Individual-Level Heterogeneity in Mask-wearing During the COVID-19 Pandemic in Malaysia (preprint)

Wearing a face mask has been a key approach to contain or slow down the spread of COVID-19 in the ongoing pandemic. However, there is huge heterogeneity among individuals in their willingness to wear face masks during an epidemic. This research aims to investigate the individual heterogeneity to wear face masks and its associated predictors during the COVID-19 pandemic when mask-wearing was not mandatory but individual choices. Based on a survey of 708 Malaysian adults and a multivariate least-squares fitting analysis, the results reveal a significant variance among individuals in wearing masks, as 34% of the individual adults did not always wear masks in public places. Female, individuals who wash their hands more frequently, and those who reported more availability of personal protective equipment were more likely to practice mask-wearing. The identification of less compliant groups of mask-wearing has critical implications by enabling more specific health communication campaigns.

Predictors of Depression and Anxiety Symptoms in Brazil during COVID-19 (preprint)

The COVID-19 pandemic in Brazil is extremely severe, and Brazil has the third-highest number of cases in the world. The goal of the study is to identify the prevalence rates and several predictors of depression and anxiety in Brazil during the initial outbreak of COVID-19. We surveyed 482 adults in 23 Brazilian states online on 9-22 May 2020, and found 70.3% of the adults (N=339) had depressive symptoms and 67.2% (N=320) had anxiety symptoms. The results of multi-class logistic regression models revealed that females, younger adults and those with fewer children had a higher likelihood of depression and anxiety symptoms; adults who worked as employees were more likely to have anxiety symptoms than those who were self-employed or unemployed; adults who spent more time browsing COVID-19 information online were more likely to have depression and anxiety symptoms. Our results provide preliminary evidence and early warning for psychiatrists and healthcare organizations to better identify and focus on the more vulnerable sub-populations in Brazil during the ongoing COVID-19 pandemic. Keywords: COVID-19; Brazil; anxiety; depression; predictors; risk factors

Typhoon Eye Effect Vs. Ripple Effect: the Role of Family Size on the Mental Health Under the COVID-19 Pandemic in Pakistan (preprint)

Background: The recent outbreak of COVID-19 impacts the mental health of people worldwide. The mental conditions and the associated predictors of adults in Pakistan, the fifth most populous country in the world, during the COVID-19 remains understudied. We aim to investigate distress, anxiety, and overall mental health and their associated predictors among Pakistani adults in this pandemic. We specifically examine the mental health issues based on the distance to the epicenter, a predictor that has revealed opposing evidence in other countries based on the theories of typhoon eye effect and ripple effect. The samples consist of 601 adults who were surveyed online about 2.5 months into the outbreak across Pakistan with varying distance to the epicenter of COVID-19 of Karachi in Pakistan. Results: The results showed that 9.2% and 19.0% of the participants surpassed the cut-off of distress and anxiety disorders, respectively. Overall, the distance to the epicenter positively predicted the mental health of adults in Pakistan, and family size negatively moderated this effect. The distance to the epicenter negatively predicted distress and anxiety disorders for adults in large families, which are quite common in Pakistan. Conclusion: The evidence of the study interestingly finds the prediction of the mental health of people by their distance to the epicenter depends on the family. The evidence of this study can help to provide the initial indicator for mental health care providers to screen vulnerable groups in Pakistan, a populous country that continues struggling to cope with the COVID-19 pandemic.

Typhoon Eye Effect vs. Ripple Effect: The Role of Family Size on the Mental Health under the COVID-19 Pandemic in Pakistan (preprint)

BackgroundThe recent outbreak of COVID-19 impacts the mental health of people worldwide. The mental conditions and the associated predictors of adults in Pakistan, the fifth most populous country in the world, during the COVID-19 remains understudied. We aim to investigate distress, anxiety and overall mental health and their associated predictors among Pakistani adults in this pandemic. We specifically examine the mental health issues based on the distance to the epicenter, a predictor that has revealed opposing evidence in other countries based on the theories of typhoon eye effect and ripple effect. The samples consist of 601 adults who were surveyed online about 2.5 months into the outbreak across Pakistan with varying distance to the epicenter of COVID-19 of Karachi in Pakistan. ResultsThe results showed that 9.2% and 19.0% of the participants surpassed the cut-off of distress and anxiety disorders, respectively. Overall, the distance to the epicenter positively predicted the mental health of adults in Pakistan, and family size negatively moderated this effect. The distance to the epicenter negatively predicted distress and anxiety disorders for adults in large families, which are quite common in Pakistan. ConclusionThe evidence of the study interestingly finds the prediction of the mental health of people by their distance to the epicenter depends on the family. The evidence of this study can help to provide the initial indicator for mental health care providers to screen vulnerable groups in Pakistan, a populous country that continues to struggle to cope with the COVID-19 pandemic.

Typhoon Eye Effect Vs. Ripple Effect: The Role of Family Size on the Mental Health Under the Covid-19 Pandemic in Pakistan (preprint)

Background: The recent outbreak of COVID-19 impacts the mental health of people worldwide. The mental conditions and the associated predictors of adults in Pakistan, the fifth most populous country in the world, during the COVID-19 remains understudied. We aim to investigate distress, anxiety and overall mental health and their associated predictors among Pakistani adults in this pandemic. We specifically examine the mental health issues based on the distance to the epicenter, a predictor that has revealed opposing evidence in other countries based on the theories of typhoon eye effect and ripple effect. The samples consist of 601 adults who were surveyed online about 2.5 months into the outbreak across Pakistan with varying distance to the epicenter of COVID-19 of Karachi in Pakistan. Results: The results showed that 9.2% and 19.0% of the participants surpassed the cut-off of distress and anxiety disorders, respectively. Overall, the distance to the epicenter positively predicted the mental health of adults in Pakistan, and family size negatively moderated this effect. The distance to the epicenter negatively predicted distress and anxiety disorders for adults in large families, which are quite common in Pakistan. Conclusion: The evidence of the study interestingly finds the prediction of the mental health of people by their distance to the epicenter depends on the family. The evidence of this study can help to provide the initial indicator for mental health care providers to screen vulnerable groups in Pakistan, a populous country that continues to struggle to cope with the COVID-19 pandemic.

Health Condition and Test Availability as Predictors of Adults’ Mental Health During the COVID-19 Pandemic (preprint)

Background: Research identifying adults’ mental health during the COVID-19 pandemic relies solely on demographic predictors without examining adults’ health status during the COVID-19 pandemic as a potential predictor. Methods: An online survey of 669 adults in Malaysia was conducted during May 2–8, 2020, six weeks after a Movement Control Order (MCO) was issued. Findings: Adults’ health condition had curvilinear relationships (horizontally reversed J-shaped) with insomnia, anxiety, depression and distress. Reported test availability for COVID-19 (from “strongly disagree” to “strongly agree” ) also had curvilinear relationships (horizontally reversed J-shaped) with anxiety and depression. Younger adults reported worse mental health, but people from various religions and ethnic groups did not differ significantly in reported mental health. Interpretation: Adults with worse health conditions had more mental health problems, especially adults at the lower end of the health spectrum. Test availability negatively predicted anxiety and depression, especially for adults experiencing poor COVID-19 test availability. The significant predictions of health condition and COVID-19 test availability suggest a new direction for the literature to identify psychiatric risk factors directly from health related variables during a pandemic.Funding Statement: Tsinghua University-INDITEX Sustainable Development Fund (Project No. TISD201904).Declaration of Interests: The authors declare that each author has no conflicts of interest with respect to the research, authorship, and/or publication of this article.Ethics Approval Statement: The survey was granted ethical approval by Tsinghua University (20200322).

The Mental Health of Healthcare Staff during the COVID-19 Pandemic: It Depends on How Much They Work and Their Age (preprint)

Background: Healthcare staff are the forefront of fight against COVID-19 and they are under enormous pressure due to the fast growth in the number and severity of infected cases. This creates their mental issues such as distress, depression and anxiety. Exploring healthcare staff's mental health during the pandemic contributes to improving their persistence in the growing challenges created by COVID-19 and enabling effective management of their mental health. Methods: An online survey of 280 healthcare staff in all the 31 provinces of Iran was conducted during April 5 to 20, 2020. The survey assessed staff's distress, depression and anxiety in the COVID-19 pandemic. Results: Nearly a third of healthcare staff suffered from distress, depression and anxiety. Females and more educated healthcare staff were more likely to experience distress. Compared to personnel who did not have COVID-19, those who were unsure whether they had COVID-19 were more likely to experience distress and depression. The number of COVID-19 cases among the staff's colleagues or friends positively predicted their anxiety. Compared to radio technologists, doctors were less likely to experience distress and anxiety. Technicians and obstetrics experienced less anxiety. Analysis the interaction between weekly working days and age of the staff indicated the chance of experiencing distress and depression varied greatly by working days among younger but not older healthcare staff. Conclusion: Exploring the potential predictors of mental health issues assists healthcare organizations to develop approaches to prevent and decrease the issues among staff and improve their task performance in sever crises such as COVID-19, so they can stay motivated in the COVID-19 pandemic. It is useful to identify more working characteristic predictors for healthcare staff at different ages.

Health Condition and Test Availability as Predictors of Adults' Mental Health during the COVID-19 Pandemic (preprint)

Background: Research identifying adults' mental health during the COVID-19 pandemic relies solely on demographic predictors without examining adults' health status during the COVID-19 pandemic as a potential predictor. Methods: An online survey of 669 adults in Malaysia was conducted during May 2-8, 2020, six weeks after a Movement Control Order (MCO) was issued. Findings: Adults' health condition had curvilinear relationships (horizontally reversed J-shaped) with insomnia, anxiety, depression and distress. Reported test availability for COVID-19 (from "strongly disagree" to "strongly agree" ) also had curvilinear relationships (horizontally reversed J-shaped) with anxiety and depression. Younger adults reported worse mental health, but people from various religions and ethnic groups did not differ significantly in reported mental health. Interpretation: Adults with worse health conditions had more mental health problems, especially adults at the lower end of the health spectrum. Test availability negatively predicted anxiety and depression, especially for adults experiencing poor COVID-19 test availability. The significant predictions of health condition and COVID-19 test availability suggest a new direction for the literature to identify psychiatric risk factors directly from health related variables during a pandemic.

Who do not wash their hands during the Covid-19 pandemic? Social media use as a potential predictor (preprint)

This study predicts handwashing behavior during the Covid-19 pandemic. An analysis of 674 adults in Malaysia identifies their time spent on social media per day as a key predictor of handwashing. The association between time spent on social media and handwashing also depends on gender and the number of children in the same household. Additional predictors include age and health condition. This study helps identify specific target groups for health communication on hand hygiene via individual use of social media, which can be a key channel for health communication campaigns during a pandemic.

Belief in Conspiracy Theory about COVID-19 Predicts Mental Health and Well-being -- A Study of Healthcare Staff in Ecuador (preprint)

Abstract Objective: We aim to provide the first evidence of belief in conspiracy theory regarding the COVID-19 virus as a predictor of the mental health and well-being of healthcare workers. Methods: We conducted a survey of 252 healthcare workers in Ecuador from April 10 to May 2, 2020. Results: In Ecuador, 32.54% of the sampled healthcare workers experienced distress disorder, and 28.17% had anxiety disorder. Compared to healthcare workers who were not sure where the virus originated, those who believed the virus was developed intentionally in a lab reported higher levels of distress and anxiety, and lower levels of job satisfaction and life satisfaction. Older healthcare workers and those who exercise more reported higher job satisfaction. Married healthcare workers, those who exercise more, and those not infected reported higher life satisfaction. Conclusion: This paper identifies belief in a COVID-19 conspiracy theory as an important predictor of distress, anxiety, and job and life satisfaction of healthcare workers. It enables mental health services to better target and help mentally vulnerable healthcare workers during the ongoing COVID-19 pandemic.

Succumbing to the COVID-19 Pandemic: Healthcare Workers not Satisfied and Intend to Leave Their Jobs (preprint)

BackgroundHealthcare workers are under such a tremendous amount of pressure during the COVID-19 pandemic that many have become concerned about their jobs and even intend to leave them. It is paramount for healthcare workers to feel satisfied with their jobs and lives during a pandemic. MethodsBetween 10 to 30 April, 2020, 240 healthcare workers in Bolivia completed a cross-sectional online survey, which assessed their job satisfaction, life satisfaction, and turnover intention in the ongoing COVID-19 pandemic. ResultsThe results revealed that their number of office days predicted job satisfaction, life satisfaction, and turnover intention, but the relationships varied by their age. For example, healthcare workers office days negatively predicted job satisfaction for the young (e.g. at 25 years old: b=-0.21; 95% CI: -0.36 to -0.60) but positively predicted job satisfaction for the old (e.g. at 65 years old: b=0.25; 95% CI: 0.06 to 0.44). ConclusionsThese findings provide evidence to enable healthcare organizations to identify staff concerned about job satisfaction, life satisfaction, and turnover intention to enable early actions so that these staff can remain motivated to fight the prolonged COVID-19 pandemic.

Developing and testing a measure of COVID-19 Organizational Support of Healthcare Workers – Results from Peru, Ecuador, and Bolivia (preprint)

During the COVID-19 pandemic, healthcare workers work under high workload with resource constraints and virus exposure, and hence the support to healthcare workers is crucial to lower anxiety. Based on a recently published 8-point framework of COVID-19 specific organization support, we deducted a measure of COVID-19 Organizational Support (COVID-OS) of healthcare workers. We tested the new measure with 712 healthcare workers in Bolivia, Ecuador, and Peru from April 10th to May 2nd, 2020. Our studies suggest the new measure of COVID-19 Organizational Support (COVID-OS) formed 3 factors to predict healthcare workers’ anxiety and life satisfaction during the COVID-19 pandemic. Personal support and work support each predicted anxiety at different levels. Risk support did not play a significant role in our sample. We call further studies testing the COVID-OS in other countries and settings.

When the storm is the strongest: The health conditions and job satisfaction of Healthcare staff and their associated predictors during the epidemic peak of COVID-19 (preprint)

This study reports the physical health, mental health, anxiety, depression, distress, and job satisfaction of healthcare staff in Iran when the country faced its highest number of total active COVID-19 cases. In a sample of 304 healthcare staff (doctors, nurses, radiologists, technicians, etc.), we found a sizable portion reached the cutoff levels of disorders in anxiety (28.0%), depression (30.6%), and distress (20.1%). Age, gender, education, access to PPE (personal protective equipment), healthcare institutions (public vs. private), and individual status of COVID-19 infection each predicted some but not all the outcome variables of SF-12, PHQ-4, K6, and job satisfaction. The healthcare workers varied greatly in their access to PPE and in their status of COVID-19 infection: negative (69.7%), unsure (28.0%), and positive (2.3%). The predictors were also different from those identified in previous studies of healthcare staff during the COVID-19 crisis in China. This study helps to identify the healthcare staff in need to enable more targeted help as healthcare staff in many countries are facing peaks in their COVID-19 cases.

First study on mental distress in Brazil during the COVID-19 crisis (preprint)

Objective: We aim to provide early evidence of mental distress and its associated predictors among adults in the ongoing COVID-19 crisis in Brazil. Methods: We conducted a primary survey of 638 adults in Brazil on March 25-28, 2020, about one month (32 days) after the first COVID-19 case in South America was confirmed in Sao Paulo. Results: In Brazil, 52% (332) of the sampled adults experienced mild or moderate distress, and 18.8% (120) suffered severe distress. Adults who were female, younger, more educated, and exercised less report-ed higher levels of distress. The distance from the Brazilian epicenter of Sao Paulo inter-acted with age and workplace attendance to predict the level of distress. The typhoon eye effect was stronger for people who were older or attended their workplace less. The most vulnerable adults were those who were far from the epicenter and did not go to their workplace in the week before the survey. Conclusion: Identifying the predictors of distress enables mental health services to better target finding and helping the more mentally vulnerable adults during the ongoing COVID-19 crisis.

The distress of Iranian adults during the Covid-19 pandemic - More distressed than the Chinese and with different predictors (preprint)

Early papers on the mental health of the public during the Covid-19 pandemic surveyed participants from China. Outside of China, Iran has emerged as one of the most affected countries with a high death count and rate. The paper presents the first empirical evidence from Iranian adults during the Covid-19 pandemic on their level of distress and its predictors. On March 25-28, 2020, a dire time for Covid-19 in Iran, we surveyed 1058 adults from all 30 provinces in Iran using the Covid-19 Peritraumatic Distress Index (CPDI). The distress level of Iranian adults (mean: 34.54; s.d.: 14.92) was significantly higher (mean difference: 10.9; t=22.7; p<0.0001; 95% CI: 10.0 to 11.8) than that of Chinese adults (mean: 23.65; s.d.: 5.45) as reported in a prior study with the same measure of Covid-19 Peritraumatic Distress Index (CPDI). We also found the predictors of distress in Iran vary from those in China. Our findings that the predictors of distress in Iran vary from those in China suggest the need to study the predictors of mental health in individual countries during the Covid-19 pandemic to effectively identify and screen for those more susceptible to mental health issues.