Six addiction components of problematic social media use in relation to depression, anxiety, and stress symptoms: a latent profile analysis and network analysis.

BACKGROUNDS: Components of addiction (salience, tolerance, mood modification, relapse, withdrawal, and conflict) is the most cited theoretical framework for problematic social media use (PSMU). However, studies criticized its ability to distinguish problematic users from engaged users. We aimed to assess the association of the six criteria with depression, anxiety, and stress at a symptom level. METHODS: Ten thousand six hundred sixty-eight participants were recruited. Bergen Social Media Addiction Scale (BSMAS) was used to detect six addiction components in PSMU. We applied the depression-anxiety-stress scale to assess mental distress. Latent profile analysis (LPA) was conducted based on BSMAS items. Network analysis (NA) was performed to determine the symptom-symptom interaction of PSMU and mental distress. RESULTS: (1) Social media users were divided into five subgroups including occasional users (10.6%, n = 1127), regular users (31.0%, n = 3309), high engagement low risk users (10.4%, n = 1115), at-risk users (38.1%, n = 4070), and problematic users (9.8%, n = 1047); (2) PSMU and mental distress varied markedly across subgroups. Problematic users had the most severe PSMU, depression, anxiety, and stress symptoms. High engagement users scored high on tolerance and salience criteria of PSMU but displayed little mental distress; (3) NA showed conflict and mood modification was the bridge symptoms across the network, while salience and tolerance exhibited weak association with mental distress. CONCLUSIONS: Salience and tolerance might not distinguish engaged users from problematic users. New frameworks and assessment tools focusing on the negative consequences of social media usage are needed.

A network analysis of anxiety and depression symptoms among Chinese nurses in the late stage of the COVID-19 pandemic.

Background: Nurses are at high risk for depression and anxiety symptoms after the outbreak of the COVID-19 pandemic. We aimed to assess the network structure of anxiety and depression symptoms among Chinese nurses in the late stage of this pandemic. Method: A total of 6,183 nurses were recruited across China from Oct 2020 to Apr 2021 through snowball sampling. We used Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder scale-7 (GAD-7) to assess depression and anxiety, respectively. We used the Ising model to estimate the network. The index "expected influence" and "bridge expected influence" were applied to determine the central symptoms and bridge symptoms of the anxiety-depression network. We tested the stability and accuracy of the network via the case-dropping procedure and non-parametric bootstrapping procedure. Result: The network had excellent stability and accuracy. Central symptoms included "restlessness", "trouble relaxing", "sad mood", and "uncontrollable worry". "Restlessness", "nervous", and "suicidal thoughts" served as bridge symptoms. Conclusion: Restlessness emerged as the strongest central and bridge symptom in the anxiety-depression network of nurses. Intervention on depression and anxiety symptoms in nurses should prioritize this symptom.

Effectiveness of a Brief Mindfulness-Based Intervention of "STOP touching your face" During the COVID-19 Pandemic: a Randomized Controlled Trial.

Objectives: Avoiding touching the eyes, nose, and mouth (T-zone) is a strategy to reduce the spread of COVID-19. This study evaluated the effectiveness of a brief mindfulness-based intervention (MBI) named "STOP (Stop, Take a Breath, Observe, Proceed) touching your face" for reducing face-touching behavior. Methods: In this online-based, two-arm, wait-list, randomized controlled trial, eligible participants were randomly assigned to the intervention (n = 545) or control group (n = 545). The results of 60-min self-monitoring of face-touching behavior were reported before and after the intervention. Reduction of the percentage of T-zone touching was the primary outcome, and reduction of face-touching frequency was a key secondary outcome. Outcomes were analyzed on an intention-to-treat (ITT) basis with a complete case analysis (CCA). Results: ITT analysis revealed that the percentage of T-zone touching was significantly reduced by 8.1% in the intervention group (from 81.1 to 73.0%, RR = 0.901, OR = 0.631, RD = - 0.081, p = 0.002), and insignificantly reduced by 0.6% in the control group (from 80.0 to 79.4%, p = 0.821). Fewer participants performed T-zone touching in the intervention group than in the control group (73.0% vs. 79.4%, RR = 0.919, OR = 0.700, RD = - 0.064, p = 0.015) after the intervention, and there was a greater reduction of T-zone touching frequency in the intervention group than in the control group [mean ± SD: 1.7 ± 5.13 vs. 0.7 ± 3.98, mean difference (95% CI): 1.03 (0.48 to 1.58), p < 0.001, Cohen's d = - 0.218]. The above results were further confirmed by CCA. Conclusions: This brief mindfulness-based intervention was potentially effective at reducing the spread of COVID-19 and could be further investigated as an intervention for preventing other infectious diseases spread by hand-to-face touching. Trial Registration: ClinicalTrials.gov NCT04330352. Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-022-02019-x.

Tracking the Impact of COVID-19 and Lockdown Policies on Public Mental Health Using Social Media: Infoveillance Study.

BACKGROUND: The COVID-19 pandemic and its corresponding preventive and control measures have increased the mental burden on the public. Understanding and tracking changes in public mental status can facilitate optimizing public mental health intervention and control strategies. OBJECTIVE: This study aimed to build a social media-based pipeline that tracks public mental changes and use it to understand public mental health status regarding the pandemic. METHODS: This study used COVID-19-related tweets posted from February 2020 to April 2022. The tweets were downloaded using unique identifiers through the Twitter application programming interface. We created a lexicon of 4 mental health problems (depression, anxiety, insomnia, and addiction) to identify mental health-related tweets and developed a dictionary for identifying health care workers. We analyzed temporal and geographic distributions of public mental health status during the pandemic and further compared distributions among health care workers versus the general public, supplemented by topic modeling on their underlying foci. Finally, we used interrupted time series analysis to examine the statewide impact of a lockdown policy on public mental health in 12 states. RESULTS: We extracted 4,213,005 tweets related to mental health and COVID-19 from 2,316,817 users. Of these tweets, 2,161,357 (51.3%) were related to "depression," whereas 1,923,635 (45.66%), 225,205 (5.35%), and 150,006 (3.56%) were related to "anxiety," "insomnia," and "addiction," respectively. Compared to the general public, health care workers had higher risks of all 4 types of problems (all P<.001), and they were more concerned about clinical topics than everyday issues (eg, "students' pressure," "panic buying," and "fuel problems") than the general public. Finally, the lockdown policy had significant associations with public mental health in 4 out of the 12 states we studied, among which Pennsylvania showed a positive association, whereas Michigan, North Carolina, and Ohio showed the opposite (all P<.05). CONCLUSIONS: The impact of COVID-19 and the corresponding control measures on the public's mental status is dynamic and shows variability among different cohorts regarding disease types, occupations, and regional groups. Health agencies and policy makers should primarily focus on depression (reported by 51.3% of the tweets) and insomnia (which has had an ever-increasing trend since the beginning of the pandemic), especially among health care workers. Our pipeline timely tracks and analyzes public mental health changes, especially when primary studies and large-scale surveys are difficult to conduct.

Gaming in China Before the COVID-19 Pandemic and After the Lifting of Lockdowns: a Nationwide Online Retrospective Survey.

With the lockdown and social distancing during the outbreak of coronavirus disease 2019 (COVID-19), gaming has become a popular leisure activity. This study aimed to explore changes in gaming behavior after the lifting of COVID-19 lockdowns and risk factors for increased gaming behavior. This online retrospective study included 5268 gamers. A total of 5% gamers scored 32 or higher on the 9-item Internet Gaming Disorder Scale-Short-Form (IGDS9-SF), suggesting diagnosis of internet gaming disorder (IGD). Over one-third of gamers reported an increase in time spent on gaming per day after the lockdowns were lifted. Logistic regression analysis revealed that gamers who were female, students, experienced stress, or scored higher on IGDS9-SF were more likely to spend more time on gaming per day after the lifting of lockdowns. These findings highlighted the needs for more effective coping strategies or interventions to prevent excessive gaming, especially for females and students.

Mental health conditions and academic burnout among medical and non-medical undergraduates during the mitigation of COVID-19 pandemic in China.

The outbreak of the novel coronavirus disease 2019 (COVID-19) has posed a great impact on people's mental health, especially for undergraduate students. This study aimed to compare the mental health conditions and academic burnout between medical and non-medical undergraduates in China when the COVID-19 pandemic is mitigating. A cross-sectional online survey was conducted among 4,972 undergraduates between October 2020 and April 2021, when the pandemic was basically under control. The survey included basic demographics information and standardized scales to evaluate depression, anxiety, perceived stress, daytime sleepiness, alcohol abuse/dependence, quality of life, fatigue, and academic burnout. Compared with medical undergraduates, non-medical undergraduates had higher rates of moderate to severe depression symptoms (29.1% vs. 17.9%, P < 0.001), moderate to severe anxiety symptoms (19.7% vs. 8.9%, P < 0.001), alcohol abuse/dependence (16.3% vs.10.3%, P < 0.001), excessive daytime sleepiness (47.4% vs. 43.4%, P = 0.018), high perceived stress (34.7% vs. 22.2%, P < 0.001), high level of fatigue (51.8% vs. 42.2%, P < 0.001), low QOL (35.8% vs. 21.4%, P < 0.001), and higher academic burnout score (59.4 vs. 57.5, P < 0.001). Being non-medical undergraduates, depression, alcohol abuse/dependence, excessive daytime sleepiness, and high perceived stress were positively associated with academic burnout, while high QOL was negatively associated with the burnout (all P < 0.001). Excessive daytime sleepiness was the strongest predictor for academic burnout.

Attitudes towards smoking and COVID-19, and changes in smoking behaviors before and after the outbreak of COVID-19: A nationwide cross-sectional survey study in China.

INTRODUCTION: China has more than 300 million current smokers. There is a controversy over smokers' risk of COVID-19 infection. Smoking is a risk factor for COVID-19 disease progression, and the outbreak of COVID-19 may change people's smoking behaviors. This study assessed people's attitudes towards 'smoking and COVID-19' and changes of smoking behaviors before and after the outbreak of COVID-19. METHODS: A cross-sectional web survey of 11009 adults in China was conducted between 7 May and 3 August 2020. Attitudes towards 'smoking and COVID-19' were compared among non-smokers (n=8837), ex-smokers (n=399) and current smokers (n=1773), and changes in smoking behaviors before and after the outbreak of COVID-19 were assessed among current smokers. RESULTS: Fewer current smokers (26.2%) agreed with the statement that 'Current smokers are more likely than ex-smokers or non-smokers to contract COVID-19' compared with non-smokers (53%) or ex-smokers (41.4%); fewer current smokers (55.9%) agreed with the statement 'If contracted, current smokers are more likely than ex-smokers or non-smokers to risk disease progression' compared with non-smokers (75.5%) or ex-smokers (68.7%). There were no changes in cigarettes smoked per day (mean ± SD: 13.3 ± 9.55 vs 13.4 ± 9.69, p=0.414), percentage of daily smokers (70.8% vs 71.1%, p=0.882) and percentage of smokers with motivation to quit (intend to quit within the next 6 months, 9.4% vs 10.9%, p=0.148) before and after the outbreak of COVID-19. CONCLUSIONS: The survey found that fewer current smokers agreed that smoking is a risk-factor for COVID-19 compared with non-smokers or ex-smokers. Among current smokers, there were no changes in their cigarette consumption and motivation to quit before and after the outbreak of COVID-19. More efforts are needed to educate smokers about the health risks of smoking, as well as efforts to promote their motivation to quit.

A Comparison of COVID-19 Stigma and AIDS Stigma During the COVID-19 Pandemic: A Cross-Sectional Study in China.

Objective: To understand the current situation of stigmatizing attitudes toward Coronavirus Disease 2019 (COVID-19) in China and compare it with acquired immunodeficiency syndrome (AIDS). Methods: Convenient sampling and vignette-based methods were used to recruit participants on WeChat. A demographic form and adopted stigma scale were used to collect participants' demographic information and stigmatizing attitudes toward COVID-19 and AIDS. Results: A total of 13,994 questionnaires were included in this study. A high portion of participants tend to avoid contact with individuals affected with COVID-19 (74.3%) or AIDS (59.0%), as well as their family members (70.4% for COVID-19 and 47.9% for AIDS). About half of the participants agreed that affected persons could not only cause problems to their own family but also have adverse effects on others (59.6% and 55.6% for COVID-19, 56.9 and 47.0% for AIDS). The agreements with statements about perceived stigma were similar but slightly higher than those about personal stigma in both COVID-19 and AIDS. Participants' agreements with all statements regarding personal and perceived stigma attitudes between COVID-19 and AIDS were all statistically significant (p < 0.001). Participants obtained COVID-19-related information mainly from social media (91.3%) and newspaper or television (77.1%) during the epidemic, and 61.0% of them thought information from newspapers or television was the most reliable. Conclusion: Several similarities and differences of people's attitude toward COVID-19 and AIDS were found. Avoidance, blame, and secondary discrimination to diagnosed persons and their surrounding persons were the main representations of COVID-19-related stigma. Stigma of COVID-19 had less moral link but more public panic. Experience from HIV-related stigma reduction and prevention can be applied to reduce COVID-19-related stigma.

Factors of Negative Affect in Elderly Patients With Substance Use Disorders During COVID-19 Pandemic.

Background: The outbreak of the novel coronavirus disease 2019 (COVID-19) has become the greatest public health emergency and has attracted global attention. During the COVID-19 pandemic, the negative affect (NA) of elderly patients with substance use disorders (SUDs) has also become a more serious public concern. The current study aims to clarify the NA and its influencing factors in elderly patients with SUDs during the pandemic. Methods: Two psychiatrists conducted semi-structured interviews with 77 SUD patients aged above 50 years to collect their demographical information and certain drug use characteristics. Barratt Impulse Scale and the Positive and Negative Affect Scale were used to obtain information about patients' self-reported impulsivity and NA. Results: Univariate linear regression analysis showed that NA was positively correlated with the frequency of drug use, type of SUDs, cravings during COVID-19, and impulsivity. Multiple linear regression analysis showed that being female, higher frequency of drug use, stronger cravings, and greater impulsiveness jointly accounted for the variation of NA in elderly patients with SUDs. Conclusions: This study confirmed that, during the COVID-19 pandemic, gender, frequency of drug use, cravings, and impulsivity were associated with NA in elderly patients with SUDs. This study provided a theoretical basis for clinicians to reduce the patients' NA.

General Perception of Doctor-Patient Relationship From Patients During the COVID-19 Pandemic in China: A Cross-Sectional Study.

The doctor-patient relationship (DPR) is essential in the process of medical consultations and treatments. Poor DPR may lead to poor medical outcomes, medical violence against doctors, and a negative perception of the healthcare system. Little is known about how DPR is affected during this novel coronavirus disease 2019 (COVID-19) pandemic. This cross-sectional study aimed to explore the DPR during the COVID-19 pandemic. There were 1,903 participants in China (95% response rate) who were recruited during the pandemic online via convenience and snowball sampling. Several questionnaires were used to evaluate participants' attitudes toward DPR, including the Patient-Doctor Relationship Questionnaire (PDRQ-9), Chinese Wake Forest Physician Trust Scale (C-WFPTS), a survey on medical violence against doctors, factors that affect and improve DPR, and general trust in medical services. Results revealed that DPR improved, and doctor-patient trust increased compared to participants' retrospective attitude before the pandemic. In addition, patients' violence against doctors decreased during the pandemic. Better doctor-patient trust and lower violence toward doctors are related to better DPR. Furthermore, we found that the main factors that could improve DPR include communication between doctors and patients, medical technology and services, and medical knowledge for patients. This study helped to better understand DPR in China, which may contribute to future health policies and medical practices in order to improve DPR and doctor-patient trust.

Social media use in China before and during COVID-19: Preliminary results from an online retrospective survey.

BACKGROUND: More people reported symptoms of stress, anxiety and depression during the outbreak of the coronavirus (COVID-19). They might have increased their social media use during the outbreak of COVID-19 compared to before COVID-19. METHODS: An online retrospective survey was conducted on a total sample of 10,963 participants. Social media use patterns before and during COVID-19, Social media addiction (SMA), and mental health problems (stress, anxiety, and depression) were assessed. RESULTS: This study found that, compared with before COVID-19, weekly social media use was significantly increased during COVID-19 (from 17.2 to 21.4 h). Nearly 40% of SMA respondents increased their weekly social media use ≥3.5 h. The prevalence rate of was 6.8%, and the prevalence rates of moderate or severe stress, anxiety, and depression were 10.8%, 26.4%, and 18.2%, respectively, during COVID-19. Female gender, experiencing moderate or severe stress, and SMA were associated with increased weekly social media use ≥3.5 h. Male gender, experiencing moderate or severe stress, anxiety, depression, and increased weekly social media use ≥3.5 h were associated with SMA. CONCLUSIONS: This study suggests a significant increase in social media use and a relatively high prevalence rate of SMA in China during COVID-19. Our findings identify factors associated with increased social media use and SMA that could be used to develop psychological interventions to prevent SMA during the COVID-19 epidemic.

Alcohol Consumption in China Before and During COVID-19: Preliminary Results From an Online Retrospective Survey.

Background: Alcohol is an important aspect of Chinese culture, and alcohol use has been traditionally accepted in China. People with stress, anxiety, and depression may use more alcohol. More people reported symptoms of anxiety and depression during the outbreak of COVID-19. Thus, people may drink more alcohol during the outbreak of COVID-19 than before COVID-19. Methods: An online retrospective survey was conducted on a total sample of 2,229 participants. Drinking behaviors before and during COVID-19, current risky drinking and hazardous drinking, and the association between high-risk drinking and mental health problems (depression, anxiety, and stress) were assessed via self-reported measures on the Alcohol Use Disorders Identification Test (AUDIT) and the 21-item Depression Anxiety Stress Scales (DASS-21). Results: This study found that, compared with before COVID-19, alcohol consumption was slightly decreased during COVID-19 (from 3.5 drinks to 3.4 drinks, p = 0.035) in the overall sample. Most (78.7%) alcohol drinkers were males. Before and during COVID-19, males consumed more drinks per week (4.2 and 4.0 vs. 1.3 and 1.2 drinks), had a higher percentage of heavy drinking (8.1 and 7.7% vs. 4.4 and 2.7%), and more drinking days per week (2.1 and 2.1 vs. 1.0 and 0.9 days). Males also had more risky drinking (43.2 vs. 9.3%) and hazardous drinking (70.2 vs. 46.6%) than female counterparts. This study also found that high-risk drinking predicted anxiety in females. Conclusions: This study suggests a slight reduction in alcohol consumption during COVID-19. However, hazardous drinking is common, especially among male alcohol drinkers. Males consumed more alcohol, had more risky and hazardous drinking than female counterparts both before and during COVID-19. Public health policy makers should pay more attention to developing effective, population-based strategies to prevent harmful alcohol consumption.

Brief mindfulness-based intervention of 'STOP (Stop, Take a Breath, Observe, Proceed) touching your face': a study protocol of a randomised controlled trial.

INTRODUCTION: Face-touching behaviour often happens frequently and automatically, and poses potential risk for spreading infectious disease. Mindfulness-based interventions (MBIs) have shown its efficacy in the treatment of behaviour disorders. This study aims to evaluate an online mindfulness-based brief intervention skill named 'STOP (Stop, Take a Breath, Observe, Proceed) touching your face' in reducing face-touching behaviour. METHODS AND ANALYSIS: This will be an online-based, randomised, controlled, trial. We will recruit 1000 participants, and will randomise and allocate participants 1:1 to the 'STOP touching your face' (both 750-word text and 5 min audio description by online) intervention group (n=500) and the wait-list control group (n=500). All participants will be asked to monitor and record their face-touching behaviour during a 60 min period before and after the intervention. Primary outcome will be the efficacy of short-term mindfulness-based 'STOP touching your face' intervention for reducing the frequency of face-touching. The secondary outcomes will be percentage of participants touching their faces; the correlation between the psychological traits of mindfulness and face-touching behaviour; and the differences of face-touching behaviour between left-handers and right-handers. Analysis of covariance, regression analysis, χ2 test, t-test, Pearson's correlations will be applied in data analysis. We will recruit 1000 participants from April to July 2020 or until the recruitment process is complete. The follow-up will be completed in July 2020. We expect all trial results to be available by the end of July 2020. ETHICS AND DISSEMINATION: The study protocol has been approved by the Ethics Committee of Sir Run Run Shaw Hospital, an affiliate of Zhejiang University, Medical College (No. 20200401-32). Study results will be disseminated via social media and peer-reviewed publications. TRIAL REGISTRATION NUMBER: NCT04330352.

Using Remote Medical Care Services to prevent the spread of the novel coronavirus

UNSTRUCTURED: This manuscript is in the category of Letters to editor, and there is no abstract.