Mental health burden of high school students, and suggestions for psychosocial support, 1.5 years into the COVID-19 pandemic in Austria.

The COVID-19 pandemic and containment efforts seem to be particularly challenging for adolescents. This study assessed mental health in high school students 1.5 years after the pandemic began in Austria. A cross-sectional survey was carried out from September to November 2021. Well-being (WHO-5), depressive symptoms, anxiety symptoms and sleep quality were assessed. A total of 1505 adolescents participated (78% girls). The cut-offs for clinically relevant symptoms were exceeded by 62% girls and 38.1% boys for depression (PHQ-9 score ≥ 11), 49% girls and 29% boys for anxiety (GAD-7 score ≥ 11) and 28% girls and 17% boys for insomnia (ISI score ≥ 15). The prevalence of suicidal ideation (item 9 of the PHQ-9) within the last 2 weeks was 47% in girls and 32% in boys. These data collected in autumn 2021 (the start of the second semester of reopened schools; t2) were compared to data collected in February 2021 (one semester after remote schooling; t1). A matched pairs analysis according to age, gender, region, school type and migration background resulted in a total sample size of N = 2514 adolescents. Results showed small deteriorations in mental health (i.e., well-being, depression, insomnia, suicidal ideation) in girls at t2 compared to t1, and an increase in suicidal thoughts in boys (all p-values < 0.05). Qualitative data show that young people have a need for more psychological support, both professional and informal, as well as increased mental health literacy. Results suggest that mental health burden in adolescents remains high 1.5 years into the pandemic and highlight the need to implement timely psychological support.

A Bayesian network analysis of psychosocial risk and protective factors for suicidal ideation

Background The aim of this study was to investigate and model the interactions between a range of risk and protective factors for suicidal ideation using general population data collected during the critical phase of the COVID-19 pandemic. Methods Bayesian network analyses were applied to cross-sectional data collected 1 month after the COVID-19 lockdown measures were implemented in Austria and the United Kingdom. In nationally representative samples (n = 1,005 Austria;n = 1,006 UK), sociodemographic features and a multi-domain battery of health, wellbeing and quality of life (QOL) measures were completed. Predictive accuracy was examined using the area under the curve (AUC) within-sample (country) and out-of-sample. Results The AUC of the Bayesian network models were ≥ 0.84 within-sample and ≥0.79 out-of-sample, explaining close to 50% of variability in suicidal ideation. In total, 15 interrelated risk and protective factors were identified. Seven of these factors were replicated in both countries: depressive symptoms, loneliness, anxiety symptoms, self-efficacy, resilience, QOL physical health, and QOL living environment. Conclusions Bayesian network models had high predictive accuracy. Several psychosocial risk and protective factors have complex interrelationships that influence suicidal ideation. It is possible to predict suicidal risk with high accuracy using this information.

Education level and COVID-19 vaccination willingness in adolescents.

Vaccination is essential to control the COVID-19 pandemic. High vaccination willingness is a key for successful vaccination programs. This study assessed attitudes toward vaccination in Austrian adolescents and determined whether there are differences in vaccination readiness regarding education status, gender and migration background. Two cross-sectional online surveys were conducted from March to July 2021 in apprentices and high school students. Willingness to receive COVID-19 vaccination was rated on a 5-point scale. In total, n = 2006 (n = 1442 apprentices and n = 564 high school students) completed the survey. Willingness to receive COVID-19 vaccination was higher in students compared to apprentices (p < 0.001). Furthermore, migration background (p = 0.023) and female gender (p = 0.001) were associated with lower vaccination willingness. In conclusion, more efforts are required to improve confidence and willingness to vaccinate adolescents with lower educational levels, those with migrant backgrounds and females.

Comparison of mental health indicators in clinical psychologists with the general population during the COVID-19 pandemic.

Mental healthcare professionals face diverse challenges during the COVID-19 pandemic, which may augment their risk of experiencing adverse mental health outcomes themselves. We aimed to compare depressive, anxiety, insomnia, and stress symptoms in Austrian clinical psychologists during the COVID-19 pandemic with the Austrian general population. A total of N = 172 Austrian clinical psychologists (91.9% women; mean age: 44.90 ± 7.97 years) participated in an online survey in spring 2022. A representative sample (N = 1011) of the Austrian general population was surveyed simultaneously. Symptoms of depression (PHQ-2), anxiety (GAD-2), insomnia (ISI-2), and stress (PSS-10) were assessed. Differences in the prevalence of clinically relevant symptoms were analyzed using univariate (Chi-squared tests) and multivariable (binary logistic regression including covariates age and gender) analyses. Clinical psychologists showed lower adjusted odds for exceeding the cut-offs for clinically relevant depression (aOR 0.37), anxiety (aOR 0.50), and moderate to high stress levels (aOR 0.31) compared to the general population (p < 0.01). No difference was observed for insomnia (aOR 0.92; p = 0.79). In conclusion, clinical psychologists experience better mental health than the general population during the COVID-19 pandemic. Future studies are needed to analyze the underlying reasons.

An Assessment of Austrian School Students' Mental Health and Their Wish for Support: A Mixed Methods Approach.

The mental health of school students has been severely impacted by the aftermath of the COVID-19 pandemic. The present study used a mixed methods approach to assess students' mental health and examine their wishes for support to improve their psychological well-being. We further investigated gender and age group differences in the amount of clinically relevant mental health problems and the roles that mental health and gender had on desired support. Between April and May 2022, a total of 616 Austrian students aged between 14 and 20 participated in a cross-sectional online survey (77.4% female; 19.8% male; 2.8% non-binary) assessing wishes for support regarding mental well-being and mental health indicators (depression: PHQ-9; anxiety: GAD-7; insomnia: ISI; stress: PSS-10; eating disorders: SCOFF; alcohol abuse: CAGE). A wish for support was expressed by 46.6% of the students. Qualitative content analysis revealed that the two most important categories of desired support types were "professional help" and "someone to talk to". The group of students with a wish for support in general significantly more often showed clinically relevant depression, anxiety, insomnia, eating disorders, or high stress symptoms. Students that wished for professional help significantly more often exceeded the cut-off for clinically relevant depression, anxiety, and high stress. Those who wished for someone to talk to significantly more often exceeded the cut-off for clinically relevant eating disorders. The results indicate a great need for support for young people's mental health problems and that this need is even more urgent for students.

A Bayesian network analysis of psychosocial risk and protective factors for suicidal ideation.

Background: The aim of this study was to investigate and model the interactions between a range of risk and protective factors for suicidal ideation using general population data collected during the critical phase of the COVID-19 pandemic. Methods: Bayesian network analyses were applied to cross-sectional data collected 1 month after the COVID-19 lockdown measures were implemented in Austria and the United Kingdom. In nationally representative samples (n = 1,005 Austria; n = 1,006 UK), sociodemographic features and a multi-domain battery of health, wellbeing and quality of life (QOL) measures were completed. Predictive accuracy was examined using the area under the curve (AUC) within-sample (country) and out-of-sample. Results: The AUC of the Bayesian network models were ≥ 0.84 within-sample and ≥0.79 out-of-sample, explaining close to 50% of variability in suicidal ideation. In total, 15 interrelated risk and protective factors were identified. Seven of these factors were replicated in both countries: depressive symptoms, loneliness, anxiety symptoms, self-efficacy, resilience, QOL physical health, and QOL living environment. Conclusions: Bayesian network models had high predictive accuracy. Several psychosocial risk and protective factors have complex interrelationships that influence suicidal ideation. It is possible to predict suicidal risk with high accuracy using this information.

Believing Processes during the COVID-19 Pandemic: A Qualitative Analysis.

Cognition, emotion, emotional regulation, and believing play a special role in psychosocial functioning, especially in times of crisis. So far, little is known about the process of believing during the COVID-19 pandemic. The aim of this study was to examine the process of believing (using the Model of Credition) and the associated psychosocial strain/stress during the first lockdown in the COVID-19 pandemic. An online survey via LimeSurvey was conducted using the Brief Symptom Inventory-18 (BSI-18), the Pittsburgh Sleep Quality Index (PSQI), and a dedicated Believing Questionnaire, which assesses four parameters of credition (propositions, certainty, emotion, mightiness) between April and June, 2020, in Austria. In total, n = 156 mentally healthy participants completed all questionnaires. Negative credition parameters were associated with higher global symptom load (from BSI-18): narratives: r = 0.29, p < 0.001; emotions r = 0.39, p < 0.001. These findings underline the importance of credition as a link between cognition and emotion and their impact on psychosocial functioning and stress regulation in implementing novel strategies to promote mental health.

How the COVID-19 Pandemic Affects the Provision of Psychotherapy: Results from Three Online Surveys on Austrian Psychotherapists.

This study aimed to assess patient numbers and the format in which psychotherapy was delivered by Austrian psychotherapists during different time points of the COVID-19 pandemic and to explore psychotherapists` experiences on pandemic-associated changes in their psychotherapeutic work as well as their wishes for support in their professional activities. Three cross-sectional online surveys were conducted between March 2020 and May 2022. The total number of participating psychotherapists was n = 1547 in 2020, n = 238 in 2021, and n = 510 in 2022. The number of patients treated was highest in 2022 and lowest at the beginning of the pandemic (p < 0.001). During the lockdown in 2020, only 25.0% of patients were treated in personal contact. This proportion increased in the following years, reaching 86.9% in 2022 (p < 0.001). After a substantial increase in the proportion of patients treated via the telephone and internet during the first lockdown, both proportions decreased during the pandemics' second and third year (p < 0.001). However, a larger proportion of patients were treated via the internet in 2022 compared to pre-pandemic times (p < 0.001). Psychotherapists reported that the pandemic affected mainly the setting in which psychotherapy was provided (29.6%), the working conditions and workload (27.1%), as well as the demand for psychotherapy (26.9%). About one-third of psychotherapists expressed support wishes for their psychotherapeutic work. Results suggest that the pandemic went along with a partial shift in the provision of psychotherapy towards psychotherapy via the internet but not the telephone. The increase in patient numbers and psychotherapists` reports of increased workload suggest a rise in the demand for mental health care during and in the aftermath of the pandemic.

Remote Psychotherapy during the COVID-19 Pandemic: A Mixed-Methods Study on the Changes Experienced by Austrian Psychotherapists.

The outbreak of the COVID-19 pandemic and associated measures to contain the SARS-CoV-2 coronavirus required a change in treatment format from face-to-face to remote psychotherapy. This study investigated the changes experienced by Austrian therapists when switching to psychotherapy at a distance. A total of 217 therapists participated in an online survey on changes experienced when switching settings. The survey was open from 26 June until 3 September 2020. Several open questions were evaluated using qualitative content analysis. The results show that the setting at a distance was appreciated by the therapists as a possibility to continue therapy even during an exceptional situation. Moreover, remote therapy offered the respondents more flexibility in terms of space and time. Nevertheless, the therapists also reported challenges of remote therapy, such as limited sensory perceptions, technical problems and signs of fatigue. They also described differences in terms of the therapeutic interventions used. There was a great deal of ambivalence in the data regarding the intensity of sessions and the establishment and/or maintenance of a psychotherapeutic relationship. Overall, the study shows that remote psychotherapy seems to have been well accepted by Austrian psychotherapists in many settings and can offer benefits. Clinical studies are also necessary to investigate in which contexts and for which patient groups the remote setting is suitable and where it is potentially contraindicated.

Mental health in the Austrian general population during COVID-19: Cross-sectional study on the association with sociodemographic factors.

Introduction: The impact of the Coronavirus disease (COVID-19) pandemic and the associated governmental restrictions on mental health have been reported in different countries. This cross-sectional study evaluated mental health during the COVID-19 pandemic in Austria and the association with sociodemographic factors (i.e., age, sex, education, income, employment status, partnership status, and migration background). Methods: A representative sample (N = 1,031) of the Austrian general population was surveyed online end of April 2022. Indicators of mental health were depression (PHQ-9), anxiety (GAD-7), insomnia (ISI), alcohol abuse (CAGE), eating disorders (SCOFF), and stress (PSS-10). Results: 1,031 participants completed the online survey (50.3% women; mean age: 45.6 ± 17.23 years). Cut-offs for clinically relevant depression were exceeded by 28%. 16% scored above the cut-off for clinically relevant anxiety symptoms, 15% for clinical insomnia, 18% for alcohol abuse, 26% for eating disorders, and 65% for moderate to high stress. Comparisons with another cross-sectional representative Austrian sample recruited during the first weeks of the COVID-19 pandemic in Austria (April 2020) revealed increases in depression (from 21 to 28%) but no significant changes in anxiety, insomnia, and moderate to high stress. Multivariable logistic regression showed the strongest associations of mental health indicators with age, income, and sex. Increasing age and income were associated with lower odds of mental health symptoms. Being female compared to male increased the odds of depressive symptoms while decreasing the odds of alcohol abuse. Discussion: The COVID-19 crisis seems particularly stressful for younger adults (<35 years) and people with low income (<€2,000 net household income per month). Policymakers need to consider the high social and economic costs of lockdowns and think of optimal intervention methods for mental disorders among young and low-income individuals.

Mental health in Austrian psychotherapists during the COVID-19 pandemic.

Although the impact of the COVID-19 pandemic on mental health has been reported in different communities, little is known about the mental health of psychotherapists during the COVID-19 pandemic. This study aimed to assess mental health during the COVID-19 pandemic in Austrian psychotherapists and compare it with the general population. A total of n = 513 psychotherapists (80.5% women; mean age: 53.06 ± 9.94 years) took part in an online survey conducted from April to June 2022. At the same time, a representative sample (N = 1,031) of the Austrian general population was surveyed online. Indicators of mental health were mental wellbeing (WHO-5), depression (PHQ-2), anxiety (GAD-2), insomnia (ISI-2), and stress (PSS-10). The general population sample was matched according to age and gender with the psychotherapist's data using propensity scores, yielding a final sample of n = 513 (80.5% women; mean age: 52.33 ± 13.39 years). Psychotherapists showed lower odds for exceeding cut-offs for clinically relevant depressive, anxiety, insomnia and stress symptoms (0.34-0.58) compared to the general population. Further studies should elucidate the protective factors underlying these findings.

Perceived Barriers and Facilitators to Psychotherapy Utilisation and How They Relate to Patient's Psychotherapeutic Goals.

Access to psychotherapy is still limited by various barriers, and little is known about the facilitating circumstances. This study aims to assess self-reported barriers and facilitators to psychotherapy utilisation in private practice and how these access factors relate to psychotherapy goals as formulated by patients. The dataset consists of 21 face-to-face semi-structured interviews with patients treated by psychotherapists in private practice in Austria. Data were analysed using qualitative content analysis, including a frequency count of the number of codings to analyse relations between categories. A critical external barrier theme was unaffordable psychotherapy and confusion about how the Austrian funding system works. A negative experience with psychotherapy prior to the current one, such as not being understood and answered well enough by one's therapist, was a frequently reported internal barrier. Individuals who faced more internal barriers and more external facilitators in seeking therapy, such as moral support from significant others and professionals, formulated less elaborate treatment goals. Although the study was carried out amid the COVID-19 pandemic, the pandemic played a minor role in patients' self-reported barrier and facilitator themes.

Burdens of Apprentices Caused by the COVID-19 Pandemic and How They Deal with Them: A Qualitative Study Using Content Analysis One-Year Post-Breakout.

The COVID-19 pandemic resulted in a variety of burdens for apprentices and, as a result, in a need for resources to deal with them. The present study examined answers to two open-ended questions, which were part of a larger online survey about the burdens and resources during the pandemic from 1442 Austrian apprentices. Data collection took place from 29 March to 18 May 2021. The answers were analyzed with qualitative content analysis and revealed that most apprentices were burdened by pandemic-related restrictions and rules, the impairment of their social life, and in their mental health. In terms of resources, they mostly fell back on their social contacts, especially their friends. Besides their social life, many apprentices also used personal attitudes, leisure activities, and distractions to deal with their stresses. The study sheds light on some of the background reasons for the high psychological distress among apprentices. In order to better support young people in coping with stress, it is recommended to expand preventive and educational mental health measures targeted at apprentices, to facilitate access to low-threshold psychosocial services for young people, and improve financial support for the receipt of these.

Assessment of the Long-Term Mental Health Effects on Austrian Students after COVID-19 Restrictions.

The mental health of adolescents has been severely affected by the COVID-19 pandemic. The aim of this study was to assess the mental health of Austrian adolescents in spring 2022, a time during which COVID-19-related restrictions had been significantly lifted. A total of N = 616 students aged between 14 and 20 participated in a cross-sectional survey between April and May 2022 (t2). The prevalence of clinically relevant symptoms was 73% among girls and 44% among boys for depression (PHQ-9 score ≥ 11), 57% in girls and 35% in boys for anxiety (GAD-7 score ≥ 11), 34% in girls and 21% in boys for sleeping problems (ISI score ≥ 15), and 95% in girls and 81% in boys for experiencing at least moderate stress (PSS-10 score ≥ 14). Frequent suicidal ideations were reported by 24% of girls and 12% of boys. These results were compared with the results from a cross-sectional study from February 2021 (t1). To account for differences in covariates between samples, data were propensity score matched before the analysis. Compared with t1, we found an increase among girls regarding clinically relevant symptoms of depression (OR = 1.78), anxiety (OR = 1.34), insomnia (OR = 1.63), and suicidal ideations (OR = 1.96; p < 0.05 for all measures). Significant correlations were found between smartphone use and mental health and physical activity and mental health for both genders. The results of this study indicated that even during the third year of the COVID-19 pandemic, the mental health of adolescents in Austria is still severely impaired.

Quality of life during the COVID-19 pandemic in Austria

The COVID-19 pandemic has had unprecedented effects on our daily lives. This study aimed to assess the quality of life (QoL) (WHOQOL-Bref physical, social, and environmental domains) at two time points during the COVID-19 pandemic with lockdown restrictions according to gender, age, and urbanization level. Qualtrics® recruited representative Austrian population samples in April 2020 (t1;N = 1,005) and December 2020/January 2021 (t2;N = 1,505). ANOVAs and the Bonferroni-corrected post-hoc tests were conducted to investigate differences between April and December 2020 and to compare with pre-pandemic data. Although the quality of life (physical, social, and environmental domains) changed from pre-pandemic (mean scores 80, 77, and 81, respectively) to April 2020 (mean scores 72, 65, and 75, all p-values < 0.001), there were no significant changes between April and December (mean scores 75, 65, and 75). Living location (urban vs. rural), gender, and age showed an effect on the quality of life. All domains of quality of life have decreased since the onset of the pandemic, and this decline has been maintained over the course of the first year of the pandemic. Creative measures should be implemented to assist people in improving one or more areas of quality of life, within the lockdown restrictions to improve the overall wellbeing of the population.

Association of Health Behaviors with Mental Health Problems in More than 7000 Adolescents during COVID-19.

Previous studies show detrimental effects of the COVID-19 pandemic and associated lockdowns on the lives of adolescents. Adolescents have experienced disruption in their daily routines, including changes in health behaviors such as an increased sedentary behavior and increased smartphone usage. The aim of this study was to assess the association of health behaviors with mental health problems in Austrian adolescents during the pandemic. Five cross-sectional surveys (February 2021 to May 2022) were performed during the pandemic assessing physical activity, smartphone usage, depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), sleep quality (ISI-7), and stress (PSS-10). In total, N = 7201 adolescents (age: 14-20 years ((MW±SD): 16.63 ± 1.49 years); 70.2% female, 18.8% migration background) participated. A strong increase in mobile phone usage as well as a decrease in physical activity as compared to pre-pandemic data were observed (p < 0.001). Compared to the lowest smartphone user group (<1 h/d), the adjusted odds ratios (aOR) for all investigated mental health symptoms increased with increasing smartphone usage up to 3.2-6.8 in high-utilizers (>8 h/d). The aORs for depressive, anxiety, insomnia, and stress symptoms decreased in physically active compared to inactive adolescents. Results highlight the need for measures to promote responsible smartphone usage as well as to increase physical activity, so as to promote mental health in adolescence.

School Students' Concerns and Support after One Year of COVID-19 in Austria: A Qualitative Study Using Content Analysis.

Adolescents suffer severely from the psychological consequences of the COVID-19 pandemic. Using qualitative content analysis, this study examined open-ended responses to a survey on the mental health of school students in Austria in February 2021. A representative sample (n = 214) was drawn from a total survey sample of 3052 adolescents aged 14-20. The analysis revealed several areas of concern, including school-related concerns, concerns about restrictions, self-related concerns, and interpersonal problems. School-related concerns associated with distance learning were mentioned most frequently. Compared with research conducted at the beginning of the pandemic, it appeared that concerns about educational and professional futures increased. The analysis also indicated young people's most important sources of support, such as social contacts, recreational activities, attitudes and abilities, distraction, and escape. Of concern is the proportion of young people citing maladaptive coping strategies and the reluctance to seek professional support. Ideas for practice-oriented measures were developed from the study results, such as embedding youth-led peer interventions in traditional mental health services.

Psychotherapists' Reports regarding the Impact of the COVID-19 Pandemic on Their Patients: A Cross-National Descriptive Study Based on the Social-Ecological Model (SEM).

The COVID-19 outbreak has raised questions about how vulnerable groups experience the pandemic. Research that focuses on the view of individuals with pre-existing mental health conditions is still limited, and so are cross-country comparative surveys. We gathered our sample of qualitative data during the first lockdown after governmental measures against the spread of the SARS-CoV-2 virus came into force in Austria, Czechia, Germany, and Slovakia. A total of n = 1690 psychotherapists from four middle European countries answered the question of how the COVID-19 pandemic was addressed in sessions by their patients during the early stage of unprecedented public health conditions. We employed a descriptive qualitative methodology to determine themes following levels of the social-ecological model (SEM) regarding how the COVID-19 pandemic affected patients. At the public policy level, stressful environmental conditions concerned the governmental mitigation efforts. At the level of community/society, reported key themes were employment, restricted access to educational and health facilities, socioeconomic consequences, and the pandemic itself. Key themes at the interpersonal level regarded forced proximity, the possibility of infection of loved ones, childcare, and homeschooling. Key themes at the individual level were the possibility of contracting COVID-19, having to stay at home/isolation, and a changing environment. Within the SEM framework, adaptive and maladaptive responses to these stressors were reported, with more similarities than differences between the countries. A quantification of word stems showed that the maladaptive reactions predominated.

A Longitudinal Study on Mental Well-Being, Perceived Stress Level and Job-Related Meaningfulness of Austrian Telephone Emergency Service Counselors during the COVID-19 Pandemic.

Telephone emergency service (TES) consultants have been challenged even more since the beginning of the pandemic. How the COVID-19 situation and the associated increasing demand for TES services affect the well-being and stress of TES counselors has not been assessed so far. This longitudinal study examined mental well-being (WHO-5), perceived stress level (PSS-10), and experienced job-related meaningfulness (CERES) of TES counselors at two measurement points during the pandemic. From December 2020 to January 2021 (t1), N = 374 counselors were recruited within the Austrian nationwide organization "TelefonSeelsorge". From those, N = 108 also participated one year later at t2. Neither well-being nor perceived stress differed significantly between t1 and t2. There was a decrease in job-related meaningfulness (from 5.46 at t1 to 5.34 at t2; p < 0.001). The consultants identified loneliness and mental health as the most common problems of helpline callers at both measurement points. The results confirm a stable level of stress and well-being during the pandemic in TES consultants. However, they also show a slight decrease in perceived job-related meaningfulness. Well-being of counselors should be watched closely, as they are an important part of the psychosocial healthcare system.