COVID-19 vaccine acceptance and related behavioral and psychological characteristics in individuals with mental disorders in Korea.

Objective: This study aimed to investigate COVID-19 vaccine acceptance and related factors in individuals with mental disorders in Korea. Methods: We surveyed 572 individuals with mental disorders about their attitudes toward COVID-19 vaccination using a 7-item self-rating questionnaire on vaccine acceptance and hesitancy. We categorized the respondents into groups based on their level of vaccine acceptance using hierarchical clustering. In addition, we evaluated the respondents' vaccination status and trust in sources of information regarding COVID-19 vaccines, and assessed their psychological characteristics using the Patient Health Questionnaire-9, Gratitude Questionnaire-6, and Big Five Inventory-10. Results: Clustering revealed three groups according to vaccine acceptance: 'totally accepting' (n= 246, 43.0%), 'somewhat accepting' (n= 184, 32.2%), and 'hesitant' (n= 142, 24.8%) groups. Three quarters of all participants, who belonged to the 'totally accepting' or 'somewhat accepting' groups, were willing to receive a COVID-19 vaccine despite concerns about its side effects. Individuals in the high vaccine acceptance group were older (F= 12.52, p< 0.001), more likely to receive the influenza vaccine regularly, and more likely to trust formal information sources. Additionally, they had higher levels of gratitude (F= 21.00, p< 0.001) and agreeableness (F= 4.50, p= 0.011), and lower levels of depression (χ2= 11.81, p= 0.003) and neuroticism (F= 3.71, p= 0.025). Conclusion: The present study demonstrated that individuals with mental disorders were generally willing to receive COVID-19 vaccination. However, they weighed its need and effectiveness against potential side effects before coming to a decision. It is important to understand the behavioral and psychological characteristics associated with vaccine acceptance, to effectively communicate its importance to individuals with mental disorders.

Trends in suicide deaths before and after the COVID-19 outbreak in Korea.

We investigated the effect of the coronavirus disease-2019 (COVID-19) pandemic on suicide trends in Korea via a time-series analysis. We used Facebook Prophet to generate forecasting models based on the monthly numbers of suicide deaths in Korea between 1997 and 2018, validated the models by comparison with the 2019 numbers, and predicted the numbers of suicides in 2020. We compared the expected and observed numbers of suicides during the COVID-19 pandemic. The total numbers of suicides during the COVID-19 pandemic did not deviate from projections based on the pre-pandemic period. However, the number of suicides among women and those under the age of 34 years significantly exceeded the expected level. The COVID-19 pandemic did not increase the overall suicide rate significantly. However, suicides among women and young people increased, suggesting that the pandemic might drive more members of these groups to suicide. Further studies are needed to verify the long-term impact of the COVID-19 pandemic on suicide.

Relationship Between Economic Loss and Anxiety During the Coronavirus Disease 2019 Pandemic: Moderating Effects of Knowledge, Gratitude, and Perceived Stress.

Objectives: The prolonged coronavirus disease 2019 (COVID-19) pandemic has caused individuals to suffer economic losses, in particular due to the implementation of intensive quarantine policies. Economic loss can cause anxiety and has a negative psychological impact on individuals, worsening their mental health and satisfaction with life. We examined the protective and risk factors that can influence the relationship between economic loss and anxiety during the COVID-19 pandemic. Methods: Panel data from 911 participants were collected in April and May 2020 and again 6 months later. We analyzed the relationship between economic loss and anxiety and investigated the moderating effects of knowledge about COVID-19, gratitude, and perceived stress. Moreover, we investigated whether there were any changes in moderating effects over time or in different demographic groups. Results: In the early stages of the spread of COVID-19, gratitude (B = -0.0211, F = 4.8130, p < 0.05) and perceived stress (B = 0.0278, F = 9.3139, p < 0.01) had moderating effects on the relationship between economic loss and anxiety. However, after 6 months, only perceived stress had a significant moderating effect (B = 0.0265, F = 7.8734, p < 0.01). Conclusion: In the early stages of COVID-19, lower levels of gratitude and higher perceived stress led to greater anxiety. In later stages of the prolonged pandemic, only perceived stress had a continued moderating effect on the relationship between economic loss and anxiety. This study suggests that psychological interventions to reduce perceived stress are needed to treat the possible adverse effects of the spread of infectious diseases on mental health.

Factors Associated With Depression and Anxiety in Korean Adolescents During the COVID-19 Pandemic.

OBJECTIVE: This study was performed to identify factors associated with depression and anxiety among Korean adolescents during the coronavirus disease (COVID-19) pandemic. METHODS: We conducted a cross-sectional study of 1,898 Korean adolescents (55.2% male, 44.8% female) ranging in age from 12 to 17 years (mean±standard deviaion age, 15.4±2.6 years). Depression and anxiety were defined as a Patient Health Questionnaire-9 score ≥10 and Generalized Anxiety Disorder-7 score ≥10, respectively. Other questionnaires included sociodemographic data, psychosocial stresses, and experiences in association with COVID-19. Psychiatric scales included Gratitude Questionnaire-6, Perceived Stress Scale-10, and UCLA Loneliness Scale-3. RESULTS: The prevalence rates of depressive and anxiety symptoms among participants were 13.8% and 21.0%, respectively. Multivariable logistic regression analysis revealed that female sex, fear of COVID-19 infection, low gratitude were risk factors for depression. Fear of COVID-19 infection, increased TV watching time, and academic-related stress were risk factors for anxiety. CONCLUSION: Depression and anxiety were prevalent during the pandemic in Korean adolescents, and were associated with fear of COVID-19 infection. Providing appropriate information on COVID-19, helping adolescents manage academic-related stress and maintain daily life patterns, and implementing interventions to foster gratitude are important for preventing depression and anxiety in Korean adolescents.

Relationship Between Economic Loss and Anxiety During the Coronavirus Disease 2019 Pandemic: Moderating Effects of Knowledge, Gratitude, and Perceived Stress

Objectives The prolonged coronavirus disease 2019 (COVID-19) pandemic has caused individuals to suffer economic losses, in particular due to the implementation of intensive quarantine policies. Economic loss can cause anxiety and has a negative psychological impact on individuals, worsening their mental health and satisfaction with life. We examined the protective and risk factors that can influence the relationship between economic loss and anxiety during the COVID-19 pandemic. Methods Panel data from 911 participants were collected in April and May 2020 and again 6 months later. We analyzed the relationship between economic loss and anxiety and investigated the moderating effects of knowledge about COVID-19, gratitude, and perceived stress. Moreover, we investigated whether there were any changes in moderating effects over time or in different demographic groups. Results In the early stages of the spread of COVID-19, gratitude (B = –0.0211, F = 4.8130, p < 0.05) and perceived stress (B = 0.0278, F = 9.3139, p < 0.01) had moderating effects on the relationship between economic loss and anxiety. However, after 6 months, only perceived stress had a significant moderating effect (B = 0.0265, F = 7.8734, p < 0.01). Conclusion In the early stages of COVID-19, lower levels of gratitude and higher perceived stress led to greater anxiety. In later stages of the prolonged pandemic, only perceived stress had a continued moderating effect on the relationship between economic loss and anxiety. This study suggests that psychological interventions to reduce perceived stress are needed to treat the possible adverse effects of the spread of infectious diseases on mental health.

Effects of COVID-19-related stress and fear on depression in schizophrenia patients and the general population.

This study compared the coronavirus disease 2019 (COVID-19)-related stress, fear of infection, loneliness, and depression between patients with schizophrenia and the general population. A face-to-face survey was administered to 1340 patients with a schizophrenia spectrum disorder and online survey of the general population (n = 2000) was conducted. The information gathered included the level of COVID-19-related stress, fear of infection, the Patient Health Questionnaire-9 score, and the three-item UCLA Loneliness Scale score. Structural equation modeling revealed a significant effect of fear of COVID-19 infection on depression among the general population and on loneliness among patients with schizophrenia. Loneliness experienced during COVID-19 exacerbated depression in both groups. In the COVID-19-related stress-loneliness-depression pathway, the partial mediating effect of loneliness was significant in both groups. Conversely, in the COVID-19-related fear-loneliness-depression pathway, the full mediating effect of loneliness was only significant in patients with schizophrenia. In conclusion, the loneliness associated with COVID-19-related stress and fear of infection was an important factor influencing depression, and the impact was greater in patients with schizophrenia compared with the general population. Thus, different mental health intervention plans are needed for patients with schizophrenia during the COVID-19 pandemic. During the long-lasting COVID-19 pandemic, social support and provision of mental health services to prevent loneliness and consequent depression are required in patients with schizophrenia.

Decline in Hospital Visits by Patients with Schizophrenia Early in the COVID-19 Outbreak in Korea.

OBJECTIVE: This study investigated trends in hospital utilization by patients with schizophrenia during the first wave of the COVID-19 outbreak in Korea. METHODS: The Prophet algorithm was used to predict the monthly number of patients with schizophrenia in 2020 based on medical insurance data between 2010 and 2019. The projected expectations were compared with the actual number of patients receiving outpatient and inpatient treatment each month in the first half of 2020. We conduct interrupted time series analyses of short-term data to determine the significance of recent changes in the trend of hospital visits by patients with schizophrenia. RESULTS: The prediction model showed that the actual number of patients receiving treatment each month during the early COVID-19 outbreak decreased by up to 3.6% compared to the projected expectations. The interrupted time series model also revealed a significant change in hospital utilization compared to the year before the onset of COVID-19 in Korea (F = 8.961, p = 0.010). CONCLUSION: This suggests that many patients with schizophrenia were not receiving adequate treatment during the COVID-19 outbreak. A strategy should be developed to keep treating patients with schizophrenia during the COVID-19 pandemic.

Using psychoneuroimmunity against COVID-19.

The worldwide outbreak of coronavirus disease 2019 (COVID-19) raises concerns of widespread panic and anxiety in individuals subjected to the real or perceived threat of the virus. Compared to general populations, patients who are institutionalized in a closed unit are also very vulnerable to COVID-19 infection and complications. This crisis touched on difficult issues of not only psychiatric care and ethics, but also psychological impacts to psychiatric care givers. In this Viewpoint, we address both physical and biopsychosocial aspects of this infection, as well as the psychoneuroimmunity of preventive strategies of healthy lifestyle, regular exercise, balanced nutrition, quality sleep and a strong connection with people. Social distancing and wearing masks might help us from pathogen exposure, yet such these measures also prevent us from expressing compassion and friendliness. Therefore, all forms of psychological support should be routinely implemented not only to consider psychological resilience but also to enhance psychoneuroimmunity against COVID-19.

The association of gratitude with perceived stress among nurses in Korea during COVID-19 outbreak.

BACKGROUND: During the COVID-19 pandemic, nurses might experience added emotional stress. This study examined the relationship between gratitude and psychological stress to explore effective psychological support among nurses. METHODS: A cross-sectional survey assessed the level of psychological distress in 646 nurses in Gwangju, South Korea, using the Perceived Stress Scale-10 (PSS-10), Gratitude Questionnaire-6 (K-GQ-6), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Maslach Burnout Inventory-General Survey (MBI-GS). Sociodemographic factors and COVID-19-related experiences were also examined. A linear regression model was used to determine the factors influencing perceived stress. RESULTS: The mean PSS-10 score was 19.0 ± 4.4. Linear regression analyses revealed that the MBI-GS-Exhaustion, PHQ-9, and GAD-7 scores were positively associated with perceived stress, while the MBI-GS-Professional efficacy score was inversely associated with perceived stress. Gratitude disposition using the K-GQ-6 score negatively predicted PSS-10 (ß = 0.829, p < 0.001). CONCLUSIONS: Psychological interventions that help cultivate gratitude and professional efficacy among nurses can help promote stress resilience throughout the course of the COVID-19 pandemic.

Factors Associated With a Negative Emotional Response to News Media and Nationwide Emergency Text Alerts During the COVID-19 Outbreak in Korea.

OBJECTIVE: To prevent the spread of infection in Korea during the corona virus disease 2019 (COVID-19) outbreak, real-time warnings have been sent to all residents via mobile phones. This study examined the factors associated with the negative emotional response to media news and emergency text alerts in the COVID-19 pandemic. METHODS: A survey was completed by 1,500 adults from an online public panel in three regions. We used Patient Health Questionnaire-9 (PHQ-9), generalized anxiety disorder-7 (GAD-7) and Perceived Stress Scale-10 (PSS-10) to assess the level of depression, anxiety and stress, respectively. Questionnaires related to COVID-19 included fear of infection, and fear of disclose of contact-tracing information. RESULTS: The negative emotional response on both news media information and emergency alert text messages about COVID-19 was associated with fear of COVID-19 infection and high anxiety. The biggest outbreak city, Daegu was associated with the less negative emotional response on emergency alert text messages. Fear of disclose of contact-tracing information was significantly associated with negative emotional perception on emergency alter text messages. CONCLUSION: Our results suggest that effective information providing services with considering vulnerable groups are needed to promote acceptance and eliminate negative emotion for disease related information.

Risk and protective factors of depression in the general population during the COVID-19 epidemic in Korea.

BACKGROUND: The risk of depression has risen in the general population during the COVID-19 epidemic. This study was conducted to explore risk and protective factors associated with depression among the general population uninfected by COVID-19. METHODS: A cross-sectional study was conducted with 1,500 representative South Korean citizens aged 19-65 years through an anonymous online survey. Depression was defined as a Patient Health Questionnaire-9 score of 10 or higher. Other questionnaires included one measuring psycho-behavioural and social changes, and stress, due to COVID-19, a six-item version of the Gratitude Questionnaire (GQ-6), and a three-item version of the UCLA loneliness scale. RESULTS: Of the 1492 participants not infected by COVID-19, 312 (20.9%) exhibited depression. Multiple logistic regression analysis revealed that depression was positively associated with COVID-19-related stress and psycho-behavioural variables such as disturbances in eating and sleeping, younger age, smoking, underlying mental illness, and loneliness scale scores. In contrast, exercise three or more times per week and GQ-6 scale scores were inversely associated with depression. CONCLUSION: During the COVID-19 pandemic, maintaining daily routines including eating, sleeping, and regular exercise and focusing on gratitude may be important for the prevention of depression. In addition, more attention should be paid to vulnerable populations, including young people, those with mental illnesses, and smokers, who might be more susceptible to depression.

Associations Between COVID-19 Symptoms and Psychological Distress.

Background: Hospital isolation for COVID-19 may cause significant psychological stress. The association between COVID-19 symptoms and psychological symptoms has not been systematically studied. We investigated the effects of telephonic intervention on the relationship between psychological symptoms and COVID-19 symptoms at the time of hospitalization and 1 week later. Method: We screened 461 patients with COVID-19 for psychiatric symptoms from February 29, 2020, to January 3, 2021. In total, 461 patients were evaluated 2 days after admission, and 322 (69.8%) were followed 1 week later. To assess anxiety and depressive symptoms, the Hospital Anxiety and Depression Scale (HADS) was administered to patients once per week. The Insomnia Severity Index (ISI) and item 9 of the Beck Depression Inventory (BDI-9) were used weekly to assess insomnia and suicidal ideation. Results: Of 461 enrolled patients, we observed clinically meaningful psychological anxiety symptoms (in 75/16.3% of patients), depression (122/26.5%), insomnia (154/33.4%), and suicidal ideation (54/11.7%). Commonly reported COVID-19 symptoms are cough/sputum/sneezing (244, 52.9%), headache/dizziness (98, 21.3%), myalgia (113, 24.5%), and sore throat (89, 19.3%). Compared to baseline, significant improvements were found in anxiety, depression, and suicidal ideation at 1 week. No significant group differences in ISI score were observed. Conclusions: COVID-19 symptoms at baseline had a significant and persistent negative impact on anxiety and depression at admission and at 1 week after hospitalization. Early intervention is essential to improve the outcomes of patients with mental illness.

Comparison of Psychosocial Distress in Areas With Different COVID-19 Prevalence in Korea.

Objectives: This study aimed to compare psychosocial distress in areas in Korea with different prevalence of coronavirus disease 2019 (COVID-19) after validating a questionnaire on psychological experiences and stress associated with the disease outbreak. Methods: Using an online-based survey, psychosocial distress associated with COVID-19 was investigated in three regions, which were selected according to their prevalence of COVID-19. A total of 1,500 people from an online public panel in the three regions participated in the study. The questionnaire included sociodemographic information, psychosocial experience and stress related to COVID-19, and the perceived stress scale (PSS), patient health questionnaire-9 (PHQ-9), and generalized anxiety disorder-7 (GAD-7). Those questionnaires and scales were compared by level of prevalence of COVID-19 after validating the questionnaire on psychosocial distress associated with COVID-19. Results: The 19 items on psychosocial experience associated with COVID-19 comprised 5 subscales, with favorable Cronbach's α ranging from 0.69 to 0.88. Six stress items related to COVID-19 had a Cronbach's α of 0.79. Disturbance in eating and sleeping, difficulty with outside activities, stress from COVID-19, and PSS scores were greater in the areas where COVID-19 was highly prevalent. Economic problems, daily activity changes, and anger toward society were higher in the higher-prevalence regions. Discussion: Psychosocial distress associated with COVID-19 was closely related to the prevalence of the disease in the areas where participants lived. Psychosocial interventions for distress associated with COVID-19 should be developed and prepared for people during this lengthy pandemic.

The Relationships among Media Usage Regarding COVID-19, Knowledge about Infection, and Anxiety: Structural Model Analysis.

BACKGROUND: We examined the effects of mass media usage on people's level of knowledge about coronavirus disease 2019 (COVID-19), fear of infection, prejudice towards infected people, and anxiety level. In addition, we investigated whether knowledge about COVID-19 can reduce fear, prejudice, and anxiety. METHODS: We performed an anonymous online survey in 1,500 residents aged 19-65 years between April 24 and May 5 of 2020. Anxiety level was assessed using the generalized anxiety disorder-7 scale. We used a questionnaire to investigate COVID-19-related media use, knowledge about COVID-19, fear of infection, and prejudice towards infected people. We analyzed the relationships among the variables using the structural equation model. RESULTS: Media use had significant effects on fear of infection, prejudice against infected people, and anxiety. Knowledge about COVID-19 had a significant protective effect on fear of infection, prejudice against infected people, and anxiety. However, the effect of media use on knowledge about COVID-19 was not statistically significant. There was a partial mediating effect of prejudice against infected people and fear of infection on media usage and anxiety. CONCLUSION: Our study demonstrated significant effects of mass media coverage regarding COVID-19 on fear, prejudice, and anxiety. While knowledge about COVID-19 could decrease fear, prejudice, and anxiety, the use of mass media did not enhance this knowledge. Medical societies should guide mass media reporting of COVID-19 and provide appropriate public education.

Telephone based Interventions for Psychological Problems in Hospital Isolated Patients with COVID-19.

OBJECTIVE: : The COVID-19 is overwhelming health care systems globally. Hospital isolation may generate considerable psychological stress. However, there has been scarce evidence on psychological interventions for these patients due to maintain staff safety. We investigated the feasibility and effectiveness of telephone based interventions for psychological problems in hospital isolated patients with COVID-19. METHODS: Psychiatrists visited the ward where the patients were hospitalized and interventions were given by using a ward telephone for 30 minutes. All patients were approached to receive a two-week psychological intervention program and/or pharmacotherapy whenever needed. Psychological problems were assessed at baseline, one, and two weeks. For the assessment of anxiety and depressive symptoms, the Hospital Anxiety and Depression Scale was administered to patients once a week. Insomnia severity index and Beck Depression Inventory 9 item were checked weekly to assess insomnia and suicide idea. RESULTS: Of 33 enrolled, clinically meaningful psychological symptoms were found in 6 (18%) patients for anxiety; 13 (39%) for depression; 10 (30%) for insomnia; and 3 (9%) for suicidal ideation. In 9 patients (27%), psychotropic medications were prescribed to manage anxiety, agitation, depressed mood, insomnia, impulsivity, and suicide idea. Compared to baseline, significant improvements were found in anxiety, depression, and suicidal ideation at one week. There were no statistical differences between the values evaluated at baseline and at two weeks. CONCLUSION: Our report at least indicates potential usefulness of telephone based interventions in hospital isolated patients with COVID-19, and will hopefully form the basis for future randomized clinical trials.