Physical and stressful psychological impacts of prolonged personal protective equipment use during the COVID-19 pandemic: A cross-sectional survey study.

BACKGROUND: Healthcare workers (HCWs) caring for COVID-19 infected patients are exposed to stressful and traumatic events with potential for severe and sustained adverse mental and physical health consequences. Our aim was to assess the magnitude of physical and mental health outcomes of HCWs due to the prolonged use of personal protective equipment (PPE) treating COVID-19 patients. METHODS: This cross-sectional study assessed the symptoms of stress, anxiety, insomnia, and psychological resilience using the Stress and Anxiety to Viral Epidemics (SAVE) scale, Insomnia Severity Index (ISI), and Resilience Scale (RS), respectively, in Italy between 1st February and 31st March 2022. The physical outcomes reported included vertigo, dyspnea, nausea, micturition desire, retroauricular pain, thirst, discomfort at work, physical fatigue, and thermal stress. The relationships between prolonged PPE use and psychological outcomes and physical discomforts were analyzed using Generalized Linear Models (GLMs). We calculated the factor mean scores and a binary outcome to measure study outcomes. FINDINGS: We found that 23% of the respondents reported stress related symptoms, 33% anxiety, 43% moderate to severe insomnia, and 67% reported moderate to very low resilience. The GLMs suggested that older people (>55 years old) are less likely to suffer from stress compared to younger people (<35 y.o); conversely, HCW aged more than 35 years are more inclined to suffer from insomnia than younger people (<35 y.o). Female HCW reported a lower probability of resilience than males. University employed HCWs were less likely to report anxiety than those who worked in a community hospital. The odds of suffering from insomnia for social workers was significantly higher than for other HCWs. Female HCW>3 years old, enrolled in training programs for nursing, social work, technical training and other healthcare professionals increased the probability of reported physical discomforts. HCW that worked on non COVID-19 wards and used PPE for low-medium exposure level, were at lower risks for lasting physical side effects as compared to the HCW who worked in high-risk PPE intense, COVID-19 environments. INTERPRETATION: The study suggests that frontline HCWs who had extensive PPE exposure while directly engaged in the diagnosis, treatment, and care for patients with COVID-19 are at significant risks for lasting physical and psychological harm and distress.

Insomnia during pregnancy and the Covid-19 pandemic: A case report

Insomnia is a key risk factor for depression and mental disorders, both in general and during peripartum. Covid-19 pandemic outbreak was associated with an alarming increase of insomnia symptoms. This case report aims to describe a digital Cognitive Behavioral Therapy for Insomnia (CBT-I) intervention adapted for pregnancy during the pandemic situation. This article describes the case of a 38 years old woman with significant problems in initiating and maintaining sleep. The intervention was conducted online. The assessment included a clinical psychological interview, semi-structured interview about sleep, sleep diaries and validated questionnaires. Adapted CBT-I protocol was performed including 5 sections lasting 45 minutes each. The case-report description follows CAse REport (CARE) guidelines. The intervention was effective in reducing insomnia symptoms as highlighted by questionnaires and sleep diaries. Furthermore, results showed positive findings with regard to depression symptomatology, stress levels and difficulties in emotion regulation. These positive results were confirmed at post-partum follow ups. Evidence-based CBT-I protocol was applied with relevant benefits for the patient. Furthermore, it was stressed the importance of considering emotions during psychotherapy. High-quality clinical trials evaluating the efficacy of adapted CBT-I in large samples of expecting mothers are suggested to guide changes in gynecological primary care for pregnancy, especially for the post-pandemic time. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Italian) L'insonnia e un fattore di rischio per la depressione e i disturbi mentali. La pandemia dovuta al Covid-19 e stata associata a un allarmante aumento dell'insonnia. Questo caso clinico ha lo scopo di descrivere un intervento digitale di terapia cognitivo comportamentale per l'insonnia (CBT-I) adattato per la gravidanza durante la pandemia. Viene descritto il caso di una donna di 38 anni con insonnia. La valutazione ha previsto un colloquio clinico psicologico, un'intervista semi-strutturata sul sonno, diari del sonno e questionari. E stato eseguito un protocollo CBT-I comprendente 5 sessioni di 45 minuti ciascuna. L'intervento eseguito e stato efficace nel ridurre i sintomi dell'insonnia e ha mostrato risultati positivi per quanto riguarda la sintomatologia depressiva, i livelli di stress e le difficolta nella regolazione delle emozioni. Questi risultati sono stati confermati anche ai follow-up. I risultati a favore dell'efficacia della CBT-I per l'insonnia in gravidanza sono stati confermati, evidenziando inoltre, l'importanza di considerare le emozioni durante il trattamento. Si suggeriscono futuri studi clinici di alta qualita che valutino l'efficacia della CBT-I adattata in grandi campioni di madri in gravidanza per guidare i cambiamenti nell'assistenza ginecologica primaria per la gravidanza, specialmente nel periodo post-pandemico. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Insomnia during pregnancy and the Covid-19 pandemic: A case report

(Italian) L'insonnia e un fattore di rischio per la depressione e i disturbi mentali. La pandemia dovuta al Covid-19 e stata associata a un allarmante aumento dell'insonnia. Questo caso clinico ha lo scopo di descrivere un intervento digitale di terapia cognitivo comportamentale per l'insonnia (CBT-I) adattato per la gravidanza durante la pandemia. Viene descritto il caso di una donna di 38 anni con insonnia. La valutazione ha previsto un colloquio clinico psicologico, un'intervista semi-strutturata sul sonno, diari del sonno e questionari. E stato eseguito un protocollo CBT-I comprendente 5 sessioni di 45 minuti ciascuna. L'intervento eseguito e stato efficace nel ridurre i sintomi dell'insonnia e ha mostrato risultati positivi per quanto riguarda la sintomatologia depressiva, i livelli di stress e le difficolta nella regolazione delle emozioni. Questi risultati sono stati confermati anche ai follow-up. I risultati a favore dell'efficacia della CBT-I per l'insonnia in gravidanza sono stati confermati, evidenziando inoltre, l'importanza di considerare le emozioni durante il trattamento. Si suggeriscono futuri studi clinici di alta qualita che valutino l'efficacia della CBT-I adattata in grandi campioni di madri in gravidanza per guidare i cambiamenti nell'assistenza ginecologica primaria per la gravidanza, specialmente nel periodo post-pandemico. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The impact of COVID-19 on Italian adolescents' sleep and its association with psychological factors.

Insomnia and circadian dysregulation during adolescence represent important risk factors for emotional and psychological problems. Recent studies have shown that the coronavirus disease 2019 (COVID-19) pandemic has been linked to a high prevalence of behavioural sleep problems in the general population. This study aimed to provide two pictures of two different time points of the pandemic regarding the prevalence of sleep problems in adolescents and their association with psychological health variables. Two different independent large samples of Italian adolescents aged 13-17 years were recruited at two pandemic time points. A total of 1,146 adolescents at Time 1 (T1; April 2020) and 1,406 at Time 2 (T2; April 2021) took part in the study. Measures of insomnia symptoms, sleep hygiene, chronotype, psychological distress and emotion regulation were collected. Prevalence of insomnia was 12.13% at T1 and 23.19% at T2. Furthermore, high levels of poor sleep habits (late bedtime, poor sleep hygiene, use of electronic devices at bedtime) were also detected at both time points. Insomnia symptoms strongly correlated with poor sleep hygiene, higher psychological distress, and emotional suppression at both time points. Results highlighted an alarming picture for two large samples at two different time points of the pandemic that showed a potential negative impact of the COVID-19 pandemic, in both the first outbreak and in the later phase of the pandemic, on sleep habits, psychological distress and insomnia symptoms in adolescents. This strongly suggests the need for monitoring these variables and their interaction in the post-pandemic period and to develop and promote interventions for insomnia and circadian disturbances during adolescence.

Event-related potentials in insomnia reflect altered perception of sleep.

STUDY OBJECTIVES: Insomnia is defined by the subjective complaint of poor sleep as well as daytime impairments. Since polysomnography (PSG) typically shows only modest sleep impairment, some still unidentified property of sleep, not mirrored in PSG, may be modified in insomnia.One possible mechanistic hypothesis is that insomnia patients may be more sensitive to inevitably occurring internal or external stimuli during the night, causing brief sleep disruptions then perceived as wake time. METHODS: Auditory event-related potentials (ERP) to low intensity (50 dB SPL) synthesized guitar tones played continuously throughout two nights of polysomnographically registered sleep were obtained in fifty patients with insomnia disorder (ID, without comorbidities) and 50 age- and sex-matched good sleeper controls (GSC) for each sleep stage and NREM/REM cycle. Phasic and tonic REM were treated as separate stages. Latencies and amplitudes of components P1, N1 and P2 were measured and analyzed by multivariate repeated-measures ANCOVA including effects of group, night, cycle, and age. RESULTS: ID showed reduced P2 amplitudes relative to GSC specifically in phasic REM sleep. The same reduction also correlated with the amount of sleep misperception across groups. Independent component analysis showed a frontal negativity to contribute most to this group difference. CONCLUSIONS: The present finding can be interpreted as increased mismatch negativity (MMN) in ID, reflecting automated detection of change in the auditory system and a concomitant orienting response. Specifically phasic REM sleep appears to be vulnerable to sensory afferences in ID patients, possibly contributing to the perception of being awake. CLINICAL TRIAL INFORMATION: Short name "PERSLEEP 2," URL https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00008965, Registration DRKS00008965.

Sleep Characteristics in Italian Children During Home Confinement Due to Covid-19 Outbreak.

OBJECTIVE: Italy faced one of the first large clusters of COVID-19 infections worldwide. Home confinement and social distancing could have negatively impacted sleep habits and prevalence of sleep disorders in children, which may be also linked with altered emotional processes. The present study focused on clinical aspects related to sleep, insomnia and emotions in Italian children aged 0-to-12 years during home confinement due to COVID-19 outbreak. METHOD: An online survey was systematically distributed in all Italian territories by contacting regional offices of the Italian Ministry of Instruction, University and Research (MIUR) and schools with available contact. All respondents had to be parents of at least one child aged 0 to 12 years old. Information on sociodemographic variables, sleep habits, sleep health behaviors, sleep disorders and mood were collected. RESULTS: Parents of 2361 children (mean age: 8.1 ± 2.62 years; 1148 females; 1213 males) answered the survey. 1.2% of children was between 0 and 2 years old; 15.3% within 3 to 5 years and 83.3% within 6 and 12 years. In all group ages, late bedtime was observed (most of them after 9 p.m.). 59.4% of all children presented at least one clinical diagnostic criterion for childhood insomnia. Logistic regression model showed that presence of at least one criterion for childhood insomnia was associated to younger age, negative mood, current parental insomnia, being the only child, presence of any other sleep disorder, and sleep hygiene behaviors. CONCLUSIONS: Data indicate an alarming increase of prevalence of insomnia related problems in Italian children during home confinement with respect to previous data. This was found to be associated with poor sleep hygiene and negative mood. Clinical programs targeting insomnia, sleep health behaviors and emotional processes should be implemented in pediatric primary care in order to prevent the development of sleep problems in a post-pandemic situation.

Insomnia in the Italian Population During Covid-19 Outbreak: A Snapshot on One Major Risk Factor for Depression and Anxiety.

Objectives: One of the largest clusters of Covid-19 infections was observed in Italy. The population was forced to home confinement, exposing individuals to increased risk for insomnia, which is, in turn, associated with depression and anxiety. Through a cross-sectional online survey targeting all Italian adult population (≥18 yrs), insomnia prevalence and its interactions with relevant factors were investigated. Methods: The survey was distributed from 1st April to 4th May 2020. We collected information on insomnia severity, depression, anxiety, sleep hygiene behaviors, dysfunctional beliefs about sleep, circadian preference, emotion regulation, cognitive flexibility, perceived stress, health habits, self-report of mental disorders, and variables related to individual difference in life changes due to the pandemic's outbreak. Results: The final sample comprised 1,989 persons (38.4 ± 12.8 yrs). Prevalence of clinical insomnia was 18.6%. Results from multivariable linear regression showed that insomnia severity was associated with poor sleep hygiene behaviors [ß = 0.11, 95% CI (0.07-0.14)]; dysfunctional beliefs about sleep [ß = 0.09, 95% CI (0.08-0.11)]; self-reported mental disorder [ß = 2.51, 95% CI (1.8-3.1)]; anxiety [ß = 0.33, 95% CI (0.25-0.42)]; and depression [ß = 0.24, 95% CI (0.16-0.32)] symptoms. Conclusion: An alarming high prevalence of clinical insomnia was observed. Results suggest that clinical attention should be devoted to problems of insomnia in the Italian population with respect to both prevention and treatment.

Dealing with sleep problems during home confinement due to the COVID-19 outbreak: Practical recommendations from a task force of the European CBT-I Academy.

In the current global home confinement situation due to the COVID-19 outbreak, most individuals are exposed to an unprecedented stressful situation of unknown duration. This may not only increase daytime stress, anxiety and depression levels, but also disrupt sleep. Importantly, because of the fundamental role that sleep plays in emotion regulation, sleep disturbance can have direct consequences upon next day emotional functioning. In this paper, we summarize what is known about the stress-sleep link and confinement as well as effective insomnia treatment. We discuss those effects of the current home confinement situation that can disrupt sleep but also those that could benefit sleep quality. We suggest adaptions of cognitive behavioural therapy elements that are feasible to implement for those facing changed work schedules and requirements, those with health anxiety and those handling childcare and home-schooling, whilst also recognizing the general limitations imposed on physical exercise and social interaction. Managing sleep problems as best as possible during home confinement can limit stress and possibly prevent disruptions of social relationships.