Investigating the psychological effects of home quarantine during the early peaks of the COVID-19 pandemic: a survey from Iran.

We assessed psychological symptoms among individuals who were quarantined during early coronavirus disease 2019 (COVID-19) peaks. This cross-sectional study was performed during April-October 2020 in Iran. We surveyed 100 individuals with COVID-19 patients in their families and 100 others with health conditions associated with a higher risk of developing critical forms of COVID-19 infection, who have completed at least 14 days of home quarantine. Validated Persian versions of the 21-item Depression, Anxiety, and Stress and 22-item Impact of Event Scale-Revised were used to measure the symptoms of depression, anxiety, stress and distress. The rates of stress, anxiety, depression and quarantine-related distress were 46.5, 48.5, 57.0 and 80.5%, respectively; however, they were not significantly different between the contact and no-contact groups. Female sex and being unemployed were significantly associated with quarantine-related distress, P = 0.007 and P = 0.018, respectively. Independent risk factors for anxiety were a history of medical comorbidity ( P = 0.025) and contact with COVID-19 patients ( P = 0.007). Findings show high prevalence rates of psychological symptoms among quarantined individuals, regardless of whether they had contact with COVID-19 patients or not. Female sex and unemployment were risk factors for quarantine-related distress.

Mental Health Outcomes and Sleep Status among Patients with Coronavirus Disease 2019.

Objective: The immediate impacts of coronavirus disease 2019 (COVID-19) on mental health of affected patients and psychiatric morbidities of these patients has been neglected by researchers. We assessed mental health outcomes and sleep status among inpatients and outpatients with COVID-19 who were initially referred to our COVID-19 clinic in Mashhad, Iran during April-October 2020. Method : In this ethically approved cross-sectional study, 130 patients with confirmed COVID-19 who were referred to outpatient clinics and wards of a referral hospital in Mashhad, Iran were surveyed during April-October 2020. Demographic data were collected after obtaining informed written consent. Validated Persian versions of insomnia severity index (ISI), 9-item patient health questionnaire (PHQ-9), and 7-item generalized anxiety disorder (GAD-7) and revised impact of event scale (IES-R) were used as main outcome measures (i.e. status of anxiety, depression, insomnia, and event-related distress). Analysis was performed with SPSS using binary logistic regression. P-values < 0.05 were considered significant. Results: Overall, 65 inpatients and 65 outpatients were surveyed. The two groups did not significantly defer in terms of insomnia and depression severity, but the outpatients showed higher levels of anxiety (52.3% vs. 24.6%, P = 0.005) and distress compared to inpatients (80.0% vs. 64.6%, P < 0.001). Male sex (OR = 0.017, 95%CI = 0.000-0.708, P = 0.032) exhibited independent and inverse association with depression in COVID-19 patients. Being married (OR = 0.102, 95% CI = 0.018-0.567, P = 0.009) was independently and inversely associated with anxiety. Insomnia was independently associated with event-related distress (OR = 7.286, 95%CI = 2.017-26.321, P = 0.002). Only depression was independently associated with insomnia (OR = 49.655, 95%CI = 2.870-859.127, P = 0.007). Conclusion: We found symptoms of psychological distress and anxiety to be more prevalent among outpatients with COVD-19 than inpatients. Insomnia can be a potential risk factor for adverse mental health outcomes in these patients.

Nagorno-Karabakh conflict: Mental health repercussions and challenges in Azerbaijan.

The Armenia-Azerbaijan Nagorno-Karabakh conflict has made many Azerbaijanis internally displaced (IDP), missing, wounded, disabled, or killed. The war and its aftermath have drastically impacted the mental health of these populations, leading to depression, anxiety, and stress-related psychosomatic illnesses such as dissociative disorder. However, their access to medical and psychological services is limited. Intervention in terms of policy making, healthcare services, information systems, and social support is required to promoting social integration and facilitate accessibility to mental healthcare. National and international organisations, foreign aids, and media support can contribute to this end. The psychological effects of the war on children, healthcare shortage associated with COVID-19, accommodation and welfare problems, limited access to vaccination, technology, and educational opportunities, dangerous explosive remnants, as well as isolation and marginalisation of the IDPs can all be challenges facing the mental health of these populations. Organising programs such as support groups to share wartime experience, resilience promotion, psychosocial support for healthcare providers, religious identification, integral COVID-19 management, beside accommodation and education support are recommended to enhance the condition of these Azerbaijani populations.

Associations of lockdown stringency and duration with Google searches for mental health terms during the COVID-19 pandemic: A nine-country study.

OBJECTIVES: We examined the associations of lockdown stringency and duration with Google searches for four mental health concepts (i.e., "Anxiety," "Depression," "Suicide," "Mental Health") in nine countries (i.e., Hungary, India, Iran, Italy, Paraguay, Serbia, South Africa, Spain, Turkey) during the COVID-19 pandemic. METHODS: We retrieved national-level data for each country from Google Trends and the Global Panel Database of Pandemic Policies. In our primary analysis, we used data from all countries to estimate a set of multilevel regression models examining associations of overall lockdown stringency and lockdown duration with relative search volumes for each mental health term. We repeated the models after replacing overall lockdown stringency with each of the lockdown stringency components. RESULTS: A negative association was found between overall lockdown stringency and "Depression." Lockdown duration and the most stringent stay-at-home requirements were negatively associated with "Anxiety." Policies that recommended or required the cancelation of public events evidenced negative associations with "Depression," whereas associations between policies that required some or all levels of schooling to close and "Depression" were positive. Policies that recommended or required workplaces to close and those that enforced quarantines on non-citizens arriving from high-risk regions or closed borders entirely were negatively associated with "Suicide." CONCLUSIONS: Lockdown duration and some lockdown policies during the COVID-19 pandemic were generally associated with significantly lower, rather than higher, Google searches for selected mental health terms. These findings could be used alongside other evidence to develop future lockdown strategies that are sensitive to mental health issues during public health crises.

Home quarantine is a useful strategy to prevent the coronavirus outbreak: Identifying the reasons for non-compliance in some Iranians.

INTRODUCTION: The coronavirus outbreak has become a worrying issue and some people refuse to stay at home. Therefore, this study aims to identify the reasons behind some Iranian people's refusal to stay at home to prevent further virus transmission. METHOD: This cross-sectional study was conducted on postgraduate students in Iran. A questionnaire was designed based on 50 experts' opinions by using the Delphi method and 203 students completed the designed questionnaire in telegram groups. RESULTS: 35% of participants were upper 30 years of age, 70.4% were female, 74.4% had no coronavirus infection among their relatives, and 54.7% of them were Ph.D. candidates. The relations between "unclear accountability of events by some officials" and age as well as "failure to provide dissenting viewpoints and critical comments" and age were statistically significant (p = 0.027، p = 0.014). Moreover the relation between coronavirus infected relative and "persistent beliefs" was statistically significant (p = 0.014). The Chi-square test showed that gender, degree, resident and education province did not affect questions answering. The greatest agreement with questions is as following: lack of real situation understanding; 89.7%, people's livelihoods, and lack of government planning for low-income groups support; 86.7%, lack of people's knowledge concerning the coronavirus; 80.8%, lack of communicative educations for crisis situations; 79.8%, false assurance as well as minimizes the risks; 78.3%. CONCLUSION: Identifying the non-compliance factors with health recommendations can guide health care providers and managers to implementation of beneficial intervention.

Management of psychiatric conditions and delirium during the COVID-19 pandemic across continents: lessons learned and recommendations.

BACKGROUND: With the uncertainties of COVID-19, people infected with coronavirus present with diverse psychiatric presentations. Some institutions have had to manage their patients with existing protocols, others have had to create them. In this article we aimed to report the challenges and good practices in the management of psychiatric conditions and delirium coexisting with COVID-19 across continents. METHODS: Early Career Psychiatrists (ECPs) from across five continents were approached to share their experiences on the management of psychiatric conditions in patients with COVID-19 during the current pandemic. RESULTS: We collected information about the experiences from sixteen countries. Commonalities were similar psychiatric presentations and poor preparedness across countries. Differences were varying adjustments made in the management of psychiatric conditions coexisting with COVID-19 and different innovations. Good practices which can be adopted by other countries are novel approaches such as telepsychiatry, proactive consultation-liaison units and enhanced community services targeted at circumventing challenges faced when providing mental health services. CONCLUSIONS: These findings highlight the need for global preparedness in the mental health sector during outbreaks of infectious diseases, and the need for concerted efforts targeted at global and locally sensitive adaptation of existing protocols and the development of new guidelines for the management of psychiatric conditions for the present pandemic and subsequent occurrences.