Long-Term Impact of COVID-19 on Heart Rate Variability: A Systematic Review of Observational Studies.

Coronavirus disease 2019 (COVID-19) sequelae (or long COVID) has become a clinically significant concern. Several studies have reported the relationship between heart rate variability (HRV) parameters and COVID-19. This review investigates the long-term association between COVID-19 and HRV parameters. Four electronic databases were searched up to 29 July 2022. We included observational studies comparing HRV parameters (measurement durations: 1 min or more) in participants with and without a history of COVID-19. We used assessment tools developed by the National Heart, Lung, and Blood Institute group to evaluate the methodological quality of included studies. Eleven cross-sectional studies compared HRV parameters in individuals who recovered from acute COVID-19 infection to controls (n = 2197). Most studies reported standard deviation of normal-to-normal intervals (SDNN) and root mean square of the successive differences. The methodological quality of the included studies was not optimal. The included studies generally found decreased SDNN and parasympathetic activity in post-COVID-19 individuals. Compared to controls, decreases in SDNN were observed in individuals who recovered from COVID-19 or had long COVID. Most of the included studies emphasized parasympathetic inhibition in post-COVID-19 conditions. Due to the methodological limitations of measuring HRV parameters, the findings should be further validated by robust prospective longitudinal studies.

Research and Public Interest in Mindfulness in the COVID-19 and Post-COVID-19 Era: A Bibliometric and Google Trends Analysis.

Public and research interest in mindfulness has been growing, and the Coronavirus disease 2019 (COVID-19) pandemic seems to have accelerated this growth. This study was conducted to investigate the public and research interest in mindfulness in the context of COVID-19. The term 'Mindfulness' was searched in Google Trends, and data were collected from December 2004 to November 2022. The relationship between the relative search volume (RSV) of 'Mindfulness' and that of related topics was analyzed, and 'Top related topics and queries' for the search term 'Mindfulness' were investigated. For bibliometric analysis, a search was conducted in the Web of Science database. Keyword co-occurrence analysis was conducted, and a two-dimensional keyword map was constructed using VOSviewer software. Overall, the RSV of 'Mindfulness' increased slightly. The RSVs of 'Mindfulness' and 'Antidepressants' showed an overall significant positive correlation (r = 0.485) but a statistically significant negative correlation during the COVID-19 era (-0.470). Articles on mindfulness in the context of COVID-19 were closely related to depression, anxiety, stress, and mental health. Four clusters of articles were identified, including 'mindfulness', 'COVID-19', 'anxiety and depression', and 'mental health'. These findings may provide insights into potential areas of interest and identify ongoing trends in this field.

The Impact of SARS-CoV-2 Infection on Heart Rate Variability: A Systematic Review of Observational Studies with Control Groups.

Autonomic nervous system (ANS) dysfunction can arise after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and heart rate variability (HRV) tests can assess its integrity. This review investigated the relationship between the impact of SARS-CoV-2 infection on HRV parameters. Comprehensive searches were conducted in four electronic databases. Observational studies with a control group reporting the direct impact of SARS-CoV-2 infection on the HRV parameters in July 2022 were included. A total of 17 observational studies were included in this review. The square root of the mean squared differences of successive NN intervals (RMSSD) was the most frequently investigated. Some studies found that decreases in RMSSD and high frequency (HF) power were associated with SARS-CoV-2 infection or the poor prognosis of COVID-19. Also, decreases in RMSSD and increases in the normalized unit of HF power were related to death in critically ill COVID-19 patients. The findings showed that SARS-CoV-2 infection, and the severity and prognosis of COVID-19, are likely to be reflected in some HRV-related parameters. However, the considerable heterogeneity of the included studies was highlighted. The methodological quality of the included observational studies was not optimal. The findings suggest rigorous and accurate measurements of HRV parameters are highly needed on this topic.

The First Attempt to Apply an Online Mindfulness Program to Nursing Staff in a Traditional Korean Medicine Clinic in COVID-19 Era: A Case Series.

The importance of medical personnel's mental health is emphasized in the COVID-19 era. The characteristics of traditional Korean medicine (KM) may affect the mental health of nursing staff working at KM clinics. In this case series, we report the first attempt to apply an online mindfulness program to the nursing staff in a KM clinic in Korea. For three female nursing assistants, an online mindfulness program consisting of five sessions was offered for two months. After the program, a decrease in emotional labor was observed in two participants, and a decrease in the level of burnout was observed in all participants. One participant showed an increase in their emotional labor level, which was associated with an increase in deep acting. The participants expressed a high level of satisfaction with this program in terms of recommendations for peers and willingness to participate again. As this report is a case series, larger studies are needed to fully evaluate the benefits of the program on emotional labor and burnout of KM clinic nursing staff. However, the potential benefits of emotional labor and burnout, high satisfaction, and some challenges identified in this case series can be considered in future extensions and modifications of the program.

Impact of COVID-19 Vaccination on Heart Rate Variability: A Systematic Review.

Establishing and disseminating evidence-based safety information could potentially facilitate beneficial choices in coronavirus disease (COVID-19) vaccinations. This systematic review investigated the potential impact of COVID-19 vaccinations on human heart rate variability (HRV) parameters through comprehensive searches of four electronic medical databases. Five observational studies reporting HRV parameters of individuals vaccinated against COVID-19 and published up to 29 July 2022 were included in this review. Among them, four studies reported the square root of the mean squared differences of successive NN intervals (RMSSD) as their outcome, and the remaining study reported an HRV-based stress indicator. These studies reported short-term changes and rapid recovery in HRV parameters within up to 3 days after COVID-19 vaccination. Some studies showed that the impact of COVID-19 vaccinations on RMSSD was greater in women than men, and in the younger group than in the older group. The methodological quality of the included studies was not optimal; the review revealed short-term changes in HRV parameters, particularly RMSSD, following COVID-19 vaccination. However, as the included studies did not report important parameters besides RMSSD, the limitation exists that the postvaccination long-term HRV stability was not reported.

Lack of Interventional Studies on Suicide Prevention among Healthcare Workers: Research Gap Revealed in a Systematic Review.

Addressing the mental health needs of healthcare workers (HCWs), who are at high risk of suicide, is an important public health issue. Therefore, this systematic review investigated the effect of psychosocial intervention targeting suicidal behavior (i.e., suicidal ideation, attempt, or fulfillment) of HCWs. Five electronic databases were searched for interventional studies reporting HCWs' suicidal behavior outcomes. Only two interventional studies were included in this review, and no consistent conclusion was drawn from the existing literature regarding the psychosocial prevention strategies focusing on the suicide risk of HCWs. The results indicate that compared with numerous observational studies reporting poor mental health and/or severity of suicidal risk among HCWs, intervention studies using psychosocial strategies to reduce the risk of suicide are relatively scarce. Although the insufficient number and heterogeneity of the included studies leave the results inconclusive, our findings emphasize the need to fill the research gap in this field. The causes of the gap are further explored, and suggestions for future research are provided.

Use of Information and Communication Technologies to Enhance Self-Acupressure: a Literature Review.

Currently, acupressure is widely accepted as a non-pharmacological therapy for managing pain, nausea and vomiting, and mental health conditions. Since acupressure can be self-administered, clinicians and researchers' interest in information and communication technologies (ICTs) for disseminating acupressure to manage symptoms has increased. This mini review was conducted to examine clinical studies of acupressure using ICTs, with a particular focus on self-acupressure. Through a search of MEDLINE, EMBASE, and CENTRAL, all studies of self-acupressure using ICTs published before December 31, 2021 were collected. Twelve studies met the inclusion criteria. More than half of the studies published since 2020 (4/7, 54.14%) were described as being related to COVID-19. As target conditions, musculoskeletal injuries or pain, cancer-related symptoms, dysmenorrhea, mental health issues, and obesity were considered. The most frequently used acupoints were LI4, LR3, and Shenmen. Moreover, smartphone applications were the most commonly used ICT method to support self-acupressure. In addition to the basic information of self-acupressure, other tools such as timers, reminders, and schedule checkers to facilitate its implementations have been incorporated into the smartphone applications. Recently, there have been some attempts to combine acupressure and ICTs. Although these studies mainly focus on musculoskeletal pain or injuries, recent studies related to mental health have emerged in relation to COVID-19. However, few studies have been conducted to date, making it difficult to fully grasp the trends in this field. Therefore, more studies are needed to evaluate the feasibility and efficacy of combining self-acupressure and ICTs in more diverse clinical areas.

Systematic Review of Mind-Body Modalities to Manage the Mental Health of Healthcare Workers during the COVID-19 Era.

Healthcare workers (HCWs) have suffered physical and psychological threats since the beginning of the coronavirus disease 2019 (COVID-19) pandemic. Mind-body modalities (MBMs) can reduce the long-term adverse health effects associated with COVID-specific chronic stress. This systematic review aims to investigate the role of MBMs in managing the mental health of HCWs during the COVID-19 pandemic. A comprehensive search was conducted using 6 electronic databases, resulting in 18 clinical studies from 2019 to September 2021. Meta-analysis showed that MBMs significantly improved the perceived stress of HCWs (standardized mean difference, -0.37; 95% confidence intervals, -0.53 to -0.21). In addition, some MBMs had significant positive effects on psychological trauma, burnout, insomnia, anxiety, depression, self-compassion, mindfulness, quality of life, resilience, and well-being, but not psychological trauma and self-efficacy of HCWs. This review provides data supporting the potential of some MBMs to improve the mental health of HCWs during COVID-19. However, owing to poor methodological quality and heterogeneity of interventions and outcomes of the included studies, further high-quality clinical trials are needed on this topic in the future.

The effectiveness of e-healthcare interventions for mental health of nurses: A PRISMA-compliant systematic review of randomized controlled trials.

BACKGROUND: Mental health problems, including burnout among nurses, are common and important. With the rapid development of information and communication technologies and the rise in use of smartphones, the use of e-mental health strategies is increasing in public and clinical settings, and initial clinical trials using this intervention have been conducted. This systematic review evaluated whether e-healthcare interventions improve burnout and other mental health aspects in nurses. METHODS: Six electronic databases including MEDLINE (via PubMed), EMBASE (via Elsevier), the Cochrane Library Central Register of Controlled Trials, the Cumulative Index of Nursing and Allied Health Literature, the Allied and Complementary Medicine Database, and PsycARTICLES were searched to collect relevant randomized controlled trials up to January 28, 2021, using e-healthcare interventions for mental health in nurses. The e-healthcare intervention was classified as web-based, smartphone-based, and real-time online interventions. The primary outcome was burnout in this population. Due to the heterogeneity of the interventions used in the included studies, quantitative synthesis was not performed, but included studies were analyzed qualitatively. Also, the details of e-healthcare for the mental health of nurses were analyzed. The methodological quality of included studies was assessed using Cochrane's Risk of Bias tool. RESULTS: Seven randomized controlled trials were included in this study. The 20-minute session of an online form of the emotional freedom technique was reported to significantly improve burnout severity compared to no intervention (P < .001). Other outcomes, such as career identity, quality of work life, workplace bullying, job stress, turnover intention, distress, anxiety, and resilience in nurses, were also reported to be improved by e-healthcare interventions. The methodological quality of the included studies was generally poor. CONCLUSIONS: In conclusion, there was some evidence that e-healthcare interventions may improve mental health outcomes, including burnout in nurses, compared with no intervention. However, due to the poor methodological quality and wide heterogeneity of the interventions and outcomes in the included studies, we were not able to reach sufficiently reliable conclusions. E-healthcare intervention for nurses in the new coronavirus disease era was discussed. High-quality clinical trials in this area should be conducted in the future.

Systematic Review of Mind–Body Modalities to Manage the Mental Health of Healthcare Workers during the COVID-19 Era

Healthcare workers (HCWs) have suffered physical and psychological threats since the beginning of the coronavirus disease 2019 (COVID-19) pandemic. Mind-body modalities (MBMs) can reduce the long-term adverse health effects associated with COVID-specific chronic stress. This systematic review aims to investigate the role of MBMs in managing the mental health of HCWs during the COVID-19 pandemic. A comprehensive search was conducted using 6 electronic databases, resulting in 18 clinical studies from 2019 to September 2021. Meta-analysis showed that MBMs significantly improved the perceived stress of HCWs (standardized mean difference, −0.37;95% confidence intervals, −0.53 to −0.21). In addition, some MBMs had significant positive effects on psychological trauma, burnout, insomnia, anxiety, depression, self-compassion, mindfulness, quality of life, resilience, and well-being, but not psychological trauma and self-efficacy of HCWs. This review provides data supporting the potential of some MBMs to improve the mental health of HCWs during COVID-19. However, owing to poor methodological quality and heterogeneity of interventions and outcomes of the included studies, further high-quality clinical trials are needed on this topic in the future.

Using Mind-Body Modalities via Telemedicine during the COVID-19 Crisis: Cases in the Republic of Korea.

The coronavirus disease 2019 (COVID-19) pandemic affected the world, and its deleterious effects on human domestic life, society, economics, and especially on human mental health are expected to continue. Mental health experts highlighted health issues this pandemic may cause, such as depression, anxiety, obsessive compulsive disorder, and post-traumatic stress disorder. Mind-body intervention, such as mindfulness meditation, has accumulated sufficient empirical evidence supporting the efficacy in improving human mental health states and the use for this purpose has been increasing. Notably, some of these interventions have already been tried in the form of telemedicine or eHealth. Korea, located adjacent to China, was exposed to COVID-19 from a relatively early stage, and today it is evaluated to have been successful in controlling this disease. "The COVID-19 telemedicine center of Korean medicine" has treated more than 20% of the confirmed COVID-19 patients in Korea with telemedicine since 9 March 2020. The center used telemedicine and mind-body modalities (including mindfulness meditation) to improve the mental health of patients diagnosed with COVID-19. In this paper, the telemedicine manual is introduced to provide insights into the development of mental health interventions for COVID-19 and other large-scale disasters in the upcoming new-normal era.

Comparison of the Mental Health Impact of COVID-19 on Vulnerable and Non-Vulnerable Groups: A Systematic Review and Meta-Analysis of Observational Studies.

Vulnerable populations may be more vulnerable to mental health problems posed by the coronavirus disease 2019 (COVID-19) pandemic. A systematic review was performed to compare the mental health impact of COVID-19 between vulnerable and non-vulnerable groups. Five electronic databases were searched for observational studies reporting the psychological outcomes of both vulnerable populations and healthy controls during the COVID-19 era. The primary outcomes are the severity of depression and anxiety, and secondary outcomes include other aspects of mental health such as stress or sleep disturbance. Meta-analysis was performed for the severity of mental health symptoms, and the results were presented as standardized mean difference and 95% confidence intervals. A total of 25 studies were included. According to the findings, the elderly generally experienced significantly lower levels of psychological symptoms including depression, anxiety, and perceived stress. Pregnant women, patients with chronic diseases, and patients with pre-existing severe mental disorders showed mixed results according to each mental health outcome. The results indicate that vulnerable groups have been affected differently in the COVID-19 era. Though the insufficient number and heterogeneity of included studies leave the results inconclusive, our findings may contribute to identifying priorities of mental health needs among various vulnerable populations and allocating health resources with efficiency.

Emotional Labor, Burnout, Medical Error, and Turnover Intention among South Korean Nursing Staff in a University Hospital Setting.

Nurses are vulnerable to mental health challenges, including burnout, as they are exposed to adverse job conditions such as high workload. The mental health of this population can relate not only to individual well-being but also to patient safety outcomes. Therefore, there is a need for a mental health improvement strategy that targets this population. This cross-sectional survey study investigates emotional labor, burnout, turnover intention, and medical error levels among 117 nursing staff members in a South Korean university hospital; it also analyzes correlations among outcomes and conduct correlation analysis and multiple regression analysis to determine relationships among these factors. The participants had moderate to high levels of emotional labor and burnout, and 23% had experienced medical errors within the last six months. Save for medical errors, all outcomes significantly and positively correlated with each other. These results can be used to improve the mental health outcomes of nurses working in the hospital and their consequences. Specifically, the job positions of nursing personnel may be a major consideration in such a strategy, and job-focused emotional labor and employee-focused emotional labor may be promising targets in ameliorating turnover intention and client-related burnout, respectively.

A Protocol for a Systematic Review and Meta-Analysis of Mind-Body Modalities to Manage the Mental Health of Healthcare Workers during the COVID-19 Era.

The coronavirus disease 2019 (COVID-19) pandemic has become an unprecedented threat to humanity worldwide, including healthcare workers (HCWs). Mind-body modalities have been used to improve the mental health, well-being, quality of life, and physical health of clinical and general populations, and may also be used to improve the mental health of HCWs during COVID-19. The objective of this review is to analyze the effectiveness of mind-body modalities for the mental health of HCWs in the COVID-19 era. Six electronic bibliographic databases were comprehensively searched to find intervention studies using mind-body modalities, including meditation, mindfulness-based intervention, autogenic training, yoga, tai chi, qigong, breathing exercise, music therapy, guided imagery, biofeedback, prayer, and faith-based techniques for HCWs. All intervention studies conducted from December 2019 to August 2021 will be included. Quality assessment will be performed according to study type, and Cochrane Collaboration's Risk of Bias tool will be used for randomized controlled clinical trials (RCTs). If sufficient homogeneous data from RCTs exist, a meta-analysis will be performed. Dichotomous data and continuous data are presented as risk ratios and mean differences with their 95% confidence intervals, respectively. The results of this systematic review will be disseminated through the publication of a manuscript in a peer-reviewed journal or by presentation at a conference.

The Effectiveness and Safety of Mind-Body Modalities for Mental Health of Nurses in Hospital Setting: A Systematic Review.

The mental health of nurses including burnout is an important issue. The purpose of this systematic review was to evaluate whether mind-body modalities improve burnout and other mental health aspects of nurses. A comprehensive search was conducted using six electronic databases. Randomized controlled trials using mind-body modalities on the mental health of nurses, up to January 2021, were included. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool. Seventeen studies were included in the review. Data on mindfulness-based interventions (MBIs) and yoga were available for burnout, and there was no evidence that multimodal resilience programs including MBIs statistically significantly improved burnout levels compared to no intervention or active control groups. However, one study reported that yoga could significantly improve emotional exhaustion and depersonalization, which are subscales of burnout, compared to usual care. In addition, the effects of MBIs, relaxation, yoga, and music on various mental health outcomes and stress-related symptoms have been reported. In conclusion, there was some evidence that yoga was helpful for improvement in burnout of nurses. However, due to the heterogeneity of interventions and outcomes of the studies included, further high-quality clinical trials are needed on this topic in the future.