THE ASSOCIATION OF GRIEF WITH MENTAL HEALTH AND THE ROLE OF LONELINESS DURING THE COVID-19 PANDEMIC

In this study, we aimed to gauge the effects of the process of bereavement on mental health in the context of the COVID-19 pandemic and to explore the mediating role of loneliness on the relationship between grief and mental health alterations by surveying a representative sample of 2000 Spanish adults interviewed by phone during the pandemic (February-March 2021). There has also been an increase in death rates from other causes during the pandemic, sometimes attributed to treatment for other life-threatening diseases being postponed or health care visits being avoided to prevent infection (Stroebe & Schut, 2021). By contrast, a group of bereaved (10 % after natural death and 50% after death due to unnatural causes) experience intense grief that persists longer than what would normally be expected (Djelantik et al., 2020), characterized by an enduring and overwhelming sense of yearning or preoccupation with the deceased and significant emotional suffering that causes functional impairment in daily life. Some authors have stated that researchers studying mental health in relation to the pandemic should include grief as a potential contributory factor (Bertuccio & Runion, 2020).

The role of social support, detachment, and depressive and anxiety symptoms in suicidal thoughts and behaviours during the Covid-19 lockdown: Potential pathways.

During the COVID-19 pandemic, anxiety and depressive symptoms, as well as problems related to social relationships, such as available social support and feelings of detachment from others, have worsened. These factors are strongly associated with suicidal thoughts and behaviours (STB). The effects of feelings of detachment on mental health and on STB have been scarcely studied, together with the relation that it may have with available social support. Therefore, the aim of the present study was to assess potential pathways connecting these conditions. A nationally representative sample of Spanish adults (N = 3305) was interviewed during the COVID-19 pandemic (June 2020). STB, social support, and depressive and anxiety symptoms were measured with the C-SSRS (modified version), OSSS-3, PHQ-8, and GAD-7 scales, respectively. Multivariable logistic regression models and mediation analyses were performed. Social support and some of its components (i.e., social network size and relations of reciprocity) were associated with lower odds of STB. Detachment significantly mediated (22% to 25%) these associations. Symptoms of emotional disorders significantly mediated the association between social support components (29% to 38%) - but not neighbourhood support - with STB, as well as the association between detachment and higher odds of STB (47% to 57%). In both cases, depressive symptoms were slightly stronger mediating factors when compared to anxiety symptoms. Our findings suggest that interventions aimed at lowering depressive and anxiety symptoms, and STB should provide social support and help tackle the feeling of detachment in a complementary way.

The Association Between Substance Use Disorder and Depression During the COVID-19 Lockdown in Spain and the Moderating Role of Social Support: a Cross-Sectional Study.

Substance use disorder is on the rise; it has increased massively during the COVID-19 lockdown and has been found as a risk factor for depressive symptoms and major depressive disorder. Less is known about the hypothetical moderating effect of social support in that association. Three thousand five hundred Spanish adults were interviewed by phone during the COVID-19 lockdown (May-June 2020). The 8-item Patient Health Questionnaire Depression Scale (PHQ-8) was used to measure the symptoms of depression. The CAGE Adapted to Include Drugs (CAGE-AID) questionnaire was used to assess substance use disorder during the previous month. Social support was measured through the Oslo Social Support Scale (OSSS-3). Regression models were constructed to assess factors related to depressive symptoms. People with substance use disorder (alcohol and drugs) showed considerable high levels of depressive symptoms, particularly among those with low levels of social support, which reported levels above major depressive disorder cut-off.

Cost-utility analysis of the UPRIGHT intervention promoting resilience in adolescents.

BACKGROUND: As mental health in adulthood is related to mental status during adolescence, school-based interventions have been proposed to improve resilience. The objective of this study was to build a simulation model representing the natural history of mental disorders in childhood, adolescence and youth to estimate the cost-effectiveness of the UPRIGHT school-based intervention in promoting resilience and mental health in adolescence. METHODS: We built a discrete event simulation model fed with real-world data (cumulative incidence disaggregated into eight clusters) from the Basque Health Service database (609,381 individuals) to calculate utilities (quality-adjusted life years [QALYs]) and costs for the general population in two scenarios (base case and intervention). The model translated changes in the wellbeing of adolescents into different risks of mental illnesses for a time horizon of 30 years. RESULTS: The number of cases of anxiety was estimated to fall by 5,125 or 9,592 and those of depression by 1,269 and 2,165 if the effect of the intervention lasted 2 or 5 years respectively. From a healthcare system perspective, the intervention was cost-effective for all cases considered with incremental cost-utility ratios always lower than €10,000/QALY and dominant for some subgroups. The intervention was always dominant when including indirect and non-medical costs (societal perspective). CONCLUSIONS: Although the primary analysis of the trial did not did not detect significant differences, the UPRIGHT intervention promoting positive mental health was dominant in the economic evaluation from the societal perspective. Promoting resilience was more cost-effective in the most deprived group. Despite a lack of information about the spillover effect in some sectors, the economic evaluation framework developed principally for pharmacoeconomics can be applied to interventions to promote resilience in adolescents. As prevention of mental health disorders is even more necessary in the post-coronavirus disease-19 era, such evaluation is essential to assess whether investment in mental health promotion would be good value for money by avoiding costs for healthcare providers and other stakeholders.

Mental health inequalities in times of crisis: evolution between 2005 and 2021 among the Spanish salaried population.

BACKGROUND: Studying the working population's mental health in times of crisis (such as the 2008 recession or the COVID-19 pandemic) is very relevant. This study aims to assess the prevalence of poor mental health among the Spanish salaried population, according to the labour market inequality axes (2005-2021). METHODS: Repeated cross-sectional study by comparing different surveys from 2005, 2010, 2016 and 2021 on workers residing in Spain who had been working in a salaried job during the week preceding the survey. n=7197 (2005), n=4985 (2010), n=1807 (2016) and n=18 870 (2021). OUTCOME VARIABLE: poor mental health (Mental Health Inventory of the 36-item Short Form Health Survey scale). Explanatory variables: gender, age, occupational class and type of contract. Prevalence of poor mental health was estimated for each year by means of logistic regression models with robust clustered SEs, stratifying by the explanatory variables. Additionally, prevalence ratios (PR) were estimated by means of robust Poisson regression models to assess differences between the explanatory variables' categories. All analyses were weighted to address unrepresentativeness. RESULTS: Poor mental health significantly increased in 2021 (55.92%), compared with the previous years of study (15%-17.72%). Additionally, pattern changes were identified on inequality axes in 2021, with better mental health status among older workers (oldest group PR: 0.76; 95% CI 0.71 to 0.8) and permanent workers (PR: 0.9; 95% CI 0.85 to 0.94). CONCLUSION: This study shows a steep worsening of mental health among the salaried population in 2021 compared with previous periods. In 2021, health inequalities have apparently narrowed, although not by improving the disadvantaged groups' mental health but by worsening the typically advantaged groups' mental health.

Mood disorders in higher education in Flanders during the 2nd and 3rd COVID-19 wave: Prevalence and help-seeking: Findings from the Flemish College Surveys (FLeCS).

To examine the prevalence of 12-month mood disorders and receipt of mental health treatment among a volunteer sample of higher education students during the 2nd and 3rd COVID-19 wave in the Flanders region. Web-based self-report surveys were obtained from 9101 students in higher education in the Flemish College Surveys (FLeCS) in Flanders, Belgium. As part of the World Health Organization's World Mental Health-International College Student Initiative, we screened for 12-month mood disorders (major depressive episode (MDE), mania/hypomania), and service use. We used poststratification weights to generate population-representative data on key socio-demographic characteristics. 50.6% of the respondents screened positive for 12-month mood disorders (46.8% MDE, of which 22.9% with very severe impact). Use of services was very low, with estimates of 35.4% for MDE, 31.7% for mania, and 25.5% for hypomania. Even among students with very severe disorders, treatment rates were never higher than 48.3%. Most common barriers for not using services were: the preference to handle the problem alone (83.4%) and not knowing where to seek professional help (79.8%). We found a high unmet need for mood problems among college students; though caution is needed in interpreting these findings given the volunteer nature of the sample. A reallocation of treatment resources for higher education students should be considered, particulary services that focus on innovative, low-threshold, and scalable interventions.

The association of age with depression, anxiety, and posttraumatic stress symptoms during the COVID-19 pandemic in Spain: the role of loneliness and pre-pandemic mental disorder.

OBJECTIVE: Older adults may be at lower risk of common mental disorders than younger adults during the COVID-19 pandemic. Previous researchers have shown differences by age in psychosocial well-being during the pandemic and have highlighted the moderating effect of pre-pandemic mental disorders on that association. In this line, we examined the association of age with self-reported symptoms of loneliness, depression, anxiety, and posttraumatic stress, as well as potential roles of loneliness symptoms and pre-pandemic mental disorders on the association between age and mental disorder symptoms. METHODS: Cross-sectional data of 2,000 Spanish adults interviewed by phone during the COVID-19 pandemic (February-March, 2021) were analyzed. Depression, anxiety, and posttraumatic stress were measured with the 8-item Patient Health Questionnaire, the 7-item GAD, and the 4-item checklist for Diagnostic and Statistical Manual of Mental Disorders (DSM-5), respectively. Loneliness was measured with the 3-item UCLA loneliness scale. Several regression models were constructed to assess factors related to loneliness and mental disorders. RESULTS: According to cut-off points used, 12.4% of participants revealed depression, 11.9% anxiety, and 11.6% posttraumatic stress. Age was negatively related with mental disorder symptoms and loneliness. Loneliness was associated with higher levels of mental disorder symptoms. This association was stronger in younger adults without pre-pandemic mental disorders and in older adults without them. The association between age and loneliness was stronger in those with pre-pandemic mental disorders. Loneliness mediated the association of age with mental disorder symptoms. CONCLUSIONS: Interventions focused on loneliness could alleviate the impact of the COVID-19 pandemic on mental health.

Suicidal Ideation and Behavior Among Mexican University Students Before and During the COVID-19 Pandemic.

OBJECTIVE: The COVID-19 pandemic has affected the mental health of populations around the world, but few longitudinal studies of its impact on suicidal thoughts and behaviors have been published especially from low- and middle-income countries. METHODS: This is a prospective cohort study of 1,385 first-year students from 5 Universities in Mexico followed-up for 1 year. We report 1-year cumulative incidence of suicidal thoughts and behaviors before (September 19, 2019-March 29, 2020) and during the COVID-19 period (March 30, 2020-June 30, 2020), focusing on those in the COVID-19 period with risk conditions and positive coping strategies during the pandemic. RESULTS: There was an increase in the incidence of suicidal ideation during the COVID-19 period compared to the pre-COVID-19 period (RR 1.65, 95%CI 1.08-2.50). This increase was mostly found among students with heightened sense of vulnerability (RR 1.95), any poor coping behavior (RR 2.40) and a prior mental disorder (RR 2.41). While we found no evidence of an increased risk of suicidal planning or attempts, there was evidence that those without lifetime mental health disorders were at greater risk of suicidal plans than those with these disorders especially if they had poor coping strategies (RR 3.14). CONCLUSION: In the short term, how students deal with the pandemic, being at high risk and having poor coping behavior, increased the new occurrence of suicidal thoughts and behaviors. Studies with longer follow-up and interventions to reduce or enhance these behaviors are needed.HIGHLIGHTSSuicidal ideation increased during the COVID-19 periodThose with heightened sense of vulnerability and poor coping were more affectedStudies with longer follow-up are needed.

Mental health symptoms 1 year after the COVID-19 outbreak in Spain: The role of pre-existing mental disorders and their type.

BACKGROUND: The type of pre-existing disorder might determine changes in mental health symptoms (i.e., anxiety, depression) during the COVID-19 pandemic and influence the effect of psychological factors (e.g., social support, resilience, stress) on such symptoms. METHODS: Longitudinal data from two assessments (June-2020 and February/March-2021) collected through telephone interviews (Spanish general population) were analysed. Outcome variables included anxiety (GAD-7) and depressive symptoms (PHQ-8). Psychological factors included COVID-perceived stress (adapted COVID-perceived risk scale), social support (OSSS-3), and resilience (CD-RISC). Pre-existing mental conditions (3 groups: mood, anxiety, and comorbid depression+anxiety) were assessed using the CIDI checklist. Changes in anxiety and depressive symptoms between baseline and follow-up were assessed with the paired samples Wilcoxon test. Tobit regression and interaction models were conducted to test associations between psychological factors and these symptoms in follow-up. RESULTS: Final sample included 1942 participants (mean age 49.6 yrs., ±16.7; 51.7 % females). Anxiety symptoms increased in all groups except for those with pre-existing mood conditions. Depressive symptoms only increased in those without pre-existing mental disorders and in those with pre-existing anxiety. Higher baseline resilience, increases in social support, and decreases in COVID-perceived stress were associated with lower anxiety and depressive symptoms. The type of pre-existing mental disorder did not modify these associations. LIMITATIONS: Lack of pre-pandemic data and the limited number of pre-existing mental conditions. CONCLUSIONS: Having pre-pandemic mental disorders is associated with different patterns of anxiety and depressive symptoms during the pandemic. COVID-related stress, social support, and resilience are key factors in improving mental health regardless of the mental diagnosis.

Psychological impact of the COVID-19 pandemic on primary care workers: a cross-sectional study.

BACKGROUND: The COVID-19 pandemic has had a major impact on the mental health of healthcare workers, yet studies in primary care workers are scarce. AIM: To investigate the prevalence of and associated factors for psychological distress in primary care workers during the first COVID-19 outbreak. DESIGN AND SETTING: This was a multicentre, cross-sectional, web-based survey conducted in primary healthcare workers in Spain, between May and September 2020. METHOD: Healthcare workers were invited to complete a survey to evaluate sociodemographic and work-related characteristics, COVID-19 infection status, exposure to patients with COVID-19, and resilience (using the Connor-Davidson Resilience Scale), in addition to being screened for common mental disorders (depression, anxiety disorders, post-traumatic stress disorder, panic attacks, and substance use disorder). Positive screening for any of these disorders was analysed globally using the term 'any current mental disorder'. RESULTS: A total of 2928 primary care professionals participated in the survey. Of them, 43.7% (95% confidence interval [CI] = 41.9 to 45.4) tested positive for a current mental disorder. Female sex (odds ratio [OR] 1.61, 95% CI = 1.25 to 2.06), having previous mental disorders (OR 2.58, 95% CI = 2.15 to 3.10), greater occupational exposure to patients with COVID-19 (OR 2.63, 95% CI = 1.98 to 3.51), having children or dependents (OR 1.35, 95% CI = 1.04 to 1.76 and OR 1.59, 95% CI = 1.20 to 2.11, respectively), or having an administrative job (OR 2.24, 95% CI = 1.66 to 3.03) were associated with a higher risk of any current mental disorder. Personal resilience was shown to be a protective factor. CONCLUSION: Almost half of primary care workers showed significant psychological distress. Strategies to support the mental health of primary care workers are necessary, including designing psychological support and resilience-building interventions based on risk factors identified.

Neuropsychological Symptom Identification and Classification in the Hospitalized COVID-19 Patients During the First Wave of the Pandemic in a Front-Line Spanish Tertiary Hospital.

Studies specifically designed to determine the profile of psychiatric symptoms among COVID-19 patients are limited and based on case series, self-report questionnaires, and surveys. The objective of the study was to identify and classify the neuropsychological symptoms of hospitalized COVID-19 patients during the first wave of the pandemic in one of the most important front-line tertiary hospitals from Spain, and to analyze its correlation with diagnosed mental disorders, as well as to explore potential risk factors associated with mental health problems. This observational, cohort study involved data from COVID-19 patients at the University Hospital 12 de Octubre (Madrid, Spain) from February to May 2020. First, patients underwent a semistructured phone interview (screening phase), based on the Mini International Neuropsychiatric Interview (MINI). Then the confirmation of the diagnosis (confirmation phase) was performed in patients who reported a mental disorder development or worsening. A factorial analysis was performed to identify groups of symptoms. A tetrachoric matrix was created, and factorial analysis, by a principal component analysis, was employed upon it. Factors showing values >1.0 were selected, and a varimax rotation was applied to these factors. Symptoms most frequently identified in patients were anosmia/ageusia (54.6%), cognitive complaints (50.3%), worry/nervousness (43.8%), slowing down (36.2%), and sadness (35.4%). Four factors were identified after the screening phase. The first ("anxiety/depression") and second ("executive dysfunction") factors explained 45.4 and 11.5% of the variance, respectively. Women, age between 50 and 60 years, duration in the hospital (more than 13 days), and psychiatric history showed significant higher levels (number of symptoms) in the factors. This study reports the factor structure of the psychiatric symptoms developed by patients with a confirmed diagnosis of SARS-CoV2 during the first wave of the COVID-19. Three item domains (anxiety, depression, and posttraumatic stress disorder symptoms) were loaded together on one factor, whereas sleep disturbance stood up as a separate factor. Interestingly, the item anosmia/ageusia was not captured by any factor. In conclusion, an increase in neuropsychiatric morbidity is expected in the upcoming months and years. Therefore, screening for early symptoms is the first step to prevent mental health problems associated with this pandemic.

Nursing Home Workers' Mental Health During the COVID-19 Pandemic in France.

OBJECTIVES: The present study sought to examine mental health problems among nursing home workers in the context of the COVID-19 pandemic, to investigate COVID-19-related fears, and to identify prepandemic factors associated with current mental health issues. DESIGN: A cross-sectional, online survey was used. SETTING AND PARTICIPANTS: All employees among 6 nursing homes in southwestern France (N = 455) were solicited between November, 2020 and June, 2021. METHODS: The survey instrument was developed within the World Mental Health consortium to screen for COVID-related fears, probable generalized anxiety, panic attacks, depression, posttraumatic stress and substance use disorders in the past 30 days. RESULTS: The survey was completed by 127 workers (89.0% female, mean age = 43.42 years, SD = 11.29), yielding a 28.5% response rate. Overall, 48.03% reported experiencing fear of infecting others at least most of the time. One in 8 (14.96%) indicated that close others feared being infected by them. One-third of the sample (34.65%) met criteria for at least 1 probable current mental disorder. Panic attacks (22.05%) were the most frequently reported mental health problem, followed by depression (16.54%). In multivariate analyses, the only factor associated with having a current probable mental disorder was the presence of any prepandemic mental health problem (adjusted odds ratio 4.76, 95% CI 2.08-10.89). Type of employment contract, full-time status, and medical vs nonmedical staff status were not significantly associated with mental health status. CONCLUSIONS AND IMPLICATIONS: The study reveals that one-third of nursing home workers in the sample report current probable mental disorders, and these were largely associated with prepandemic mental health status. Screening for common mental health problems and facilitating access to appropriate care should be prioritized in nursing homes.

The Mental Health of Employees with Job Loss and Income Loss during the COVID-19 Pandemic: The Mediating Role of Perceived Financial Stress.

The COVID-19 outbreak, which was followed by home confinement, is expected to have had profound negative impact on the mental health of people. Associated factors, such as losing jobs and income, can be expected to lead to an increased risk of suffering from psychopathological problems. Therefore, this study was aimed at researching the associations of job and income loss with mental health, as well as the possible mediating role of perceived financial stress during the COVID-19 outbreak. The sample included 2381 Spanish workers who were interviewed right after the first COVID-19 lockdown. Measures were taken for generalized anxiety disorder, panic attacks, depression, post-traumatic stress disorder, substance abuse, suicidal thoughts and behaviors, working conditions, sociodemographic variables, and perceived financial stress. Logistic regression models were calculated with psychological variables as outcomes, and with job loss and income loss as predictors. Mediation analyses were performed by adding the financial threat as a mediator. Nineteen point six percent and 33.9% of participants reported having lost their jobs and incomes due to the pandemic, respectively. Only income loss was related to a higher risk of suffering from depression and panic attacks. When adding financial stress as a mediator, the indirect effects of job and income loss on the mental health measures were found to be significant, therefore indicating mediation. These findings pinpoint the vulnerability of this population, and highlight the need for interventional and preventive programs targeting mental health in economic crisis scenarios, such as the current one. They also highlight the importance of implementing social and income policies during the COVID-19 pandemic to prevent mental health problems.

The impact of COVID-related perceived stress and social support on generalized anxiety and major depressive disorders: moderating effects of pre-pandemic mental disorders.

BACKGROUND: We assessed the moderating effect of pre-pandemic mental disorders on the association of COVID-related perceived stress and social support with mental health. METHODS: A nationally representative sample of 3500 Spanish adults was interviewed in June 2020 (mean age 49.25 years, ± 15.64; 51.50% females). Mental health included Generalized Anxiety Disorders (GAD; GAD-7, cut-off point of ≥ 10), Major Depressive Disorders (MDD; PHQ-8, cut-off point of ≥ 10) and the comorbid form (those screening positive for GAD and MDD). COVID-related stress was assessed using an adapted version of the Peri Life Events Scale, and social support using the Oslo Social Support Scale. Logistic regression models were used to assess if COVID-related stress and social support were related to mental health outcomes and interactions were conducted to examine whether these relationships differed according to the presence of pre-pandemic mental disorders. RESULTS: Higher COVID-related stress was associated with a higher risk of lower mental health. The association between COVID-related stress with GAD and MDD was significantly moderated by pre-pandemic mental disorders, except for comorbid GAD + MDD. Higher levels of social support were linked to better mental health. Only the association between social support and GAD was significantly moderated by pre-pandemic mental disorders. That is, for those without pre-pandemic mental disorders, higher levels of social support decreased the odds of GAD, while minor decreases were observed in those with pre-pandemic mental disorders. CONCLUSIONS: The impact of COVID-related stress and social support on specific indicators of mental health may vary depending on the existence of a previous mental disorder.

The association of detachment with affective disorder symptoms during the COVID-19 lockdown: The role of living situation and social support.

INTRODUCTION: There is growing concern about the effect of lockdown and social distancing on mental health. Subjective feelings related to social relationships such as detachment have shown a strong effect on mental health, whereas objective factors might have a moderating role in that association. OBJECTIVE: To investigate whether social support and living situation have a moderating effect on the association between detachment and affective disorder symptoms during the COVID-19 lockdown. METHODS: 3,305 Spanish adults were interviewed by phone at the end of the COVID-19 lockdown (May-June 2020). Detachment during confinement was assessed with a single-item frequency question. Anxiety symptoms were measured through GAD-7, depressive symptoms through PHQ-9, and social support through the Oslo Social Support Scale (OSSS). Associations with anxiety and depressive symptoms were tested through Tobit regression models. Interactions of detachment with living situation and social support were tested as independent variables. RESULTS: People living alone showed significantly lower levels of anxiety whereas people living with another (but not as a couple) showed higher levels of depression. Detachment was strongly associated with both affective disorders. Social support had a statistically significant moderating effect on that association. Those with a low level of social support and a high level of detachment reported means of depression and anxiety above major depression (10.5 CI 95% 9.6, 11.4 at OSSS=10) and generalized anxiety disorders (10.1 CI 95% 9.2, 11.0 at OSSS=9) cut offs CONCLUSION: Interventions centered on improving social support could alleviate feelings of detachment and prevent affective disorders during lockdowns.

Study Protocol-Coping With the Pandemics: What Works Best to Reduce Anxiety and Depressive Symptoms.

Background: The coronavirus disease 2019 (COVID-19) pandemic and lockdown might increase anxiety and depressive symptoms in most individuals. Health bodies recommend several coping behaviors to protect against such symptoms, but evidence on the relationship between these behaviors and symptoms mostly comes from cross-sectional studies in convenience samples. We will conduct a prospective longitudinal study of the associations between coping behaviors and subsequent anxiety and depressive symptoms during the COVID-19 pandemic in a representative sample of the Spanish general adult population. Methods: We will recruit 1,000 adult participants from all autonomous communities of Spain and with sex, age, and urbanicity distributions similar to those of their populations and assess anxiety and depressive symptoms and coping behaviors using fortnightly questionnaires and real-time methods (ecological momentary assessments) for 1 year. The fortnightly questionnaires will inquire about anxiety and depressive symptoms [General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9)] and the frequency of 10 potential coping behaviors (e.g., follow a routine) during the past 2 weeks. In addition, we will collect several variables that could confound or moderate these associations. These will include subjective well-being [International Positive and Negative Affect Schedule Short Form (I-PANAS-SF) and Satisfaction with Life Scale (SWLS)], obsessive-compulsive symptoms [Obsessive Compulsive Inventory-Revised (OCI-R)], personality and emotional intelligence [International Personality Item Pool (IPIP) and Trait Emotional Intelligence Questionnaire Short Form (TEIQue-SF)], sociodemographic factors (e.g., work status, housing-built environment), and COVID-19 pandemic-related variables (e.g., hospitalizations or limitations in social gatherings). Finally, to analyze the primary relationship between coping behaviors and subsequent anxiety and depressive symptoms, we will use autoregressive moving average (ARMA) models. Discussion: Based on the study results, we will develop evidence-based, clear, and specific recommendations on coping behaviors during the COVID-19 pandemic and lockdown. Such suggestions might eventually help health bodies or individuals to manage current or future pandemics.

Mental health impact of the first wave of COVID-19 pandemic on Spanish healthcare workers: A large cross-sectional survey.

INTRODUCTION: Healthcare workers are vulnerable to adverse mental health impacts of the COVID-19 pandemic. We assessed prevalence of mental disorders and associated factors during the first wave of the pandemic among healthcare professionals in Spain. METHODS: All workers in 18 healthcare institutions (6 AACC) in Spain were invited to web-based surveys assessing individual characteristics, COVID-19 infection status and exposure, and mental health status (May 5 - September 7, 2020). We report: probable current mental disorders (Major Depressive Disorder-MDD- [PHQ-8≥10], Generalized Anxiety Disorder-GAD- [GAD-7≥10], Panic attacks, Posttraumatic Stress Disorder -PTSD- [PCL-5≥7]; and Substance Use Disorder -SUD-[CAGE-AID≥2]. Severe disability assessed by the Sheehan Disability Scale was used to identify probable "disabling" current mental disorders. RESULTS: 9,138 healthcare workers participated. Prevalence of screen-positive disorder: 28.1% MDD; 22.5% GAD, 24.0% Panic; 22.2% PTSD; and 6.2% SUD. Overall 45.7% presented any current and 14.5% any disabling current mental disorder. Workers with pre-pandemic lifetime mental disorders had almost twice the prevalence than those without. Adjusting for all other variables, odds of any disabling mental disorder were: prior lifetime disorders (TUS: OR=5.74; 95%CI 2.53-13.03; Mood: OR=3.23; 95%CI:2.27-4.60; Anxiety: OR=3.03; 95%CI:2.53-3.62); age category 18-29 years (OR=1.36; 95%CI:1.02-1.82), caring "all of the time" for COVID-19 patients (OR=5.19; 95%CI: 3.61-7.46), female gender (OR=1.58; 95%CI: 1.27-1.96) and having being in quarantine or isolated (OR= 1.60; 95CI:1.31-1.95). CONCLUSIONS: One in seven Spanish healthcare workers screened positive for a disabling mental disorder during the first wave of the COVID-19 pandemic. Workers reporting pre-pandemic lifetime mental disorders, those frequently exposed to COVID-19 patients, infected or quarantined/isolated, female workers, and auxiliary nurses should be considered groups in need of mental health monitoring and support.

Positive screens for mental disorders among healthcare professionals during the first covid19 wave in Belgium.

We examined the manifestation of major depressive disorder, generalized anxiety disorder, substance use disorder, post-traumatic stress disorder, and panic attacks among health care professionals during the first COVID-19 wave (n = 6409) by means of mental disorder screening instruments. Logistic regressions were used to gauge individual risk factors; population attributable risk proportions (PARP) were inferred to identify the most important risk factors at the societal level. Data were weighted to represent general profiles of Belgian health care professionals. Lifetime, pre-pandemic emotional problems and work-related factors during the first wave of COVID-19 were strongly associated (mean adjusted odds ratios of 3.79 and 1.47, respectively) with positive screens for current mental disorders (occurrence of 29.3%). Most prominently, the data suggest that disruptions of work-life balance account for more than a quarter of the observed mental health problems due to the combination of widespread occurrence and strong association.

Is the COVID-19 pandemic a risk factor for suicide attempts in adolescent girls?

BACKGROUND: The COVID-19 pandemic might increase suicide behaviors. However, results are still limited and inconclusive, especially in adolescents. METHODS: To provide a preliminary evidence of the effects of the COVID-19 pandemic on suicide attempts (SA), we compared data from the Catalonia Suicide Risk Code (CRSC), during the first 12 months of Spain COVID-19 pandemic (March 2020 to March 2021) with data of the previous 12 months (March 2019 to March 2020). The CRSC is a well-established population-based registry of suicide attempts (SA) which allows monitoring of the dynamic changes that COVID-19 may produce in a Spanish region. RESULTS: SA among adolescents increased 25% during the COVID-year, whatever, SA among adults decreased 16,5% in the same period. The increase of SA in girls was especially prominent in the starting school period in the COVID-year (September 2020-March 2021), where the increase reached 195%. LIMITATIONS: This study did not evaluate other individual risk factors of SA in the context of the COVID-19 pandemic, so is unable to make concrete causal inferences. CONCLUSIONS: These finding suggest that SA increased in adolescent girls during the last period of the COVID-19 pandemic, underscoring the need to implement effective preventive measures by public health systems and stakeholders into response during this public health crisis.

Suicidality among healthcare professionals during the first COVID19 wave.

BACKGROUND: Prevalence estimates of suicidal thoughts and behaviours (STB) among clinically active healthcare professionals during the first wave of COVID19 pandemic are non-existing. The main aim of this study was to investigate the 30-day prevalence of STB and associated risk factors. METHODS: As part of the Recovering Emotionally from COVID study (RECOVID), 30-day STB among healthcare professionals (N = 6,409) was assessed in an e-survey in healthcare settings in Belgium. The prevalence of STB and associated risk factors were estimated in multivariable models with individual-level and society-level measures of association. We used post-stratification weights to make the data representative for the entire clinical workforce in Belgium. RESULTS: Prevalence was 3.6% death wish, 1.5% suicide ideation, 1.0% suicide plan, and 0.0% suicide attempt. Thirty-day STB was (a) increased among respondents with lifetime and current mental disorders (mostly depression) and those hospitalized for COVID19 infection, (b) decreased among respondents with social support, and (c) unrelated to work environment. LIMITATIONS: This is an explorative cross-sectional study using multivariate models that generates specific hypotheses on the prevalence of and risk factors for STB during the COVID19 pandemic rather than testing specific pathways that lead to STB onset. CONCLUSIONS: Across age, gender, professional discipline, and exposure to COVID, lifetime and current mental disorders were highly associated with STB. These factors could guide governments and healthcare organizations in taking up responsibilities in preventing emotional problems and developing resilience among healthcare professionals during, but probably beyond, the current COVID19 pandemic.