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Chan JK, Marzuki AA, Vafa S, Thanaraju A, Yap J, Chan XW, Harris HA, Todi K, Schaefer A. A systematic review on the relationship between socioeconomic conditions and emotional disorder symptoms during Covid-19: unearthing the potential role of economic concerns and financial strain. BMC Psychol 2024; 12:237. [PMID: 38671542 PMCID: PMC11046828 DOI: 10.1186/s40359-024-01715-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Covid-19 has disrupted the lives of many and resulted in high prevalence rates of mental disorders. Despite a vast amount of research into the social determinants of mental health during Covid-19, little is known about whether the results are consistent with the social gradient in mental health. Here we report a systematic review of studies that investigated how socioeconomic condition (SEC)-a multifaceted construct that measures a person's socioeconomic standing in society, using indicators such as education and income, predicts emotional health (depression and anxiety) risk during the pandemic. Furthermore, we examined which classes of SEC indicators would best predict symptoms of emotional disorders. METHODS Following PRISMA guidelines, we conducted search over six databases, including Scopus, PubMed, etc., between November 4, 2021 and November 11, 2021 for studies that investigated how SEC indicators predict emotional health risks during Covid-19, after obtaining approval from PROSPERO (ID: CRD42021288508). Using Covidence as the platform, 362 articles (324 cross-sectional/repeated cross-sectional and 38 longitudinal) were included in this review according to the eligibility criteria. We categorized SEC indicators into 'actual versus perceived' and 'static versus fluid' classes to explore their differential effects on emotional health. RESULTS Out of the 1479 SEC indicators used in these 362 studies, our results showed that 43.68% of the SEC indicators showed 'expected' results (i.e., higher SEC predicting better emotional health outcomes); 51.86% reported non-significant results and 4.46% reported the reverse. Economic concerns (67.16% expected results) and financial strains (64.16%) emerged as the best predictors while education (26.85%) and living conditions (30.14%) were the worst. CONCLUSIONS This review summarizes how different SEC indicators influenced emotional health risks across 98 countries, with a total of 5,677,007 participants, ranging from high to low-income countries. Our findings showed that not all SEC indicators were strongly predictive of emotional health risks. In fact, over half of the SEC indicators studied showed a null effect. We found that perceived and fluid SEC indicators, particularly economic concerns and financial strain could best predict depressive and anxiety symptoms. These findings have implications for policymakers to further understand how different SEC classes affect mental health during a pandemic in order to tackle associated social issues effectively.
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Affiliation(s)
- Jee Kei Chan
- Department of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia.
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia.
- Sunway University Malaysia, Room: 4-4-11, Jalan Lagoon Selatan, Bandar Sunway, Petaling Jaya, 47500, Selangor, Malaysia.
| | - Aleya A Marzuki
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Samira Vafa
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Arjun Thanaraju
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Jie Yap
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Xiou Wen Chan
- Department of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Hanis Atasha Harris
- Department of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Khushi Todi
- Department of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Alexandre Schaefer
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
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Charul, Raina JK, Sharma S, Pal S, Dogra V, Kumar P, Panjaliya RK. COVID and depression among stratified population groups: a narrative review. Eur J Med Res 2023; 28:265. [PMID: 37537632 PMCID: PMC10398951 DOI: 10.1186/s40001-023-01213-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 07/07/2023] [Indexed: 08/05/2023] Open
Abstract
The Covid-19 pandemic has impacted and infiltrated every aspect of our lives. Successive lockdowns, social distancing measures, and reduction in economic activity have developed a new way of living and, in many cases, tend to lead to depression. The initial strict lockdown for about 3 months and eventually for a few more months has imposed greater challenges on children and adolescents in terms of psychological problems and psychiatric disorders. Regardless of their viral infection status, many people have been affected by the psychosocial changes associated with the Covid-19 pandemic. In the present review, we have attempted to evaluate the impact of COVID on the mental health of people from different age groups and occupations. The present review has highlighted the need for taking effective measures by the stakeholder to cope with depression among human population groups worldwide.
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Affiliation(s)
- Charul
- Department of Zoology, University of Jammu, Jammu and Kashmir, 180006, India
| | - Jyotdeep K Raina
- GGM Science College, Cluster University of Jammu, Jammu and Kashmir, 180001, India
| | - Sourabh Sharma
- Department of Zoology, University of Jammu, Jammu and Kashmir, 180006, India
| | - Shash Pal
- Department of Zoology, University of Jammu, Jammu and Kashmir, 180006, India
| | - Vikas Dogra
- Department of Zoology, Govt. College for Women, Parade Ground, Jammu, Jammu and Kashmir, 180001, India
| | - Parvinder Kumar
- Department of Zoology, University of Jammu, Jammu and Kashmir, 180006, India
- Institute of Human Genetics, University of Jammu, Jammu and Kashmir, 180006, India
| | - Rakesh K Panjaliya
- Department of Zoology, University of Jammu, Jammu and Kashmir, 180006, India.
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de Vargas D, Ramírez EGL, Pereira CF, de Oliveira SR. Telenursing in mental health: effect on anxiety symptoms and alcohol consumption during the COVID-19 pandemic. Rev Lat Am Enfermagem 2023; 31:e3932. [PMID: 37283418 PMCID: PMC10243443 DOI: 10.1590/1518-8345.6172.3932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 02/26/2023] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE (1) A remote intervention with a positive impact on reducing anxiety and alcohol use. (2) Nursing as a protagonist of preventive care in mental health (3) A low-cost intervention that covers several population groups. (4) Telenursing in mental health as a care strategy during COVID-19. to investigate the effect of a remote intervention on anxiety symptoms and alcohol use in users of the Primary Health Care service. METHOD a quasi-experimental study conducted with 1,270 participants who answered the Alcohol Use Disorders Identification Test and the State-Trait Anxiety Inventory-6. Of these, 1,033 interviewees scored for moderate/severe anxiety symptoms (STAI-6 > 3) and moderate/severe risk alcohol use (AUDIT-C > 3), and received the interventions via telephone calls with follow-up periods lasting seven and 180 days. For data analysis, a mixed-effects regression model was used. RESULTS the effect of the intervention performed was positive in reducing anxiety symptoms between T0 and T1 (µ=1.6, p<0.001) and in reducing the alcohol use pattern between T1 and T3 (µ=1.57, p<0.001). CONCLUSION the follow-up results suggest a positive effect of the intervention in reducing anxiety and the alcohol use pattern, which tends to be maintained over time. There is diverse evidence that the intervention proposed can be an alternative for preventive care in mental health, in situations where accessibility of the user or the professional is compromised.
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Affiliation(s)
- Divane de Vargas
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil
| | - Erika Gisseth León Ramírez
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil
- Universidade de Guarulhos, Guarulhos, SP, Brasil
- Becaria de la Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil
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Silva GDDOD, Martins G, Rocha LAD, Machado MT, Pott Junior H, Gratão ACM. Burden and psychological symptoms on informal caregivers of the elderly in the COVID-19 pandemic. Rev Gaucha Enferm 2022; 43:e20220163. [PMID: 36515322 DOI: 10.1590/1983-1447.2022.20220163.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/17/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate the burden and psychological symptoms of informal caregivers of the elderly during the COVID-19 pandemic. METHOD Cross-sectional study with 50 caregivers from the Gerontology Outpatient Clinic in the interior of São Paulo, evaluated in 2021 via teleconsultation by the Hospital Anxiety and Depression Scale and the Zarit-Brief Burden Interview. Poisson's multivariate regression was applied to the two instruments scores according to the set of characteristics of the participants. RESULTS Psychological symptoms were highlighted in caregivers with longer time in exercise (p=0.01; p=0.001) and who lived in the same environment with the elderly (p=0.04; p=0.02). Burden was associated with age (p<0.001) and living with the elderly (p=0.001). CONCLUSION There is a need for interventions that attenuate psychological symptoms and burden in older caregivers, who live with the elderly and have been working for a longer time.
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Affiliation(s)
- Giuliana Duarte de Oliveira da Silva
- Universidade Federal de São Carlos (UFScar). Centro de Ciências Biológicas e da Saúde. Departamento de Gerontologia. São Carlos, São Paulo, Brasil
| | - Gabriela Martins
- Universidade Federal de São Carlos (UFScar). Departamento de Enfermagem. Programa de Pós-Graduação em Enfermagem. São Carlos, São Paulo, Brasil
| | - Luana Aparecida da Rocha
- Universidade Federal de São Carlos (UFScar). Departamento de Enfermagem. Programa de Pós-Graduação em Enfermagem. São Carlos, São Paulo, Brasil
| | - Mariane Teixeira Machado
- Universidade Federal de São Carlos (UFScar). Centro de Ciências Biológicas e da Saúde. Departamento de Gerontologia. São Carlos, São Paulo, Brasil
| | - Henrique Pott Junior
- Universidade Federal de São Carlos (UFScar). Centro de Ciências Biológicas e da Saúde. Departamento de Medicina. São Carlos, São Paulo, Brasil
| | - Aline Cristina Martins Gratão
- Universidade Federal de São Carlos (UFScar). Centro de Ciências Biológicas e da Saúde. Departamento de Gerontologia. São Carlos, São Paulo, Brasil
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Sott MK, Bender MS, da Silva Baum K. Covid-19 Outbreak in Brazil: Health, Social, Political, and Economic Implications. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2022; 52:442-454. [PMID: 36062608 PMCID: PMC9445630 DOI: 10.1177/00207314221122658] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
COVID-19 outbreak quickly spread to all corners of the globe. In Brazil, the outbreak was
particularly frightening because it worsened existing health, political, economic, and
social problems. The results already observed show the contagion ripple-spreading process
across the country, causing the death of thousands of people each day and counting, added
to a very serious wave of unemployment, scientific denial, and social precariousness.
Based on this, this study reviews recent research that looked at the role of the
government, the Brazilian health system, and the main economic and social impacts fostered
by the pandemic. We perform a scoping review according to the PRISMA-ScR to structure the
qualitative synthesis of the 67 associated documents. The results reinforce the negative
effects of the country's mismanagement and its consequent impacts on the Brazilian economy
and society. The battleground against COVID-19 has fueled political tensions, shaken the
health system, and unleashed social despair tinged with thousands of deaths. Finally, in
the present scoping review, we discuss concerns about the impacts of the COVID-19 outbreak
in Brazil and what the world hopes the country has learned from the current crisis.
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Affiliation(s)
| | - Mariluza Sott Bender
- Department of Psychology, 67889University of Santa Cruz do Sul, Santa Cruz do Sul, Brazil
| | - Kamila da Silva Baum
- Department of Economics, 28102Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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Hernández-Díaz Y, Genis-Mendoza AD, Ramos-Méndez MÁ, Juárez-Rojop IE, Tovilla-Zárate CA, González-Castro TB, López-Narváez ML, Nicolini H. Mental Health Impact of the COVID-19 Pandemic on Mexican Population: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116953. [PMID: 35682536 PMCID: PMC9180045 DOI: 10.3390/ijerph19116953] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic has had an impact on mental health in the general population, but no systematic synthesis of evidence of this effect has been undertaken for the Mexican population. Relevant studies were identified through the systematic search in five databases until December, 2021. The selection of studies and the evaluation of their methodological quality were performed in pairs. The Newcastle-Ottawa Scale (NOS) was used for study quality appraisal. The protocol of this systematic review was registered with PROSPERO (protocol ID: CRD42021278868). This review included 15 studies, which ranged from 252 to 9361 participants, with a total of 26,799 participants. The findings show that COVID-19 has an impact on the Mexican population’s mental health and is particularly associated with anxiety, depression, stress and distress. Females and younger age are risk factors for development mental health symptoms. Mitigating the negative effects of COVID-19 on mental health should be a public health priority in Mexico.
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Affiliation(s)
- Yazmín Hernández-Díaz
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Mendez 86205, Mexico; (Y.H.-D.); (T.B.G.-C.)
| | - Alma Delia Genis-Mendoza
- Laboratorio de Genómica de Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, Mexico City 14610, Mexico;
| | - Miguel Ángel Ramos-Méndez
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Beautiful Villa 86100, Mexico;
| | - Isela Esther Juárez-Rojop
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco 86040, Mexico;
| | - Carlos Alfonso Tovilla-Zárate
- Hospital Chiapas “Dr. Jesús Gilberto Gómez Maza”, Tuxtla Gutierrez 29000, Mexico;
- Correspondence: (C.A.T.-Z.); (H.N.)
| | - Thelma Beatriz González-Castro
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Mendez 86205, Mexico; (Y.H.-D.); (T.B.G.-C.)
| | | | - Humberto Nicolini
- Laboratorio de Genómica de Enfermedades Psiquiátricas y Neurodegenerativas, Instituto Nacional de Medicina Genómica, Mexico City 14610, Mexico;
- Correspondence: (C.A.T.-Z.); (H.N.)
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Chen J, Zhang SX, Yin A, Yáñez JA. Mental health symptoms during the COVID-19 pandemic in developing countries: A systematic review and meta-analysis. J Glob Health 2022; 12:05011. [PMID: 35604881 PMCID: PMC9126304 DOI: 10.7189/jogh.12.05011] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background This systematic review aims to 1) summarize the prevalence of anxiety, depression, distress, insomnia, and PTSD in the adult population during the first year of the COVID pandemic in developing countries and 2) uncover and highlight the uneven distribution of research on mental health in all developing countries across regions. Methods Several literature databases were systemically searched for meta-analyses published by September 22, 2021, on the prevalence rates of mental health symptoms in developing countries worldwide. We meta-analysed the raw data of the individual empirical results from the previous meta-analysis papers in developing countries in different regions. Results The prevalence rates of mental health symptoms were summarized based on 341 empirical studies with a total of 1 704 072 participants from 40 out of 167 developing countries in Africa, Asia (East, Southeast, South, and West), Europe, and Latin America. Comparatively, Africa (39%) and West Asia (35%) had the worse overall mental health symptoms, followed by Latin America (32%). The prevalence rates of overall mental health symptoms of medical students (38%), general adult students (30%), and frontline health care workers (HCWs) (27%) were higher than those of general HCWs (25%) and general populations (23%). Among five mental health symptoms, distress (29%) and depression (27%) were the most prevalent. Interestingly, people in the least developing countries suffered less than those in emergent and other developing countries. The various instruments employed lead to result heterogeneity, demonstrating the importance of using the well-established instruments with the standard cut-off points (eg, GAD-7, GAD-2, and DASS-21 for anxiety, PHQ-9 and DASS-21 for depression, and ISI for insomnia). Conclusions The research effort on mental health in developing countries during COVID-19 has been highly uneven in the scope of countries and mental health outcomes. This meta-analysis, the largest on this topic to date, shows that the mental health symptoms are highly prevalent yet differ across regions. The accumulated systematic evidence from this study can help enable the prioritization of mental health assistance efforts to allocate attention and resources across countries and regions.
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Affiliation(s)
- Jiyao Chen
- College of Business, Oregon State University, Corvallis, Oregon, USA
| | - Stephen X Zhang
- Adelaide Business School, University of Adelaide, Adelaide, Australia
| | - Allen Yin
- School of Humanities, Southeast University, Nanjing, China
| | - Jaime A Yáñez
- Vicerrectorado de Investigación, Universidad Norbert Wiener, Lima, Peru.,Gerencia Corporativa de Asuntos Científicos y Regulatorios, Teoma Global, Lima, Peru
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Abstract
AIMS There is a lack of evidence related to the prevalence of mental health symptoms as well as their heterogeneities during the coronavirus disease 2019 (COVID-19) pandemic in Latin America, a large area spanning the equator. The current study aims to provide meta-analytical evidence on mental health symptoms during COVID-19 among frontline healthcare workers, general healthcare workers, the general population and university students in Latin America. METHODS Bibliographical databases, such as PubMed, Embase, Web of Science, PsycINFO and medRxiv, were systematically searched to identify pertinent studies up to August 13, 2021. Two coders performed the screening using predefined eligibility criteria. Studies were assigned quality scores using the Mixed Methods Appraisal Tool. The double data extraction method was used to minimise data entry errors. RESULTS A total of 62 studies with 196 950 participants in Latin America were identified. The pooled prevalence of anxiety, depression, distress and insomnia was 35%, 35%, 32% and 35%, respectively. There was a higher prevalence of mental health symptoms in South America compared to Central America (36% v. 28%, p < 0.001), in countries speaking Portuguese (40%) v. Spanish (30%). The pooled prevalence of mental health symptoms in the general population, general healthcare workers, frontline healthcare workers and students in Latin America was 37%, 34%, 33% and 45%, respectively. CONCLUSIONS The high yet heterogenous level of prevalence of mental health symptoms emphasises the need for appropriate identification of psychological interventions in Latin America.
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Predicting the Severity of Lockdown-Induced Psychiatric Symptoms with Machine Learning. Diagnostics (Basel) 2022; 12:diagnostics12040957. [PMID: 35454005 PMCID: PMC9025309 DOI: 10.3390/diagnostics12040957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/07/2022] [Accepted: 04/10/2022] [Indexed: 12/05/2022] Open
Abstract
During the COVID-19 pandemic, an increase in the incidence of psychiatric disorders in the general population and an increase in the severity of symptoms in psychiatric patients have been reported. Anxiety and depression symptoms are the most commonly observed during large-scale dramatic events such as pandemics and wars, especially when these implicate an extended lockdown. The early detection of higher risk clinical and non-clinical individuals would help prevent the new onset and/or deterioration of these symptoms. This in turn would lead to the implementation of public policies aimed at protecting vulnerable populations during these dramatic contingencies, therefore optimising the effectiveness of interventions and saving the resources of national healthcare systems. We used a supervised machine learning method to identify the predictors of the severity of psychiatric symptoms during the Italian lockdown due to the COVID-19 pandemic. Via a case study, we applied this methodology to a small sample of healthy individuals, obsessive-compulsive disorder patients, and adjustment disorder patients. Our preliminary results show that our models were able to predict depression, anxiety, and obsessive-compulsive symptoms during the lockdown with up to 92% accuracy based on demographic and clinical characteristics collected before the pandemic. The presented methodology may be used to predict the psychiatric prognosis of individuals under a large-scale lockdown and thus supporting the related clinical decisions.
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Silva GDDOD, Martins G, Rocha LAD, Machado MT, Pott Junior H, Gratão ACM. Sobrecarga e sintomas psicológicos em cuidadores informais de idosos na pandemia da COVID-19. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20220163.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
RESUMO Objetivo Avaliar sobrecarga e sintomas psicológicos dos cuidadores informais de idosos durante a pandemia da COVID-19. Método Estudo transversal com 50 cuidadores do Ambulatório de Gerontologia do interior de São Paulo, avaliados em 2021 via teleconsulta pela Escala Hospitalar de Ansiedade e Depressão e Entrevista de Sobrecarga de Zarit. A Regressão multivariada de Poisson foi aplicada nos escores dos dois instrumentos em função do conjunto de características dos participantes. Resultados Destacaram-se os sintomas psicológicos nos cuidadores com maior tempo em exercício (p=0,01; p=0,001) e que viviam no mesmo ambiente que o idoso (p=0,04; p=0,02). A sobrecarga associou-se com sua idade (p<0,001) e morar junto ao idoso (p=0,001). Conclusão Urgem intervenções atenuantes dos sintomas psicológicos e de sobrecarga nos cuidadores com idade avançada, que residem junto ao idoso e desempenham a função há maior tempo.
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