIM

Perceived COVID-19-related stigmatizations have a strong impact on healthcare workers' wellbeing and quality of professional life, decreasing satisfaction and increasing fatigue. This work aims to investigate the role of professional identification in moderating the impact of COVID-19-related stigma on quality of professional life in a sample of healthcare professionals working in hospital.

METHODS

A cross-sectional design in which a web-based questionnaire was sent to professionals was used to collect answers from 174 participants, most of whom women and nurses.

RESULTS

Perceived stigma was negatively related with compassion satisfaction and positively related with an increase in both burnout and secondary traumatic stress. Professional identification had a positive correlation with satisfaction and a negative correlation with burnout, but this was not directly related with secondary traumatic stress. Importantly, stigma and identification interacted so that stigma decreased compassion satisfaction only when identification was low, and increased secondary traumatic stress only when identification was high. No interaction effect appeared with respect to burnout.

CONCLUSIONS

Experience of stigmatization has the potential to decrease the quality of professional life of healthcare professionals. Professional identification seems to help professional to maintain higher level of compassion satisfaction and reduced burnout. However, professional identification seems also be associated with vicarious trauma experienced following stigma. (www.actabiomedica.it).

Cumulative and independent effects of experiences of social adversity on support for violent radicalization during the COVID-19 pandemic: the mediating role of depression

PURPOSE

Social adversity experiences have increased during the pandemic and are potential risk factors for both depression and support for violent radicalization (VR). However, the cumulative and independent effects of various social adversity experiences on support for VR have yet to be explored. This paper examines the cumulative and independent effects of COVID- and non-COVID-related discrimination, exposure to violence, traditional and cyberbullying victimization on support for VR. In addition, we investigate whether depression mediates the relationship between these forms of social adversity and support for VR.

METHODS

A total of 6003 young adults (M_age = 27, SD_age = 4.40, range 18-35) living in metropolitan areas in Canada responded to an online survey. We used multivariable regression models, controlling for socio-demographic characteristics, to infer covariate adjusted associations between social adversity measures and support for VR. Additionally, we conducted a formal mediation analysis to estimate the proportion mediated by depression.

RESULTS

There was a cumulative relationship between experiences of social adversity and support for VR (β = 1.52; 95% CI: 1.32, 1.72). COVID-related discrimination and cyberbullying victimization were independently associated with stronger support for VR. Depression partially mediated the effect of cumulative social adversity, COVID-related discrimination and cyberbullying on support for VR.

CONCLUSION

Prevention programs during the present pandemic should prioritize decreasing discrimination and providing psychosocial support to depressed young adults who experience social adversity. Practitioners should prioritize developing programs that foster digital literacy skills and critical thinking among young adults to address the concerning impact of cyberbullying on support for VR.

How Social Exclusion, Embitterment, and Conspiracy Beliefs Mediate Individual's Intention to Vaccination against COVID-19: Results from a Moderated Serial Mediation Analysis

INTRODUCTION

As Switzerland faced the "second wave" of COVID-19 incidences, a discussion of a potential vaccine against the virus emerged. While some individuals accept vaccines, others challenge or refuse to be vaccinated, a phenomena called vaccine hesitancy. Here, trust plays a vital role in vaccination intention. Embitterment not only goes along with the sense of being treated unjust but also innates a distrust in others. Thus, embitterment may influence individuals' vaccination intention against COVID-19. In the present study, we investigate how feelings of being socially excluded and the perceived negative impact of the pandemic are associated with embitterment and in turn, how embitterment is related to individuals' vaccination intention and the tendency to hold COVID-19-related conspiracy beliefs (CCBs). This is in regard of the perceived communication style by the government.

METHOD

A convenience sample of 281 individuals completed an online survey developed on Qualtrics. In this cross-sectional, nonexperimental designed study, indirect effects of a moderated serial mediation were analyzed using Jamm (Jamovi, Version 0.9; 2019).

RESULTS

Results indicated that embitterment went along with increased feelings of social exclusion (β = 0.45, p < 0.001). Further, individuals high in embitterment generally indicated a higher vaccination intention against COVID-19 (β = 0.15, p < 0.01). However, embittered individuals holding CCBs had a decreased vaccination intention against COVID-19 (β = -0.71, p < 0.001). Thus, whether or not embittered individuals develop CCBs might be a crucial determinant for their vaccination intention. Noteworthy, the relationship between embitterment and the tendency to hold CCBs was reinforced by the notion of an unsatisfactory style of communication by the government.

CONCLUSION

Taken together, results suggest that embitterment not only plays a relevant role in vaccination intention against COVID-19 but also for the susceptibility to engage in conspiracy beliefs.

Mental Health of COVID-19 Survivors at 6 and 12 Months Postdiagnosis: A Cohort Study

OBJECTIVE

As COVID-19 persists around the world, it is necessary to explore the long-term mental health effects in COVID-19 survivors. In this study, we investigated the mental health outcomes of survivors of COVID-19 at 6 and 12 months postdiagnosis.

METHODS

Posttraumatic stress disorder (PTSD checklist for the DSM-5, PCL-5), depression (PHQ-9), anxiety (Generalized Anxiety Disorder Scale, GAD-7), resilience (Connor-Davidson Resilience Scale, CD-RISC-10), perceived social support (PSSS), personality traits (Chinese Big Five Personality Inventory-15, CBF-PI-15), and sociodemographic information were examined among 511 survivors of COVID-19 (48.1%, females; M _age = 56.23 years at first assessment) at 6 and 12 months postdiagnosis. The data were analyzed with Wilcoxon signed rank tests and multivariable logistic regression models.

RESULTS

The prevalence of anxiety, depression, and posttraumatic stress disorder (PTSD) at 6 and 12 months after diagnosis was 13.31% and 6.26%; 20.35% and 11.94%; and 13.11% and 6.07%, respectively. The risk factors for all symptoms were as follows: higher neuroticism; lower openness, extraversion, agreeableness, and resilience; greater life disruptions due to COVID-19; poorer living standards; and increased symptoms of PTSD or depression at 6 months postdiagnosis.

CONCLUSION

The mental health of COVID-19 survivors improved between 6 and 12 months postdiagnosis. Mental health workers should pay long-term attention to this group, especially to survivors with risk factors.

Chinese infection-control strategies for COVID-19 prevention: A qualitative study with confirmed cases

OBJECTIVE

We aimed to describe how the prevention and controlling strategies have been experienced by COVID-19 patients in China, especially those who had passed through the suspected, diagnosed, hospitalized, and recovery stages of the disease.

DESIGN

A descriptive qualitative study followed the Standards for Reporting Qualitative Research guidelines.

SAMPLES

COVID-19 patients were recruited from a COVID-19-designated facility in Shanghai, China, from April to June 2020, by the purposive sampling method.

METHODS

Semi-structured, in-depth interviews by cell phone were used and transcriptions were analyzed using inductive qualitative content analysis method.

RESULTS

We recruited 26 COVID-19 patients. Three theme categories emerged from the data analysis. The first was "Consciously adhere to COVID-19-related controlling strategies." The second category was "Positive experiences of the COVID-19-related controlling strategies." These patients experienced a quick and adequate medical response, confident in the medical system, or received help from community workers. The third category was "Negative experiences of the COVID-19-related controlling strategies." These patients experienced psychological distress, stigma, privacy exposures, and inconveniences from the controlling strategies.

CONCLUSIONS

It is urgent to develop a culturally sensitive intervention to eliminate the psychological distress and stigma of patients with COVID-19 and to protect their privacy during and after the pandemic.

Stigma, Perceived Discrimination, and Mental Health during China's COVID-19 Outbreak: A Mixed-Methods Investigation

Research on stigma and discrimination during COVID-19 has focused on racism and xenophobia in Western countries. In comparison, little research has considered stigma processes, discrimination, and their public health implications in non-Western contexts. This study draws on quantitative survey data (N = 7,942) and qualitative interview data (N = 50) to understand the emergence, experiences, and mental health implications of stigma and discrimination during China's COVID-19 outbreak. Given China's history of regionalism, we theorize and use a survey experiment to empirically assess region-based stigma: People who lived in Hubei (the hardest hit province) during the outbreak and those who were socially associated with Hubei were stigmatized. Furthermore, the COVID-19 outbreak created stigma around people labeled as patients by the state. These stigmatized groups reported greater perceived discrimination, which-as a stressor-led to psychological distress. Our interview data illuminated how the stigmatized groups perceived, experienced, and coped with discrimination and stigma.

Tracking the impact of COVID-19 in Victoria, Australia: Shocks, vulnerability and insurances among residents of share houses

COVID-19 is re-shaping cities and regions, as residents respond to large disruptions to employment and social interaction and threats to public health. While the impacts of COVID-19 are extensive, certain groups are more vulnerable than others. Our research examines the impact of COVID-19 on members of share houses in the state of Victoria, Australia. This cohort is more likely to be young, casually employed, living in informal arrangements and at risk of homelessness than the broader population. We propose a conceptual framework for investigating the factors driving vulnerability to shocks and the resources most likely to support individuals to respond to or recover from these shocks. We surveyed 1052 share house occupants in June 2020. We found dramatic results, with 74% losing their job or having their hours reduced, 47% experiencing a reduction in their financial situation and 50% reporting that their mental health had deteriorated. These outcomes were worse for young people, casual employees or immigrants. Our research highlights the positive influence of social support for low-income individuals. We find that government social welfare payments are the most impactful form of insurance, calling for a greater appreciation of the role of social welfare in supporting resilience following a disaster.

Concerns and Anxieties of Patients During Hospitalization for COVID-19

Objective

The objective of this study was to evaluate the concerns and anxieties of hospitalized coronavirus disease (COVID-19) patients.

Methods

A questionnaire was distributed to patients on discharge. The responses were analyzed once they were returned by mail.

Results

Responses were received from 27 of 39 patients (average age, 50 ± 17 years). Among the participants, 16 were male (59.3%), 19 were symptomatic (70.4%), and two required a ventilator (7.4%). Anxiety about symptom exacerbation was reported by 36.0% of participants. Quarantine-associated stress was experienced by 60.0% of participants, and 72.0% of participants supported the change in federal policy that allows asymptomatic patients and patients with mild conditions to isolate themselves at a hotel or their home. Following discharge, 44.0% of participants experienced anxieties regarding their lives after discharge, and 56.0% were anxious regarding discrimination and rumors. During hospitalization, 68.0% of participants re-evaluated their attitude toward health, 44.0% regretted the preventative measures they took before contracting COVID-19, and 44.0% felt guilty for becoming infected.

Conclusions

Participants experienced various kinds of stress related to hospitalization for COVID-19. There was a trend of people being more concerned about their relationships than their own health. Therefore, as asymptomatic participants and participants with mild symptoms also experienced psychological stresses, it is also necessary to consider the psychological and social effects of the disease.

Changes in patients' outlook, behaviors, and attitudes toward COVID-19 after hospitalization and their experiences of discrimination and harassment

Objective

This study aims to examine changes in patients’ perspectives and outlooks regarding the disease and their health after hospitalization for COVID-19 and investigate their discrimination and harassment experiences. This prospective observational study surveyed discharged patients who had been admitted to Hyogo Prefectural Tamba Medical Center in Japan for COVID-19. Patient characteristics, changes in outlook and behaviors after discharge, and incidents of discrimination and harassment were examined. The study was conducted in two waves: March–June 2020 and July–September 2020.

Results

Responses were obtained from 27 patients aged 50 ± 17 years, including 16 men (59.3%). We found most patients feared infection before hospitalization (88.5%) and had taken some preventive measures (96.3%), however after discharge, all (100%) practiced social distancing and infection prevention. Twenty patients (80%) considered changing their lifestyles, and 19 (79.2%) decided to use sick leave when they felt ill; these trends were more prominent during the second wave. Six patients (23.1%) reported experiencing discrimination or harassment after discharge. While most patients with COVID-19 had a strong fear of infection before hospitalization, their views about health and health behaviors changed after hospitalization.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13104-021-05780-9.

COVID-19 related discrimination in Japan: A preliminary analysis utilizing text-mining

To assess the general Japanese population's thoughts on coronavirus disease of 2019 related discrimination by Tweets.Tweets were retrieved from search queries using the keywords "health care providers and discrimination (no hashtags)" and "corona and rural area (no hashtags)" via the Twitter application programming interface. Subsequently, a text-mining analysis was conducted on tokenized text data. R version 4.0.2 was used for the analysis.In total, 51,906 tweets for "corona and health care providers", 59,560 tweets for "corona and rural" were obtained between the search period of July 29, 2020 and September 30, 2020. The most common 20 words from the tokenized text data were translated to English. Word clouds with the original Japanese words are presented.Tweets for corona and health care providers did not suggest significant evidence of discrimination toward health care providers on Twitter. Results for corona and rural area, however, showed the unexpected word "murahachibu" (an outmoded word meaning ostracism), suggesting persistent strong social pressure to prevent bringing the disease to the community. This kind of pressure may not be supported by scientific facts. These results demonstrate the need for continued educational efforts to disseminate factual information to the public.

A cross-sectional study of COVID-19-related bullying in a sample of Lebanese adults: scale validation, correlates, and mediating effect of fear and anxiety

Background

The COVID-19 pandemic has led to prolonged exposure to stress and anxiety, raising concerns about a large spectrum of psychological side effects. The primary objective of the study was to validate the COVID-19 Bullying Scale (CBS-11). The second objective was to explore factors associated with COVID-19-related bullying and evaluate the mediating effect of fear and anxiety between knowledge and COVID-19-related bullying.

Methods

A cross-sectional online survey conducted between December 20, 2020, and January 5, 2021, recruited 405 Lebanese adults using a snowball sampling technique. The CBS-11, an 11-item tool specifically created for this study, was used to measure bullying behaviors towards COVID-19 patients.

Results

All items of the CBS-11 converged over a 1-factor solution with an eigenvalue over 1, accounting for a variance of 75.16%. The scale has a high Cronbach’s alpha (.974), indicating excellent reliability. A positive correlation was found between the COVID-19 bullying scale and fear, anxiety, and stigma discrimination. The logistic regression showed that higher fear of COVID-19 (ORa = 1.04), a positive attitude toward COVID-19 preventive measures and hygiene recommendations (ORa = 1.18), higher stigma discrimination scores (ORa = 1.09), and having a health professional family member (ORa = 2.42) were significantly associated with bullying.

Conclusion

Our main findings showed that the CBS-11 could be an efficient tool to measure bullying behaviors toward COVID-19 patients. Stigma discrimination and fear from COVID-19 were associated with higher bullying attitudes. Future prospective studies are needed to understand better the factors related to bullying among adults during a pandemic, such as COVID-19.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00643-1.