Mental health burden of patients with diabetes before and after the initial outbreak of COVID-19: predictors of mental health impairment.

BACKGROUND: The COVID-19 pandemic is affecting people's mental health worldwide. Patients with diabetes are at risk for a severe course of illness when infected with SARS-CoV-2. The present study aims to retrospectively examine mental health changes in patients with diabetes in Germany before and after the initial COVID-19 outbreak, and to furthermore explore potential predictors of such changes. METHODS: Over the course of eight weeks from April to June 2020, 253 individuals diagnosed with diabetes participated in an online cross-sectional study. Participants completed an anonymous survey including demographics, depression (PHQ-2) and generalized anxiety symptoms (GAD-2), distress (DT), and health status (EQ-5D-3L). In addition, all instruments used were modified to retrospectively ask participants to recall their mental health and health status before the outbreak had started. Additionally examined factors were COVID-19-related fear, trust in governmental actions to face the pandemic, and the subjective level of information about COVID-19. RESULTS: This study shows a significant increase in prevalence of depression symptoms, generalized anxiety symptoms and distress, as well as significantly decreased health statuses in diabetes patients after the initial COVID-19 outbreak. Increased depression symptoms, generalized anxiety symptoms and distress were predicted by COVID-19-related fear, whereas trust in governmental actions to face COVID-19 predicted higher depression symptoms. CONCLUSIONS: The results indicate a negative impact of the initial COVID-19 outbreak on mental health and health status in patients with diabetes. In order to improve the efficacy of psychological support strategies for diabetes patients during the pandemic, possible predictors of mental health impairment such as the aforementioned should be examined more thoroughly and addressed more openly.

Changes in Substance Use and Mental Health Burden among Women during the Second Wave of COVID-19 in Germany.

Unlike men, who are disproportionately affected by severe disease progression and mortality from COVID-19, women may be more affected by the economic, social and psychological consequences of the pandemic. Psychological distress and mental health problems are general risk factors for increases in the use of alcohol and other substances as a dysfunctional coping mechanism. METHODS: An analysis was carried out of the female subset (n = 2153) of a population-based, cross-sectional online survey (October-December 2020), covering the "second wave" of the COVID-19 pandemic in Germany. RESULTS: Among women, 23% increased their alcohol use, 28.4% increased their nicotine use and 44% increased their illicit substance use during the COVID-19 pandemic. Twenty percent reported major depressive symptoms and 23.4% symptoms of generalized anxiety. Generalized anxiety proved to be a significant predictor of increases in alcohol and nicotine use in logistic regression. DISCUSSION: The mental health burden remained high during the second wave of COVID-19 and alcohol, nicotine and other substance use increased. However, the association between mental health and substance use was weak. Psychological distress does not seem to be the main motivator of substance use.

COVID-19-Fear Affects Current Safety Behavior Mediated by Neuroticism-Results of a Large Cross-Sectional Study in Germany.

Objectives: Although many research studies concerning changes in personality and behavior in time of COVID-19 pandemic emerged, important questions still have not been answered. This study with a large sample aimed to give insights into the impact of personality on pandemic fear and behavior by investigating the Big Five traits, COVID-19-fear, and associated behavioral changes in a large German-speaking sample. Methods: About 14,048 healthy respondents (65.5% female, 34.2% male, and 0.32% other gender/gender queer; range = 18-85 years, median age 35-44 years) participated in the survey during the COVID-19 pandemic. Two scales, "adherent" safety behavior (ASB, α = 0.857) and "dysfunctional" safety behavior (DSB, α = 0.876), three items each, measured pandemic-associated behavior. The Big Five Inventory-10 (BFI-10) tested personality traits. Results: While ASB correlated negatively with extraversion (rho = -0.053, ≤ 0.001), the other four traits were positively associated, with the highest association for neuroticism (rho = 0.116, ≤ 0.001), whereas neuroticism showed a positive correlation (rho = 0.142, ≤ 0.001) with DSB, extraversion (rho = -0.042, ≤ 0.001), agreeableness (rho = -0.028, ≤ 0.001), and conscientiousness (rho = -0.025, ≤ 0.001) correlated negatively with it. Regression analyses showed a small extent of the effect of personality traits. Moreover, neuroticism mediated the association between COVID-19-fear and DSB (positive-directed). Conclusions: Even though our results on correlations between personality, pandemic fear, and related behavior are in line with the existing literature studies, the analyses clearly show that the impact of personality traits, including neuroticism, on pandemic behavior is very small. Rather, pandemic fear has a much larger influence on the safety behavior mediated through neuroticism. Further studies should bear in mind that personality traits can not only have influencing effects but also mediating effects.

Corona doubt and scepticism: repression and denial as psychological defence mechanisms to process distress?

After more than a year of pandemic, SARS-CoV-2 (Severe acute respiratory syndrome coronavirus type 2) remains a relevant health care and society issue. Movements doubting the dangerousness or the existence of the virus have emerged and became a challenge to social cohesion. About 3487 individuals (434 Corona doubters and 3053 non-doubters) have participated in an online survey (predominat age group: 35-45 years). Particularly, COVID-19-related anxiety, generalized anxiety (Generalizied Anxiety Disorder Screener, GAD-7), depression (Patient Health Questionnaire, PHQ-2) and functional/adherent safety behaviour were assessed. COVID-19 doubters describe less functional safety behaviour. Fear of the virus is evident, similar to non-doubters. Generalized anxiety and depression were significantly higher in doubters. Repression and denial as psychological defence mechanisms could be the unconscious psychological strategy for coping with the distress variables. The results point out that public strategies may only be successful in managing opinions and beliefs if they address fears and worries.

Differences and similarities between the impact of the first and the second COVID-19-lockdown on mental health and safety behaviour in Germany.

BACKGROUND: Governmental restrictions of daily life are key elements in reducing the transmission of COVID-19, but they have also put a strain on people's mental health. Preventive policies differ all over the world as well as over different periods of time, and depend mostly on current infection rates. In Germany, there were two periods of restraint of varying severity, during which the government used different combinations of containment and mitigation measures to protect risk groups and to lower the number of hospitalizations. METHODS: In two online studies, we aimed to determine differences and similarities in COVID-19-related fear, generalized anxiety, depression and distress levels, as well as in the adherence to safety behaviour between the first lockdown in March and April and the second lockdown in November. RESULTS: This study showed continued high psychological burden and even increased levels of depression symptoms, as well as less safety behaviour in the second phase of restrictions. CONCLUSIONS: The results hint at a prolonged negative impact on people's mental health and their safety behaviour despite lesser restrictions in the second lockdown, which may be interpreted as pandemic fatigue and hence strengthens the argument for a low-threshold access to psychological care.