Risk and protective factors for psychological distress during COVID-19 in Israel.

The purpose of the present study was to identify the protective and risk factors related to psychological distress during COVID-19 in an Israeli sample. An online survey was administered from April 19 to May 2, 2020, while a strict lockdown was in place. Participants were recruited by snowball sampling. Psychological distress was evaluated using the Generalized Anxiety Disorder questionnaire (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Risk and protective factors for psychological distress were assessed on the Multi-dimensional Perceived Social Support (MSPSS), the coping strategies (COPE), the Life Orientation Test (LOT), and the Gratitude questionnaire. Out of the 655 valid questionnaires collected (from participants ranging in age from 18 to 86, 246 males, 409 females), 138 (21.3%) were positive for moderate to very severe depression and 87 (13.2%) for moderate to extremely severe anxiety. Participants who were screened for depression and anxiety were more likely to be women and young adults (18-24). After adjusting statistically for gender, age, and socioeconomic status, depression and anxiety remained significantly associated with both emotion-focused (PHQ-ß =.437, p < .001, GAD-ß=.441, p < .001) and problem-focused (PHQ-ß =-.219, p < .001, GAD-ß=-.143, p < .001) coping strategies, as well as on the social support (PHQ-ß =-.167, p < .001, GAD-ß=-.155, p < .001), life orientation (GAD-ß=-.09, p < .001), and gratitude scales (PHQ-ß =-.07, p < .001). Levels of anxiety and depression were generally associated with gender (women), age (younger population), socioeconomic status (low), and an emotion-focused strategy as risk factors. A problem-focused strategy, social support, life orientation, and gratitude served as protective factors above and beyond personal background.

Effect of patient COVID-19 vaccine hesitancy on hospital care team perceptions.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic posed new challenges in patient care worldwide. Vaccinations, which have proven efficacious in lowering the COVID-19 hospital burden, are still avoided by large populations. We, therefore, hypothesized that hospital care teams would have worse perceptions regarding the characteristics and care of patients with vaccine hesitancy. AIM: To evaluate whether patient vaccine hesitancy affected the hospital care team (HCT) perceptions. METHODS: We performed a prospective clinical study using structured questionnaires. We approached physicians and nurses with previous experience caring for COVID-19 patients from 11 medical centers across Israel during the fourth COVID-19 surge (September and October 2021). The participants completed a questionnaire with the following parts: (1) Sociodemographic characteristics; (2) Assessment of anger (STAXI instrument) and chronic workplace stress (Shirom-Melamed burnout measure); and (3) Three tools to assess the effect of patient vaccine hesitancy on the HCT perceptions (the difficult doctor-patient relation questionnaire, the medical staff perception of patient's responsibility questionnaire and the characterological derogation questionnaire). Results were evaluated according to each part of the questionnaire and the questionnaire as a whole. Associations between HCT perceptions and their baseline characteristics, anger or chronic workplace stress were assessed. RESULTS: The HCT experienced their relationship with unvaccinated patients as more difficult (P < 0.001, Cohen's d = 0.85), perceived unvaccinated patients as responsible for their medical condition (P < 0.001, d = 1.39) and perceived vaccinated patients as having a higher character value (P < 0.001, d = 1.03). Unvaccinated patients were considered selfish (P < 0.001), less mature (P < 0.001) and less satisfying to care for (P < 0.001). The relationship with unvaccinated patients was more difficult among HCT with higher burnout (r = 0.37, n = 66, P = 0.002). No correlations with baseline characteristics were found. All three study tools showed high internal consistency (α between 0.72 and 0.845). CONCLUSION: Our results should raise awareness of the possible effects of vaccine hesitancy on HCT perceptions regarding unvaccinated patients. In order to minimize the potential negative impact on patient care, designated departments should promote specific patient-centered preparations. Further investigations should assess whether vaccine hesitancy directly affects patient quality of care.

Risk Factors and Multidimensional Assessment of Long Coronavirus Disease Fatigue: A Nested Case-Control Study.

BACKGROUND: Fatigue is the most prevalent and debilitating long-COVID (coronavirus disease) symptom; however, risk factors and pathophysiology of this condition remain unknown. We assessed risk factors for long-COVID fatigue and explored its possible pathophysiology. METHODS: This was a nested case-control study in a COVID recovery clinic. Individuals with (cases) and without (controls) significant fatigue were included. We performed a multidimensional assessment evaluating various parameters, including pulmonary function tests and cardiopulmonary exercise testing, and implemented multivariable logistic regression to assess risk factors for significant long-COVID fatigue. RESULTS: A total of 141 individuals were included. The mean age was 47 (SD: 13) years; 115 (82%) were recovering from mild coronavirus disease 2019 (COVID-19). Mean time for evaluation was 8 months following COVID-19. Sixty-six (47%) individuals were classified with significant long-COVID fatigue. They had a significantly higher number of children, lower proportion of hypothyroidism, higher proportion of sore throat during acute illness, higher proportions of long-COVID symptoms, and of physical limitation in daily activities. Individuals with long-COVID fatigue also had poorer sleep quality and higher degree of depression. They had significantly lower heart rate [153.52 (22.64) vs 163.52 (18.53); P = .038] and oxygen consumption per kilogram [27.69 (7.52) vs 30.71 (7.52); P = .036] at peak exercise. The 2 independent risk factors for fatigue identified in multivariable analysis were peak exercise heart rate (OR: .79 per 10 beats/minute; 95% CI: .65-.96; P = .019) and long-COVID memory impairment (OR: 3.76; 95% CI: 1.57-9.01; P = .003). CONCLUSIONS: Long-COVID fatigue may be related to autonomic dysfunction, impaired cognition, and decreased mood. This may suggest a limbic-vagal pathophysiology. CLINICAL TRIALS REGISTRATION: NCT04851561.

Associations between social support and anxiety during the COVID-19 lockdown in young and middle-aged Israelis: A cross-sectional study.

BACKGROUND: This study examined the associations between social support and anxiety during the coronavirus disease 2019 (COVID-19) in an Israeli sample. AIM: To examine the associations between social support and anxiety during the COVID-19 in an Israeli sample. METHODS: Data for this cross-sectional study were retrieved from an online survey. Linear regression, logistic regression and restricted cubic spline models were conducted to test for associations between social support and anxiety. RESULTS: A total of 655 individuals took part in the present study. In the univariate linear regression model, there is a negative correlation between the Generalized Anxiety Disorder-7 score (GAD-7) and the Multidimensional Perceived Social Support Scale (MSPSS) score. For MSPSS score, the multivariable adjusted regression coefficient and 95% confidence interval (CI) of GAD-7 score were -0.779 (-1.063 to -0.496). In the univariate logistic regression model, there was a negative correlation between anxiety (GAD-7 ≥ 9) and MSPSS score, and there was still a negative correlation in multivariate logical regression analysis. The odds ratios and 95%CI were 0.709 (0.563-0.894). CONCLUSION: Social support was inversely correlated with anxiety during COVID-19 in an Israeli sample.

Social Support Mediates the Association between Attachment Style and Psychological Distress during COVID-19 in Israel.

AIM: The aim of this study was to examine the relationships between attachment style, social support, and psychological distress (i.e., depression and anxiety) during the COVID-19 lockdown of the third wave in Israel. Specifically, we examined whether social support mediates the well-documented relationship between attachment style and psychological distress. METHODS: An online survey was administered from 3 January to 6 February, 2021, while a strict lockdown was in place. The sample included 288 Israelis ranging between the ages of 18-78, recruited by snowball sampling. Psychological distress was evaluated by Patients Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder questionnaire (GAD-7); attachment style by the Experiences in Close Relationships (ECR-36), and social support by the Multi-dimensional Perceived Social Support (MSPSS). A mediation model was applied with social support mediating the association between attachment style and depression and anxiety. RESULTS: Significant correlations were found between attachment style and psychological distress, and between social support and psychological distress. Social support partially mediated the associations between attachment style and psychological distress (Depression: p < 0.001, confidence interval [CI] = 0.4018, 1.7468; Anxiety: p < 0.001, confidence interval [CI] = 0.0493, 0.9822). These results remained the same while controlling for age. CONCLUSION: Our findings suggest that the secure attachment style serves as a protective factor against psychological distress and vice versa; insecure attachment style serves as a risk factor for developing psychological distress during a peak period of COVID-19. Nevertheless, social support played a central role in the association between attachment style and psychological distress, thus, individuals with an insecure attachment may thus be helped by offering them social support during a crisis, which in turn may increase their well-being.

Physical and mental impact of COVID-19 outbreak on fibromyalgia patients.

OBJECTIVES: Acute or chronic stress may trigger or aggravate symptoms of fibromyalgia (FM). We aimed to evaluate the physical and mental health of fibromyalgia patients during the COVID 19 outbreak and identify protective/risk factors. METHODS: An online survey was published in May 2020, following two months of lockdown due to the COVID 19 outbreak, including questionnaires regarding demographic characteristics, access to medical services, anxiety, depression, life approach, coping strategies, perception of social support, widespread pain index (WPI) and symptoms severity scale (SSS), insomnia severity index (ISI) and patient global assessment. RESULTS: Of the 233 patients included in the study, 98% were forced to discontinue complementary or alternative treatments during lockdown. Up to 30% of responders who had been treated with medical cannabis had to stop due to logistic difficulties and this was associated with significantly higher scores of WPI/SSS (p=0.024). Higher levels of anxiety and depression were significantly correlated with higher levels of pain, sleep disorders and subjective perception of deterioration (p=0.00). Higher scores of social support and positive life approach were correlated with less anxiety and depression (p<0.01), lower levels of pain (p<0.05) and less sleep disturbances (p<0.01). Avoidant coping style was strongly associated to higher levels of pain, sleep disturbances, anxiety, depression, and subjective perception of worsening (p<0.01). CONCLUSIONS: Fibromyalgia patients reported adverse mental and physical outcomes during the COVID-19 outbreak. Factors such as stopping current treatments may play a central role. Social support and a positive life approach appear to be protective.

Social Support Mediates the Association between Attachment Style and Psychological Distress during COVID-19 in Israel

Aim: The aim of this study was to examine the relationships between attachment style, social support, and psychological distress (i.e., depression and anxiety) during the COVID-19 lockdown of the third wave in Israel. Specifically, we examined whether social support mediates the well-documented relationship between attachment style and psychological distress. Methods: An online survey was administered from 3 January to 6 February, 2021, while a strict lockdown was in place. The sample included 288 Israelis ranging between the ages of 18–78, recruited by snowball sampling. Psychological distress was evaluated by Patients Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder questionnaire (GAD-7);attachment style by the Experiences in Close Relationships (ECR-36), and social support by the Multi-dimensional Perceived Social Support (MSPSS). A mediation model was applied with social support mediating the association between attachment style and depression and anxiety. Results: Significant correlations were found between attachment style and psychological distress, and between social support and psychological distress. Social support partially mediated the associations between attachment style and psychological distress (Depression: p < 0.001, confidence interval [CI] = 0.4018, 1.7468;Anxiety: p < 0.001, confidence interval [CI] = 0.0493, 0.9822). These results remained the same while controlling for age. Conclusion: Our findings suggest that the secure attachment style serves as a protective factor against psychological distress and vice versa;insecure attachment style serves as a risk factor for developing psychological distress during a peak period of COVID-19. Nevertheless, social support played a central role in the association between attachment style and psychological distress, thus, individuals with an insecure attachment may thus be helped by offering them social support during a crisis, which in turn may increase their well-being.