Long term sleep disturbances in Tunisian COVID-19 patients discharged from hospital: a cohort study

Background: A spectrum of long-term COVID19 effects have been reported. Much less data areavailable about how COVID19 will affect sleep over time in recovered patients. We Assessed the long-term impact of COVID 19 infection on sleep. Methodology:A prospective cohort study including 84 Tunisian COVID19 patients discharged fromhospital. Patients were asked about the period before SARS COV2 related hospital stay, and the 6-9 month-period after hospital discharge, using several self- reported evaluation scales (Pittsburgh Sleep Quality Inde, the Insomnia Severity Index, Epworth Sleepiness Scale, Patient Health Questionnaire (PHQ)-9 and the EuroQol five-dimension five-level questionnaire). Result(s): The mean age was 57,59 years with 46 men and 38 women. As compared with baseline statue of patients, all assessed outcomes were significantly impaired (VAS pain: 1,71+/-1,1 Vs 3,8+/-2,84;PSQI: 3,25+/-2,4 VS 6,39+/-4,73;ESS: 1,94+/-2,44 VS 3,59+/-4,53;ISI: 1,95+/-2,76 VS 6,07+/-5,96, and PHQ-9: 1,45+/-2,74 VS 7,47 +/- 6,61;p=0.0001). The percentage of poor sleepers (PSQI global score higher than 5) and patients with insomnia had significantly increased from 15,5% to 48,8% and from 1,2 to 11%, respectively (p=0.0001). The percentage of patients experiencingdepression symptoms has also doubled (25% to 58,3%), while severe pain was reported by more than one out of five patients against only 1,2% at baseline. The post-COVID -19 PSQI was significantly correlated with body mass index (r=0,328, p=0,003);the post-COVID-19 VAS pain (r=0,479, p=0,0001) as well as the post-COVID-19 PHQ-9 scale (r=0,712, p=0,0001). Conclusion(s): Sleep disturbances, depression symptoms as well as chronic pain are highly prevalent in long-term follow-up period in hospitalized COVID19 survivors therefore,they should be systematically screened.

Factors Associated With The Covid-19 Infection Severity In Patients With Mental Disorders

Introduction: Recent research showed that persons with mental disorders may represent a population at increased risk for coronavirus disease (COVID-19) infection with more adverse outcomes. Objective(s): We aimed to analyze clinical profile of psychiatric inpatients during their infection with COVID-19, and to explore factors associated with the disease progression. Method(s): Weanalyzed retrospectively the medical records of 32 psychiatric inpatients, hospitalized in psychiatry "B" department at Hedi Chaker hospital (Sfax, Tunisia), and who contracted the COVID-19 infection. We used "Charlson Comorbidity Index Score" (CCIS), predicting 10-year survival in patients with multiple comorbidities. Result(s): Somatic history was reported in 50% of patients. The CCIS ranged between 0 and 4. Psychiatric diagnosis was schizophrenia in 81.3% and bipolar disorder in 18.7% of cases. The clinical symptoms reported were fever (50%), dry cough (75%);dyspnea (34.4%). Biological assessment showed a lymphopenia in 40.6% and a high C-Reactive Protein (CRP) in 53.1%. Among our patients, 37,5% needed oxygen, and 25% were transferred to the intensive care unit. The COVID-19 complications were mostly bacterial pulmonary superinfections (21.9%) and pulmonary embolism (9.4%). Only three (9.4%) patients died from the virus. Patients with medical history were more likely to need oxygen (p<0.001). Clinical and paraclinical parameters associated with oxygen need were: fever (p<0.001);dyspnea (p<0.001);lymphopenia (p<0.001);high CRP (p=0.001). Patients presenting pulmonary superinfection or embolism were more likely to require oxygen (p=0.006 and p=0.044 respectively). Conclusion(s): This study highlighted factors that may worsen the COVID-19 infection evolution, and which require special attention, in order to improve the prognosis of this disease.

Bidirectional Associations Between Covid-19 Infection And Mental Disorders

Introduction: The COVID-19 pandemic brought unbearable psychological pressure to people worldwide, because of serious threats to one's physical health and life. From early stages of this pandemic, concerns have been raised about its effect on mental health. However, we still know little whether pre-existing psychiatric disorder (PD) affects the susceptibility and evolution of this infection. Objective(s): We aimed to assess the interactions between COVID- 19 infection and PD. Method(s): We conducted a litterature review through pubmed database, using the keywords :COVID 19, psychiatry, mental disorders, schizophrenia , anxiety , depression , insomnia. Result(s): On one hand, prior surveys suggested that the infection is associated with increased incidence of a first psychiatric symptom. Mental health disturbances mostly include anxiety, depression, sleep disturbances, cognitive impairment and posttraumatic stress disorder. On the other hand, recent studies showed that patients with pre-existing mental disorders were associated with high susceptibility to be infected, increased risk of intensive care unit admission and a high mortality. The susceptibility to contracting COVID-19 was associated with preexisting mood disorders, anxiety, and attention-deficit hyperactivity disorder. Infection severity was associated with preexisting or subsequent mood disorders and sleep disturbances;or a pre-extisting schizophrenia. Mortality is increased in patients diagnosed with schizophrenia. Conclusion(s): The complicated interactions between COVID-19 infection and PD have several implications. Enhanced psychiatric follow-up should be considered for survivors of COVID-19. Besides, early detection and intervention for PD are needed to control morbidity and mortality induced by the COVID-19 infection.

Qualite de vie professionnelle et resilience chez les professionnels de sante en Tunisie au cours de la pandemie a COVID-19

During the COVID-19 pandemic, repeated exposure of health care workers to unpre-dictable challenges in practice can affect their professional quality of life. The objectives of this study were to assess professional quality of life among healthcare workers during the COVID-19 pandemic and to investigate the relationships between professional quality of life and resi-lience. We conducted a cross-sectional, descriptive, and analytical study, carried out in October and November 2020, among 250 health professionals, practicing in Tunisia. Data were collec-ted through an online questionnaire distributed on social networks. We used the "Professional Quality of Life Scale-5" to assess professional quality of life and the "Brief Resilience Scale"to assess resilience. Compassion satisfaction was low to moderate in 77.6% of participants. Most participants (90.4%) had moderate burnout. Compassion fatigue was low to moderate in 98% of cases. Healthcare professionals with higher resilience scores had significantly higher compassion satisfaction scores, and significantly lower burnout and compassion fatigue scores. In addition, higher burnout scores were associated with significantly lower compassion satisfac-tion scores and significantly higher compassion fatigue scores. These associations were found after multivariate analysis using multiple linear regression. Our results highlight the altered professional quality of life among healthcare workers during the COVID-19 pandemic. Imme-diate interventions are essential to improve psychological resilience and build health systems capacity.

Perceived stigma among Tunisian healthcare workers during the COVID-19 pandemic.

BACKGROUND AND OBJECTIVES: Stigma was a major issue during the COVID-19 pandemic. It posed a serious threat to the lives of healthcare workers (HCWs) who were expected to experience higher levels of stigma and increased psychological distress. This is the first survey to investigate forms and correlates of perceived stigma in Tunisian HCWs during the COVID-19 pandemic. METHODS: A cross-sectional web-based survey was conducted between October 8th and November 10th 2020, among 250 Tunisian HCWs. Data were collected using an online questionnaire using the Google Forms® platform. We used a self-reported instrument measuring COVID-19-related stigma, and the Multidimensional Scale of Perceived Social Support (MSPSS) to measure the perceived adequacy of social support from three sources: family, friends, and significant other. RESULTS: The mean stigma score was 18.6±8. Participants sometimes to often experienced stigma in their relationships with friends (22%), neighbors (27.2%), parents (22,4%), and in social activities (30.8%). This stigma was perceived mainly through avoidance (68.4%), and rarely through verbal (6%) or physical aggression (1.2%). The mean MSPSS total score was 5.26±1.24. In multivariate analysis, depression history (P<0.001), long working experience (P<0.001), having presented ageusia/anosmia (P=0.007) and lower total social support scale (P<0.001) were significantly associated with higher perceived stigma score. CONCLUSION: Our findings showed that HCWs perceived stigma in professional, societal and familial domains. Social support from family, friends and others seemed to protect against perceived stigma. Proper health education targeting the public appears to be an effective method to prevent social harassment of both HCWs and COVID-19 survivors.

Professional quality of life and resilience strategies among Tunisian healthcare workers during the COVID-19 pandemic

During the COVID-19 pandemic, repeated exposure of health care workers to unpredictable challenges in practice can affect their professional quality of life. The objectives of this study were to assess professional quality of life among healthcare workers during the COVID-19 pandemic and to investigate the relationships between professional quality of life and resilience. We conducted a cross-sectional, descriptive, and analytical study, carried out in October and November 2020, among 250 health professionals, practicing in Tunisia. Data were collected through an online questionnaire distributed on social networks. We used the “Professional Quality of Life Scale-5” to assess professional quality of life and the “Brief Resilience Scale” to assess resilience. Compassion satisfaction was low to moderate in 77.6% of participants. Most participants (90.4%) had moderate burnout. Compassion fatigue was low to moderate in 98% of cases. Healthcare professionals with higher resilience scores had significantly higher compassion satisfaction scores, and significantly lower burnout and compassion fatigue scores. In addition, higher burnout scores were associated with significantly lower compassion satisfaction scores and significantly higher compassion fatigue scores. These associations were found after multivariate analysis using multiple linear regression. Our results highlight the altered professional quality of life among healthcare workers during the COVID-19 pandemic. Immediate interventions are essential to improve psychological resilience and build health systems capacity. © 2022 Elsevier Masson SAS

Qualité de vie professionnelle et résilience chez les professionnels de santé en Tunisie au cours de la pandémie à COVID-19 Professional quality of life and resilience strategies among Tunisian healthcare workers during the covid-19 pandemic

Résumé La pandémie à COVID-19 a mis à rude épreuve les systèmes de santé partout dans le monde. L’exposition répétée des professionnels de la santé à des défis imprévisibles dans la pratique pourrait retentir sur leur qualité de vie professionnelle.Les objectifs de cette étude étaient d’évaluer la qualité de vie professionnelle chez les professionnels de santé au cours de la pandémie du COVID-19 et d’étudier la nature des liens entre les différentes composantes de la qualité de vie professionnelle et la résilience. Notre étude est de type transversal, descriptif et analytique. Elle a été réalisée aux mois d’octobre et novembre 2020, auprès de 250 professionnels de santé, exerçant en Tunisie. Les données ont été collectées au moyen d’un questionnaire en ligne diffusé sur les réseaux sociaux. Nous avons utilisé l’échelle « The Professional Quality of Life Scale–5 » pour évaluer la qualité de vie professionnelle et l’échelle « Brief Resilience Scale » pour évaluer la résilience. La satisfaction de compassion était faible à moyenne chez 77,6% des participants. La plupart des participants (90,4%) présentaient un burnout moyen. La fatigue de compassion était faible ou moyenne chez 98% des participants. Les professionnels de santé ayant des scores plus élevés de résilience avaient des scores de satisfaction de compassion significativement plus élevés, et des scores de burnout et d’usure de compassion significativement moins élevés. Ces mêmes associations ont été retrouvées après analyse multivariée par régression linéaire multiple.Nos résultats mettent en exergue l’altération de la qualité de vie professionnelle chez les professionnels de santé au cours de la pandémie du COVID-19. Des interventions immédiates sont essentielles pour améliorer la résilience psychologique et renforcer les capacités des systèmes de santé.

Perceived stress among suspected patients during the COVID-19 outbreak in Tunisia

IntroductionWidespread outbreaks of infectious disease, such as COVID-19, are associated with psychological distress and symptoms of mental illness especially for patients with suggestive symptoms.ObjectivesPredict the prevalence of perceived stress and study associated factors among patients with suspected COVID-19 infection.MethodsA cross sectional study was conducted between April and May 2020. Patients consulting the sorting box at the Hedi Chaker Hospital of Sfax and declared suspect to be infected by COVID-19 were invited to participate in our study after given their cosent. Perceived Stress Scale-10 was used to evaluate prevalence of perceived stress.ResultsIn total, 149 participants participated. The mean age was 38.8±15.39 years. Medical or surgical history and psychiatric history were identified respectively in 30,2% and 12.1% of participants. Among all respondents, 74.5% took a nasopharyngeal swab to look for COVID-19 and only 6.4% had a positive test. Close contact with someone with a positive COVID-19 infection was found in 8.05%. Several participants (79,2%) expressed fear of transmitting the disease to their family members. The mean of the PSS-10 score was 11.97±9.83. Moderate to severe perceived stress was found in 44.3% of patients. Significantly higher scores were observed among participants with a positive pharyngeal swab for COVID-19 as well as those who perceived worry of transmetting the disease. No significant differences in perceived stress’ scores according to socio-demographic data.ConclusionsPerceived stress was high among patients with suspected COVID-19 infection. Perceiving worry of transmetting the disease and having a positive pharyngeal swab for COVID-19 were the principal risk factors.DisclosureNo significant relationships.

Anxiety and depression among tunisian health professionals facing COVID-19

IntroductionIn March 2020, the World Health Organization characterized the COVID-19 outbreak as a pandemic. This new health situation has created an anxiety-provoking climate, in particular among health professionalsObjectivesTo study the prevalence and predictors of anxiety and depression among health workersMethodsOur study was descriptive and analytical cross-sectional, carried out with healthcare on the period between May until June 2020. An anonymous online survey was sent to caregivers. The HADS questionnaire was used to screen for anxiety and depressionResults125 responses was collected The average age of the sample was 32 years. The participants were predominantly female (72.8%), married (48%), and had at least one child (39.2%). 21.6% of the participants worked in the resuscitation anesthesia service and urgent medical aid, 14.4% in the medical services at high risk of contamination, 1.6% in the COVID-19 unit Many changes in habits were reported by the participants: 28.7% had increased their consumption of coffee/tea, especially with anxious people (p = 0.001). This increase was also noted for tobacco (30.8%) and alcohol consumption (12.5%). According to the HADS scale, anxiety was retained in 44% and depression in 47.2%. Anxiety was significantly related to sex with (p = 0.039) and affects more women than men The consumers of coffee/tea developed more anxiety (p = 0.034) and depression (p = 0.026).ConclusionsThis tragic health crisis had a major impact on the mental health of our heroes This is why we should better understand their vulnerability to psychological suffering to provide them with the necessary support

Evaluation of anxiety and coping strategies among tunisian health professionals in the pandemic of the covid 19

IntroductionThe rapid spread of coronavirus has forced the healthcare systems in Tunisia to reorganize its structures, thus mobilizing all caregivers. Their professional and emotional burden was put to the test.ObjectivesTo evaluate the level of anxiety and to study coping strategies among caregivers during this pandemic.MethodsA cross-sectional descriptive and analytical study among150 caregivers in two hospitals in Sfax in Tunisia;during April 2020. We used anonymous questionnaire, the Spielberger State Anxiety Scale(STAI) to assess tension felt at anxiety-producing situations;and the Coping Inventory Scale for Stressful Situations (CISS): to assess coping strategies.ResultsThe average age was 30.33± 6,93 years and the sex-ratio M/W = 0,29. Caregivers followed the news of this pandemic with these means of communication: 96% Facebook, 80%TV. The increase of the time spent in front of media:84% Sleep disorders were present in 64.7%: insomnia (36%), chopped sleep(34%). Caregivers used sleeping pills in 12% of case. STAI: The mean ascore =48.85 and a high anxiety level was noted in72% of case. CISS: Task-oriented coping strategies : a mean score= 47.90 and Emotion-centered coping : a mean score = 40,49 High anxiety was correlated with: age>40 years old (p=0.042). The increase of the time spent in front of media, chopped sleep and use of sleeping pills are correlated respectively (p= 0,043, p=0,003, p=0,003) with an emotionally focused coping strategy.ConclusionsHealth professionals had a painful psychological experience with significant anxiety. Strengthening prevention strategies, management of health crises should be a priority of our health-system.

Depression in quarantined patients during the COVID-19 pandemic

IntroductionQuarantine for suspected patients of being infected by the COVID-19 can lead to negative consequences for mental health and the appearance of depressive symptoms.ObjectivesTo assess the prevalence of depression in quarantined patients, and to analyze the associated factors.MethodsThis was a descriptive and analytical survey, carried out from April 4 to May 30, 2020, with 149 patients consulting the COVID-19 sorting box at the Hedi Chaker CHU in Sfax. Suspected COVID-19 patients were contacted by phone during their quarantine and invited to participate in our study. The Patient Health Questionnaire (PHQ-9) scale was used to assess the severity of depression. Cutoffs of 5, 10, 15, and 20 represent minimal, mild, moderate, moderately severe, and severe levels of depression based on PHQ-9 scores. A cutoff score of 10 determines major depression.ResultsThe results showed a prevalence of major depression of 10.7%. Of all patients, 89.3% had minimal to mild depression;10% had moderate to moderately severe depression and 0.7% had severe depression. The PHQ-9 score was statistically correlated with travel to a suspect area during the 14 days preceding the consultation (p = 0.008), contact with a subject confirmed COVID-19 (p = 0.01), previous follow-up in psychiatry (p = 0.047), the change of residence during quarantine (p = 0.045), the fear of transmitting the disease to relatives (p = 0.00) and the positive result of the nasopharyngeal swab (p = 0.00).ConclusionsPsychological distress was felt in our patients. We recommend that necessary measures should be taken to combat depression.

Psychological and behavioral impact of the COVID-19 pandemic and containment among the general tunisian population

IntroductionSince COVID19 pandemic emergence, containment measure have been taken by the Tunisian government imposing a new lifestyle resulting in psychological repercussions and a change in behavior.ObjectivesHighlighting changes of behavior and lifestyle of the general public secondary to the COVID19 pandemic and to confinement and to assess their levels of psychological.MethodsThis is a qualitative, descriptive and analytical cross-sectional study realized between April and May 2020 with the general public using an anonymous online questionnaire covering: socio-demographic data;behavior during confinement;epidemic psychological impact;Mental health status was measured using Depression, Anxiety and Stress Scale(DASS-21). Anger level was assessed by STAXI-10 items.Results132 responses were received: 68.2% were women;the average age 32.01(±11.10);half were single;77.3% were at higher education level;41.7% were healthcare professionnels. Consumption increased by 26.5% in coffee, 8.3% tobacco and 1.5% alcohol. 33.3% of participants increased their religious practice. 56.1% experienced sleep disorder mostly women(p<0.05). 91.7% followed COVID19 evolution through media essentially Facebook. Partners relationship was deteriorated in1.7% and improved in 25%. Child abuse increased by 13.7%. During confinement: 15.9%depression (0.8%severe depression), 12.9%anxiety (0.8%severe anxiety), 5.3% stress and 27.3%feelings of anger. Depression, anxiety and anger were related to younger age(p<0.05). Stress wasn’t age related. Depression was observed in participants without children (p<0.05). No association founded between psychological impact and gender, profession and civil status.ConclusionsThe COVID19 pandemic and the containment had consequences on individuals behavior and mental health. A psychological listening unit was launched during the period of confinement to overcome psychological impact.