The mediating role of sleep quality in the relationship between orthorexia nervosa and fear of COVID-19

The COVID-19 (SARS-CoV-2) pandemic has jeopardized humanity worldwide and has considerably altered the healthy lifestyle behaviors of societies. This study examined the possible mediating role of sleep quality in the relationship between orthorexia nervosa and fear of COVID-19 among Turkish adults. This study used an observational and descriptive design. It was carried out online with 1,130 participants across Turkey between April and August 2021. The data were collected using a questionnaire, the Fear of COVID-19 Scale (FC-19S), the Pittsburgh Sleep Quality Index (PSQI), and Orthorexia Nervosa-R (ON-R). The participants had an ON-R mean score of 3.08 ± 0.90 and a mean PSQI score of 8.03 ± 2.80. Likewise, their mean FC-19S score was 18.24 ± 6.55. There was a significant positive correlation between the FC-19S and the PSQI (r = 0.208; p = 0.000) as well as a significant negative correlation between the ON-R and the PSQI (r = - 0.145; p = 0.000). In addition, the results of the process model analysis supported our hypotheses that the PSQI was a predictor of ON-R and that its direct and indirect effects were moderated by FC19S and the PSQI. A one-unit increase in FC-19S scores causes an average 1% increase on the ON-R scale, while it generates an 8% increase on the PSQI. It was determined that the PSQI total score caused an average of 6% increase in the ON-R scale score. The findings of this study showed that sleep quality has a mediating role in the relationship between orthorexia nervosa and fear of COVID-19 experienced by Turkish adults during the pandemic. For this reason, governments need to take the necessary precautions concerning this subject when creating action plans for possible global crisis situations that may adversely affect public health in the future.

Brazilian Adaptation of the Coronavirus Anxiety Scale: A Psychometric Investigation of a Measure of Coronaphobia

This study examined the psychometric properties of a Brazilian adapted version of the Coronavirus Anxiety Scale (CAS-BR) in a sample of adults in Brazil. Confirmatory factor analyses demonstrated that the CAS-BR produces a reliable (α = .84), unidimensional construct whose structure was shown to be invariant across gender, race, and age. However, some items of the CAS-BR were stronger indicators of the coronavirus anxiety construct for women and younger adults. Although the CAS-BR demonstrated evidence of discrimination ability for functional impairment (AUC = .77), Youden indexes were low to identify a clinical cut-score. Construct validity was demonstrated with correlations between CAS-BR scores and measures of functional impairment, generalized anxiety, and depression. Exploratory analyses revealed that CAS-BR total scores were higher among women and participants with a history of anxiety disorder. These findings are consistent with previous investigations and support the validity of CAS-BR for measuring coronavirus anxiety with Brazilian adults.

Psychological Distress Impact of Coronavirus Disease (COVID-19) Outbreak on Three Continents: A Systematic Review and Meta-analysis

BACKGROUND

The dire state of coronavirus disease (COVID-19) outbreak has had a substantial psychological impact on society.

METHODS

A systematic search was performed through Medline, PubMed, Embase, Scopus, and Web of Science, to investigate the impact of the COVID-19 pandemic on the psychological health of individuals in various countries. Subgroup analyses considered gender and classification of countries into three continents of America, Europe, and Asia. Only studies that used the COVID-19 Peritraumatic Distress Index (CPDI) questionnaire as a tool to assess mental distress were included in this meta-analysis. Heterogeneity among studies was assessed by I² statistic, and the random-effects model was utilized to obtain the pooled prevalence.

RESULTS

This pooled analysis included a large data sample of 21 studies consisting of 94,414 participants. The pooled prevalence of the psychological distress during the time of COVID-19 pandemic by CPDI for the continent of Asia was 43% (34.6% mild-to-moderate and 8.4% severe) which was greater than that for Europe (35%; 30% mild-to-moderate and 5% severe) but lower than that for America (64.3%; 45.8% mild to moderate and 18.5% severe). In addition, the prevalence of psychological distress according to CPDI was higher in females (48%; 40% mild to moderate, 13% severe) compared with males (59%; 36% mild to moderate and 5% severe).

CONCLUSIONS

Our findings suggest that psychological distress in the Americas is a larger problem than in Asia and European continents. Females appear to be more vulnerable and may therefore require further attention in terms of preventive and management strategies. Implementation of both digital and molecular biomarkers is encouraged to increase objectivity and accuracy of assessing the dynamic changes in mental health in the current and future pandemics.

Evaluation of peritraumatic distress at the point of care: A cross-sectional study

BACKGROUND

COVID-19 related peritraumatic distress has been investigated in the general population with contrasting results probably due to the perceived risk of developing COVID-19. Our study aims to investigate this condition in individuals with ascertained or probable SARS-CoV-2 exposure.

METHODS

The Coronavirus Peritraumatic Distress Index (CPDI) was administered to people attending a COVID-19 point of care. The sample was stratified for perceived risk in SARS-CoV-2 positive cases, close contacts, case relatives, undergoing screening subjects, and symptomatic subjects.

RESULTS

1463 subjects participated, and with a mean CPDI Score of 28.2 (SD 16.9). CPDI Scores in SARS-CoV-2 positive cases were significantly higher than case relatives (p = 0.02). Multiple logistic regression revealed that having had work changes (p = 0.001), night sleep changes (p < 0.001), physical activity reduction (p = 0.002), alcohol consumption changes (p = 0.003), and at least one relative lost to COVID-19 (p < 0.001) independently predicted higher CPDI Scores. Male sex (p < 0.001), age ≥ 35 years (p < 0.001), higher educational level (p = 0.002), night sleep >7 hours (p = 0.002), and being physically active (p = 0.018) were identified as protective factors.

LIMITATIONS

Cross-sectional design and the regional recruitment area limit the generalizability of results.

CONCLUSIONS

Mean CPDI values were above the threshold for medium grade peritraumatic distress, with greater CPDI Scores in subjects who tested positive for SARS-CoV-2, compared to family members or caregivers without a clear indication to undergo the swab. Specific demographics, physical and mental health events could help in identifying individuals at greater risk of COVID-19 related peritraumatic distress that may benefit from early treatment.

Cross-cultural measurement invariance of the fear of COVID-19 scale in three Portuguese-speaking countries

This study evaluated the measurement invariance of the Portuguese version of the Fear of COVID-19 Scale (FCV-19S) across three countries: Brazil (South America), Mozambique (East Africa), and Portugal (Southwest Europe). A total of 8694 participants were recruited through convenience sampling (7430 Brazilians, 387 Mozambicans, and 877 Portuguese adults). The unidimensional structure of the FCV-19S fitted well with each country’s data. Multigroup confirmatory factor analysis showed that the FCV-19S was partially invariant across countries and fully invariant across gender and age groups, thus providing a solid basis for cross-group comparisons. Structural invariance tests revealed different levels of fear across countries and genders but not across age groups.

Knowledge, Attitudes, and Practices Toward Coronavirus and Associated Anxiety Symptoms Among University Students: A Cross-Sectional Study During the Early Stages of the COVID-19 Pandemic in Bangladesh

BACKGROUND

University students' knowledge, attitude, and practice (KAP) toward COVID-19 are vital to prevent the spread of the virus, especially in the context of developing countries. Consequently, the present study aimed to determine the KAP levels of university students and associated anxiety during the earlier stage of the pandemic in Bangladesh.

METHODS

A cross-sectional, online study with 544 university students was conducted during April 17-May 1, 2020. The questionnaire incorporated several KAP-related test items aligned with the World Health Organization (WHO) guidelines. Anxiety was measured with the 2-item Generalized Anxiety Disorder scale (GAD-2). Multivariable logistic regression analysis was performed to determine the association between KAP levels and anxiety adjusting for sociodemographic variables. Subgroup analyses included rerunning models stratified by gender and quarantine status.

RESULTS

Approximately 50% of students showed high levels of knowledge about COVID-19 guidelines, 59% reported behavioral practices that aligned with COVID-19 guidelines, and 39% had negative attitudes toward COVID-19 guidelines. Attitudes differed by anxiety (χ² = 23.55, p < 0.001); specifically, negative attitudes were associated with higher anxiety (OR: 2.40, 95% CI = 1.66-3.46, p < 0.001). Associations were significant for male (OR = 2.36; 95% CI = 1.45-3.84, p < 0.001) and female (OR = 2.45; 95% CI = 1.3-4.34; p < 0.001) students. Stratified analyses found non-quarantined students with negative attitudes had three times the chance of experiencing anxiety (OR = 3.14, 95% CI: 1.98-4.98, p < 0.001). Non-quarantined students with low levels of knowledge had half the chance of developing anxiety (OR = 0.49, 95% CI: 0.31-0.78, p < 0.01).

CONCLUSION

Based on these findings, it is recommended that university authorities continue to prioritize proactive and effective measures to develop higher levels of knowledge, more positive attitudes and better behavioral practices regarding COVID-19 for the mental health of their students.

The Psychological Impact of the COVID-19 Pandemic in Remote Learning in Higher Education

Stressful events can cause a significant impact on education; however, it is not yet clear how the interplay between anxiety, work, and social dysfunction relates to learning impairments. In this study, we investigated the impact of the COVID-19 pandemic on students’ learning and mental health. This study was conducted during four modules of a remote Psychopharmacology course between 5 October and 20 December 2020. We collected data from 28 Psychology undergraduate students at the University of São Paulo, Brazil. We used pre- and post-test multiple-choice questions to obtain a quantitative measure of learning. Students completed an online survey to report demographic information, functional impairment (Work and Social Adjustment scale; WSAS), generalized anxiety (Generalized Anxiety Disorder scale; GAD-7), coronavirus anxiety (Brazilian adapted version of the Coronavirus Anxiety Scale; CAS-BR), and self-perception with the remote lectures’ methodology. In our sample, 42.9% of respondents experienced symptoms of generalized anxiety disorders (GAD-7 ≥ 15), and 53.6% had moderate to severe functional impairment (WSAS > 20). We also observed an overlapping profile of highly anxious and dysfunctional students. A chi-square test of independence revealed a relation between pairs of multiple-choice questions answers and GAD-7 scores, indicating that less anxious students were more likely to perform better in pairs of pre- and post-tests. Intriguingly, the correlational analysis suggested that students with moderate to severe functional impairment (WSAS scores > 20) were less likely to change from an incorrect to a correct answer to pairs of pre- and post-tests. This data suggests that psychological distress and anxiety states might influence students’ ability to coordinate social and work activities and performance during remote learning. Although this study evaluated a small sample of students, our data highlights the importance of investigating anxiety and functional impairment measures as part of the remote-learning curriculum.

Systematic Review and Meta-Analysis of Fear of COVID-19

Background: Due to lack of preparedness of health systems, fast spread of the new virus, high mortality rates, and lack of a definite treatment, the outbreak of Coronavirus disease (COVID-19) led to high levels of fear and anxiety in different populations. In addition, isolation, mental disorders, and limitations in social interactions as a result of lockdown and travel ban increased the fear of the new coronavirus. Methods: International databases, including Scopus, PubMed, Web of Science, and Google scholar, were searched without any time limitation, and all observational studies published in English reporting the mean of fear of COVID-19 based on the Fear of COVID-19 scale (FCV-19S) were included in the analysis. Methodological quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Random effects model, subgroup analysis, and meta-regression analysis were used to analyze the data. Heterogeneity across studies was examined using Cochran's Q test and I ² statistic. All the statistical analyses were conducted using R software v4.0.3. Results: A total of 44 articles with a sample size of 52,462 were reviewed. A pooled mean of 18.57 was found for fear of COVID-19. The mean of fear of COVID-19 was higher in women than in men (20.67 vs. 18.21). The highest and lowest means of fear of COVID-19 had been found in Asia (18.36) and Australia (17.43) based on continent, and in hospital staff (19.51) and college students (17.95) based on target population, respectively. In addition, the highest and lowest means of fear of COVID-19 were related to items #1 and #3 of the scale, respectively. According to the results of meta-regression analysis, there was no significant association between the mean of fear of COVID-19 and sample size and participants' age. In addition, publication error was not significant (P = 0.721). Conclusion: The mean of fear of COVID-19 was high around the world; therefore, it seems necessary to pay more attention to the negative effects of the COVID-19 pandemic on mental health.

COVID-19 Peritraumatic Distress as a Function of Age and Gender in a Spanish Sample

The sudden outbreak of the COVID-19 pandemic has profoundly altered the daily lives of the population with dramatic effects caused not only by the health risks of the coronavirus, but also by its psychological and social impact in large sectors of the worldwide population. The present study adapted the COVID-19 Peritraumatic Distress Index (CPDI) to the Spanish population, and 1094 Spanish adults (mean age 52.55 years, 241 males) completed the Spanish version in a cross-sectional online survey. To analyze the factorial structure and reliability of the CPDI, we performed an exploratory factor analysis (EFA) followed by a confirmatory factor analysis (CFA) on the Spanish sample. The effects of gender and age on the degree of distress were analyzed using the factorial scores of the CPDI as the dependent variables. Results showed that, after rotation, the first factor (Stresssymptoms) accounted for 35% of the total variance and the second factor (COVID-19 information) for 15%. Around 25% (n = 279) of the participants experienced mild to moderate distress symptoms, 16% (n = 179) severe distress, and about 58% (n = 636) showed no distress symptoms. Women experienced more distress than men (p<0.01), and distress decreased with age (p<0.01). We conclude that the CPDI seems a promising screening tool for the rapid detection of potential peritraumatic stress caused by the COVID-19 pandemic.

Validation of the FCV-19 Scale and Assessment of Fear of COVID-19 in the Population of Mozambique, East Africa

PURPOSE

This study aimed to validate the Portuguese version of the Fear of COVID-19 Scale (FCV-19S) and investigate its association with sociodemographic and pandemic-related variables in the population of Mozambique.

PARTICIPANTS AND METHODS

A cross-sectional online survey recruited 387 Mozambicans aged 18 to 70 years. The psychometric properties of the Portuguese version of the FCV-19S were evaluated using confirmatory factor analysis and Rash analysis. Additionally, the association of the FCV-19S with sociodemographic and pandemic-related variables was investigated using the two-sample t-test, one-way analysis of variance, and logistic regression.

RESULTS

The unidimensional factor structure of the Portuguese version of the FCV-19S was confirmed, and the scale showed good internal consistency reliability. The FCV-19S properties tested from the Rasch analysis were satisfactory. Women and those with lower education levels had higher scores of fear. Moreover, significantly higher levels of fear were observed among those being in an at-risk group for COVID-19, having family members or friends diagnosed or with death confirmed by COVID-19, and not being confident that they would receive adequate care from the public health services in case of COVID-19 infection.

CONCLUSION

The Portuguese version of FCV-19S has strong psychometric properties and can be used to assess the fear of COVID-19 in the Portuguese-speaking population of Mozambique. As the adverse impacts of the COVID-19 pandemic on mental health represents a challenge to clinical psychiatry, and information on mental health in African countries is still scarce, our findings may assist in the planning of public mental health policies, aimed mainly at specific segments of the population, such as women and people in extreme poverty.

The relationship between fear of COVID-19 and mental health problems: A meta-analysis

The coronavirus disease-2019 (COVID-19) pandemic has caused physical and mental health problems among individuals around the world. Recent studies have reported various mental health problems among both health-care workers and the general population. In this meta-analysis, evidence is provided concerning the relationships between the Fear of COVID-19 Scale. The fear of COVID-19 scale: Development and initial validation. International Journal of Mental Health and Addiction] - the most widely used, translated, and validated scale - and mental health problems including, anxiety, stress, depression, distress, post-traumatic stress, and sleep problems among the general population. We searched for relevant studies on Web of Science, Google Scholar, PubMed, and ERIC databases and conducted a meta-analysis with selected studies in accordance with the inclusion criteria. A total of 33 studies met the inclusion criteria. The results demonstrated that fear of COVID-19 was strongly related to anxiety (r = 0.55, n = 19,578), traumatic stress (r = 0.54, n = 8,752), distress (r = 0.53, n = 11,785) as well as being moderately related to stress (r = 0.47, n = 4,340) and depression (r = 0.38, n = 23,835). The correlation with insomnia (r = 0.27, n = 2,114) was modest. These results demonstrate that fear of COVID-19 is associated a wide range of mental health problems among the general population.

Psychological distress among Italians during the 2019 coronavirus disease (COVID-19) quarantine

BACKGROUND

Quarantine as a preventive action to reduce people's exposure to a contagious disease has substantial psychological impact. We aimed to collect information on psychologically distressing experiences of Italians living in quarantine during the COVID-19 pandemic.

METHODS

From 6 to 20 April 2020 participants filled out an online questionnaire. Demographic and physical symptoms data from the prior 14 days of quarantine were collected. Psychological impact of quarantine was assessed by the COVID-19 Peritraumatic Distress Index (CPDI).

RESULTS

In all, 20,158 participants completed the online survey. Of these, 11,910 (59.1%) were from Lombardy, the region with 37.7% of positive cases identified during the survey period. 30.1% of responders were male. About half (55.9%) of responders were 18-50 years old, 54.3% had a tertiary level of education, 69.5% were workers, 84.1% were living in houses with ≥3 rooms, and 13.7% were living alone. 9.7% had had contact with COVID-19 positive people. Of all responders, 9978 (48.6%) reported a psychological impact, 8897 (43.4%) of whom reported mild or moderate and 1081 (5.2%) severe psychological impact. The multivariate analysis, after adjustments, showed that an increasing CPDI score was associated with gender (female), first-second educational level, being unemployed, living in a ≤2 room house, having had new health problems during the previous 14 days, and not having been out of the house in the previous week. Concerning the type of psychological distress, 2003 responders (9.9%) reported moderate to severe depressive symptoms, 1131 (5.5%) moderate to severe anxiety symptoms, and 802 (3.9%) moderate to severe physical symptoms. A positive correlation was found between responder rate (per 10.000 residents) and positive COVID-19 cases (per 10.000 residents) by region (r_s = + 0.83, p = < 0.0001), and between responder rate and region latitude (r_s = + 0.91, p = < 0.0001), with a greater response rate in the north. Considering Lombardy Region responders, a negative correlation between CPDI score and distance from place of residence to the red zone (Nembro-Alzano) was found. Higher prevalence of psychological distress was found up to 25 km away from the red zone and, in particular, severe distress up to 15 km.

CONCLUSIONS

Policy makers and mental health professionals should be aware of quarantine's adverse mental health consequences. Factors influencing the success of quarantine and infection control practices for both disease containment and community recovery should be identified and additional support to vulnerable persons at increased risk of adverse psychological and social consequences of quarantine should be guaranteed.

Resilience, Hope, and Subjective Happiness Among the Turkish Population: Fear of COVID-19 as a Mediator

Psychology deals with not only mental disorders but also psychological strengths within individuals. Psychological strengths will play an important role in struggling with the global novel coronavirus 2019 (COVID-19) pandemic. The present study tested a model concerning the relationship between resilience, hope, and subjective happiness using structural equation modeling to identify the mediating role of fear of COVID-19. A cross-sectional survey was conducted among a convenience sample of 971 Turkish individuals (aged 18 to 74 years) from 75 of 81 cities in Turkey. The survey included the Subjective Happiness Scale, Fear of COVID-19 Scale, Brief Resilience Scale, and the Dispositional Hope Scale, and data were analyzed using structural equation modeling (SEM). The SEM demonstrated an association between resilience-hope and subjective happiness was mediated by fear of COVID-19 (CMIN/df = 2.664, CFI = 0.994, NFI = 0.984, TLI = 0.984, GFI = 0.994, RMSEA = 0.044, SRMR = 0.024, AIC = 81.334, ECVI = 0.084). Resilience had a direct effect and an indirect effect on subjective happiness via fear of COVID-19. Hope also had a direct effect and an indirect effect on subjective happiness via fear of COVID-19. Consequently, in the fight against COVID-19, individuals who are resistant to stress and have a belief that they can find a way to cope can help prevent the fear of COVID-19 and so enhance good mental health.