Illness anxiety predicts higher mental strain and vaccine willingness-A nine-wave longitudinal study during the first 1.5 years of the COVID-19 pandemic in Germany.

Illness anxiety may amplify vulnerability to psychopathological symptoms during the COVID-19-pandemic-perhaps especially at the beginning of the pandemic and during high infection waves, but empirical evidence on this is lacking. In addition, considering a potentially functional facet of it, illness anxiety might be associated with higher vaccine willingness. We analyzed data of a nine-wave longitudinal online-survey (March 2020-October 2021) with 8148 non-probability sampled adults of the general population in Germany (clinicaltrials.gov: NCT04331106). Using multilevel analysis, we investigated longitudinal associations of dimensionally assessed illness anxiety (worry about illness, bodily preoccupation) with mental strain and vaccine willingness and considered the dynamic of the pandemic (i.e., duration and infection rates). Higher worry about illness and bodily preoccupation were associated with higher COVID-19-related fears, unspecific anxiety, depressive symptoms, and vaccine willingness. Vaccine willingness increased over time and in parallel to higher infection rates. Symptoms of mental strain decreased with continuing duration of the pandemic but increased when infection rates inclined. This decrease and increase, respectively, was steeper in individuals with higher illness anxiety. Our findings suggest that individuals with higher illness anxiety are more vulnerable to experience psychopathological symptoms during the ongoing pandemic, particularly at its beginning and during times of high infection rates. Thus, illness anxiety and associated symptoms should be targeted by adaptive measures. The fluctuation of symptoms parallel to the pandemic situation implies that support should be particularly issued at the beginning of extraordinary situations as well as during phases of high infection rates.

Pandemieassoziierte Konsequenzen und Unterstützungsbedarf : Mixed-methods-Längsschnittanalyse über 2 Jahre der COVID-19-Pandemie in Deutschland Pandemic-associated consequences and need for supportMixed methods longitudinal analysis over 2 years of the COVID-19 pandemic in Germany

Hintergrund Die COVID-19-Pandemie geht potenziell mit zahlreichen Veränderungen im Leben der Allgemeinbevölkerung einher. Dennoch gibt es bisher kaum Befunde dazu, welche Auswirkungen als besonders gravierend und negativ erlebt wurden, wie sich diese Auswirkungen und ihre Bewertungen im Verlauf der Pandemie änderten, und welche Unterstützungswünsche in diesem Kontext entstanden. Methode Längsschnittliche Daten einer Onlinestudie mit 10 Messzeitpunkten über die ersten 2 Jahre der Pandemie (März 2020 bis April 2022) wurden in einer Mixed-methods-Analyse betrachtet. Die Stichprobe aus 8337 Erwachsenen der Allgemeinbevölkerung in Deutschland beantwortete qualitative Freitextfragen zu den gravierendsten Konsequenzen der Pandemie auf ihr Leben sowie Unterstützungswünschen. Quantitativ wurden zudem die Bewertung der Konsequenzen im Pandemieverlauf und ihre Assoziationen mit psychischer Belastung betrachtet. Ergebnisse Die erlebten Konsequenzen und insbesondere ihre Bewertung veränderten sich im Pandemieverlauf. Sozial-gesellschaftliche und das allgemeine Leben betreffende Konsequenzen wurden im Schnitt besonders gravierend und negativ erlebt. Negativer erlebte Konsequenzen waren quer- und teilweise auch längsschnittlich mit stärkeren Angst- und depressiven Symptomen assoziiert. Psychotherapeutische sowie evaluativ-kommunikative Unterstützung wurde im Pandemiekontext besonders häufig erbeten. Schlussfolgerungen Subjektiv negativ erlebte Konsequenzen sollten möglichst durch adäquate Maßnahmen abgemildert werden. Die dynamischen Veränderungen der Konsequenzen und damit auch des Unterstützungsbedarfs im Pandemieverlauf sollten berücksichtigt werden. Die Unterstützungsmöglichkeiten reichen von sehr niedrigschwelligen Angeboten (z. B. Tipps online) bis hin zu einer Psychotherapie.

1.5 years pandemic - Psychological burden over the course of the COVID-19 pandemic in Germany: A nine-wave longitudinal community study.

BACKGROUND: The dynamic COVID-19 pandemic has been associated with mental strain. However, most studies focused primarily on the beginning of the pandemic and rarely took into account the long-term course. The aim of this prospective-longitudinal study was to investigate levels and changes of pandemic-related fears, unspecific anxiety, depressive symptoms, and psychosocial-behavioral factors over the first 1.5 years of the pandemic. METHODS: We conducted a nine-wave longitudinal online-survey from March 2020 to October 2021 with a total of 8148 participants of the adult general population in Germany. Descriptive examination and multilevel analysis were carried out to assess psychological burden, risk-bearing and protective psychosocial-behavioral factors, and associations with sociodemographics and the pandemic's duration and severity over the course of the pandemic. RESULTS: Symptoms of mental strain fluctuated across the pandemic and displayed a relative maximum at the pandemic's early beginning and during the second and third COVID-19 waves. Most participants (approximately 67.4 %-82.1 %) reported mild and transient symptoms, but a substantial portion (approximately 17.9 %-32.6 %) experienced pronounced mental health problems during the pandemic. Symptom severity was negatively associated with the duration of the pandemic and positively associated with the rate of new infections. LIMITATIONS: The observational study design, non-probability-sampling methods, and online self-report assessments limit the generalizability of our results. CONCLUSIONS: The fluctuating course of psychological burden during the pandemic emphasizes the relevance of continuous monitoring during this challenging time. Particularly individuals with pronounced subclinical symptoms or manifesting mental disorders should be targeted with adequate prevention and early intervention programs.

Mental Health in German Paralympic Athletes During the 1st Year of the COVID-19 Pandemic Compared to a General Population Sample.

Introduction: The COVID-19 pandemic has huge influences on daily life and is not only associated with physical but also with major psychological impacts. Mental health problems and disorders are frequently present in elite paralympic athletes. Due to the pandemic situation, new stressors (e.g., loss of routine, financial insecurity) might act upon the athletes. Therefore, the assessment of mental health in athletes during the COVID-19 pandemic is important to identify prevalence of psychological problems and propose countermeasures. Methods: The mental health of German paralympic athletes was longitudinally monitored (starting in May 2019). The athletes completed the Patient Health Questionnaire 4 (PHQ-4) on a weekly basis and reported a stress level, training hours, and training load. During the pandemic, 8 measurement time points (March 2020 to April 2021) were used to reflect the psychological health course of the athletes. In parallel, a convenience sample of the general population was questioned about their psychological distress, including the PHQ-4. To be included in the analysis, participants of both groups had to complete at least 4 measurement time points. Matching of the para-athletes and the general population sample was prioritized upon completion of the same measurement time points, gender, and age. Results: Seventy-eight paralympic athletes (40 women, 38 men, age: 29.8 ± 11.4 years) met the inclusion criteria. Seventy-eight matched pairs of the general population (40 women; 38 men; age: 30.5 ± 10.9 years) were identified. The para-athletes had a significantly (p <0.0001; 0.39 < r <0.48) lower PHQ-4 value at each measurement time point compared to the matched control group. No significant age or sex differences were evident regarding the symptom burden. In para-athletes, no significant and a weak positive correlation was found between decreased training load and PHQ-4 values and a stress level, respectively. Reduced physical activity was significantly (p <0.0001) associated with higher PHQ-4 values in the general population sample. Discussion: Lower PHQ-4 values were reported by the para-athletes compared to the general population sample. However, small sample sizes must be considered while interpreting the data. Nevertheless, adequate support for individuals suffering from severe psychopathological symptoms should be provided for para-athletes as well as for the general population.

COVID-19 vaccine hesitancy and related fears and anxiety.

BACKGROUND: Vaccination is crucial to limit the pandemic spread of SARS-CoV-2/COVID-19. Therefore, besides the development and supply of vaccines, it is essential that sufficient individuals are willing to get vaccinated, but concerning proportions of populations worldwide show vaccine hesitancy. This makes it important to determine factors that are associated with vaccine acceptance. METHODS: 1779 adults of a non-probability convenience sample in Germany were assessed with an online survey in a cross-sectional survey period from 1st to 11th January 2021 (a few days after the beginning of vaccinations in Germany). RESULTS: 64.5% of the sample stated that they absolutely would accept the vaccination, 13.8% would rather accept it, 10.4% were undecided, and 5.2% would rather not and 6.0% absolutely not get vaccinated. COVID-19-related anxiety, and fears of infection and health-related consequences correlated significantly positively with vaccine acceptance (all p < .001). In contrast, social (p = .006) and economic fears (p < .001) showed significant negative associations with vaccination willingness. The broader constructs of unspecific anxiety and depressive symptoms were not significantly associated with vaccine acceptance. Vaccine acceptance differed between users/non-users of social media and official websites to gain information about the pandemic (p < .001). CONCLUSIONS: COVID-19-related anxiety and health-related fears were associated with higher vaccine acceptance, whereas the fear of social and economic consequences showed the contrary direction. These findings highlight the need to differentiate between several types of fears and anxiety to predict their influence on vaccine acceptance, and provide important information and an essential base for future studies and interventions.

Longitudinal changes of anxiety and depressive symptoms during the COVID-19 pandemic in Germany: The role of pre-existing anxiety, depressive, and other mental disorders.

Especially individuals with mental disorders might experience an escalation of psychopathological symptoms during the COVID-19 pandemic. Therefore, we investigated the role of anxiety, depressive, and other mental disorders for levels and longitudinal changes of COVID-19-related fear, anxiety and depressive symptoms during the first months of the COVID-19 pandemic in Germany. In a longitudinal observational design with four assessment waves from March, 27th until June, 15th 2020, a total of 6,551 adults from Germany was assessed. 4,175 individuals participated in one, 1,070 in two, 803 in three, and 503 in all four waves of data collection. Multilevel analyses revealed that across all assessment waves, COVID-19-related fear, anxiety, and depressive symptoms were significantly higher in individuals with vs. without anxiety, depressive, and other mental disorders. All symptoms decreased on average over time, and this decrease was significantly stronger in individuals with vs. without anxiety disorders, and particularly driven by individuals with generalized anxiety disorder. Our findings suggest that individuals with mental disorders, especially anxiety disorders - and in particular those with a generalized anxiety disorder - seem to be vulnerable to experience psychological strain in the context of the pandemic, might likely overestimate potential threat, and should be targeted by preventive and therapeutic interventions.

Longitudinal changes in anxiety and psychological distress, and associated risk and protective factors during the first three months of the COVID-19 pandemic in Germany.

BACKGROUND: The COVID-19 pandemic is related to multiple stressors and therefore may be associated with psychological distress. The aim of this study was to longitudinally assess symptoms of (un-)specific anxiety and depression along different stages of the pandemic to generate knowledge about the progress of psychological consequences of the pandemic and to test the role of potential risk and resilience factors that were derived from cross-sectional studies and official recommendations. METHODS: The present study uses a longitudinal observational design with four waves of online data collection (from March 27 to June 15, 2020) in a convenience sample of the general population in Germany. A total of N = 2376 participants that completed at least two waves of the survey were included in the analyses. FINDINGS: Specific COVID-19-related anxiety and the average daily amount of preoccupation with the pandemic decreased continuously over the four waves. Unspecific worrying and depressive symptoms decreased on average but not on median level. Self-efficacy, normalization, maintaining social contacts, and knowledge, where to get medical support, were associated with fewer symptoms relative to baseline. Suppression, unhealthy habits, and a longer average daily time of thinking about the pandemic were correlated with a relative increase of symptoms. INTERPRETATION: Our findings provide insight into the longitudinal changes of symptoms of psychological distress along the first three months of the COVID-19 pandemic in Germany. Furthermore, we were able to reaffirm the anticipated protective and risk factors that were extracted from previous studies and recommendations.

Development of the COVID-19-Anxiety Questionnaire and first psychometric testing.

The coronavirus disease 2019 (COVID-19) pandemic may cause psychological distress in the general population and has the potential to cause anxiety regarding COVID-19. No validated questionnaires exist for the measurement of specific COVID-19 anxiety. We modified the DSM 5 - Severity Measure for Specific Phobia-Adult scale specifically for anxiety regarding COVID-19, and report the psychometric properties from an online study with 6262 participants from the general population in Germany. We analysed internal consistency as well as concordant validity. The scale showed good internal consistency (α = 0.86) and good concordant validity (rs = 0.60) with the 2-item Generalized Anxiety Disorder measure and rs = 0.61 with self-rating of limitations in daily life caused by COVID-19 anxiety.

Associations between COVID-19 related media consumption and symptoms of anxiety, depression and COVID-19 related fear in the general population in Germany.

In context of the current COVID-19 pandemic the consumption of pandemic-related media coverage may be an important factor that is associated with anxiety and psychological distress. Aim of the study was to examine those associations in the general population in Germany. 6233 participants took part in an online-survey (March 27th-April 6th, 2020), which included demographic information and media exploitation in terms of duration, frequency and types of media. Symptoms of depression, unspecific anxiety and COVID-19 related anxiety were ascertained with standardized questionnaires. Frequency, duration and diversity of media exposure were positively associated with more symptoms of depression and unspecific and COVID-19 specific anxiety. We obtained the critical threshold of seven times per day and 2.5 h of media exposure to mark the difference between mild and moderate symptoms of (un)specific anxiety and depression. Particularly the usage of social media was associated with more pronounced psychological strain. Participants with pre-existing fears seem to be particularly vulnerable for mental distress related to more immoderate media consumption. Our findings provide some evidence for problematical associations of COVID-19 related media exposure with psychological strain and could serve as an orientation for recommendations-especially with regard to the thresholds of critical media usage.

Risk, resilience, psychological distress, and anxiety at the beginning of the COVID-19 pandemic in Germany.

BACKGROUND: The current COVID-19 pandemic comes with multiple psychological stressors due to health-related, social, economic, and individual consequences and may cause psychological distress. The aim of this study was to screen the population in Germany for negative impact on mental health in the current COVID-19 pandemic and to analyze possible risk and protective factors. METHODS: A total of 6,509 people took part in an online survey in Germany from 27 March to 6 April. The questionnaire included demographic information and ascertained psychological distress, anxiety and depressive symptoms, and risk and protective factors. RESULTS: In our sample, over 50% expressed suffering from anxiety and psychological distress regarding the COVID-19 pandemic. Participants spent several hours per day thinking about COVID-19 (M = 4.45). Psychological and social determinants showed stronger associations with anxiety regarding COVID-19 than experiences with the disease. CONCLUSIONS: The current COVID-19 pandemic does cause psychological distress, anxiety, and depression for large proportions of the general population. Strategies such as maintaining a healthy lifestyle and social contacts, acceptance of anxiety and negative emotions, fostering self-efficacy, and information on where to get medical treatment if needed, seem of help, while substance abuse and suppression of anxiety and negative emotions seem to be associated with more psychological burden.

[Dealing with psychological distress by healthcare professionals during the COVID-19 pandemia]. / Umgang mit psychischer Belastung bei Gesundheitsfachkräften im Rahmen der Covid-19-Pandemie.

BACKGROUND: In the current COVID-19 pandemia, health workers from all professions are facing great challenges in coping with the crisis. In this situation health professionals are confronted with specific stressors and risks not only for the physical but also for the mental health. OBJECTIVE: This article summarizes the first recommendations for the reduction of stress and psychological burden in health professionals during the current COVID-19 pandemia. METHODS: The recommendations of the World Health Organization, the United Nations and the International Red Cross Society are summarized. Recommendations for the reduction of stress and psychological distress in health professionals as well as important factors that team leaders can consider in order to reduce psychological distress in employees are presented. RESULTS: The normalization of strong emotions and stress, the fulfillment of basic needs, social support, clear communication and distribution of tasks, flexible working hours and the utilization of psychosocial and psychological help without stigmatization seem to be particularly important measures. CONCLUSION: This article presents guidelines for health professionals and team leaders in healthcare that help to maintain mental health during the COVID-19 pandemia.