Feeling Informed and Safe Are Important Factors in the Psychosomatic Health of Frontline Workers in the Health Sector during the COVID-19 Pandemic in Austria.

The global spread of the coronavirus disease (COVID-19) has created new challenges for the entire healthcare system, and those who work directly with the patients or even on the front lines with COVID-19 patients have been particularly stressed. Only a few studies are currently available investigating psychosomatic symptoms among healthcare workers, particularly frontline workers, over the entire pandemic period (2020-2022). There is also a lack of knowledge about strategies to prevent stress during and after a health crisis. METHODS: An online survey was conducted at three times (April 2020, winter 2020/2021, and winter 2021/2022) during the COVID-19 pandemic in Austria. The sample included 160 healthcare workers at screening time 1, 1.361 healthcare workers at screening time 2, and 1.134 healthcare workers at screening time 3. The survey included COVID-19 work-related fears, satisfaction with the frontline work, and standardized inventories to assess psychosomatic symptoms, such as the Patient Health Questionnaire (PHQ-D). RESULTS: Psychosomatic symptoms were more common among women compared to men, and among frontline workers compared to non-frontline workers, especially during the course of the pandemic at t2 and t3. Self-reported scores of COVID-19 work-related fears were significantly associated with psychosomatic symptoms. Furthermore, in frontline workers, there was a significant association between the feeling of being safe and well-informed and psychosomatic symptoms. CONCLUSION: COVID-19 work-related fears and psychosomatic symptoms have been prevalent among healthcare workers throughout the pandemic. Feeling safe and informed appears to be essential to prevent psychosomatic symptoms, leading to a recommendation for employers in the healthcare sector to focus on communication and information. As frontline workers are especially prone to psychosomatic symptoms, more stress prevention programs for them will be essential to maintain productivity and reduce sick days and fluctuations in the healthcare system.

[COVID-19 and Bipolar Affective Disorder: Subjective Changes in Lifestyle Variables During the First Lockdown During the COVID-19 Pandemic in Austria]. / COVID-19 und bipolare affektive Störung: Subjektive Veränderung der Lebensstilvariablen während des ersten Lockdowns in der COVID-19-Pandemie in Österreich.

INTRODUCTION: The COVID-19 pandemic with its protective measures (e. g. lockdown) had far-reaching effects on everyone's well-being. The aim of this study was to examine lifestyle variables during the first Austrian lockdown in patients with bipolar disorder in comparison to a healthy control group and to assess subjective changes caused by the pandemic. METHOD: At the beginning of April 2020, an online survey of n=75 participants (35 people with bipolar disorder and 40 healthy controls) with standardized questionnaires (Beck Depression Inventory-2, Food Craving Inventory, Altman Self Rating Mania Scale) as well as non-standardized COVID-19-specific questions on the subject of "Psychological stress and effects of the COVID-19 pandemic in bipolar disorder" was created and distributed via LimeSurvey. RESULTS: Both groups reported a negative impact on their mental health. The participants with bipolar disorder showed significantly higher values in the Beck Depression Inventory-2 score (p<0,001), in emotional distress due to social distancing (p=0,003) and significantly lower values in muscle-strengthening exercise (p=0,039) and in sport units (p=0,003) compared to the control group. In addition, patients with bipolar disorder smoked more often than individuals of the control group. People with bipolar disorder were 42,9% more likely to report they were less efficient during the pandemic, and 22,9% experienced weight gain compared to before the pandemic. The control group, on the other hand, was less efficient at 17,5% and 5,0% reported weight gain. However, a comparison with pre-pandemic data showed a decrease in food craving in both groups. CONCLUSION: This study provided first evidence of self-reported adverse effects on mental stress and lifestyle in people with bipolar disorder at the beginning of the COVID-19 pandemic. Psychiatric care and early interventions for patients with bipolar disorder would be particularly important in times of crisis in order to help maintain a healthy lifestyle and thus counteract unfavourable developments.

Influences of COVID-19 Work-Related Fears and Anhedonia on Resilience of Workers in the Health Sector during the COVID-19 Pandemic

Background: During the peak of the COVID-19 pandemic, healthcare workers worked under stressful conditions, challenging their individual resilience. Therefore, we explored the bidirectional influence of resilience and the factors of COVID-19 work-related fears and anhedonia in Austrian healthcare workers. Methods: Healthcare workers in Austria completed an online survey at two points in time. The first measurement started in winter 2020/2021 (t1), and a second measurement began approximately 1.5 years later (t2). One hundred and eight six individuals completed both surveys and were investigated in a longitudinal design. We applied the Resilience Scale, the Snaith-Hamilton Pleasure Scale, and a self-created questionnaire assessing COVID-19 work-related fears. We used a repeated measures analysis of variance and applied Pearson-Correlations as well as univariate and multivariate analyses of covariance. Results: Resilience was significantly correlated with COVID-19 work-related fears and anhedonia at both points in time in all participants. We found no significant differences for frontline vs. non-frontline workers at t1 and t2. Resilience decreased significantly over time. Limitations: Most subjects were examined cross-sectionally. Frontline workers were underrepresented in our sample. Conclusion: Our findings highlight the importance of resilience in healthcare providers. Steps must be taken to maintain and promote resilience in healthcare workers. We suggest that the improvement of resilience, dealing with fears and uncertainty, and the ability to experience joy might have a beneficial influence on the respective other categories as well.

Sleep quality among workers in the health sector exposed to the COVID-19 pandemic.

The ongoing pandemic of coronavirus disease (COVID-19) is a global health crisis that has posed enormous pressure on workers in the health sector (WHS), having a massive impact on their mental health. In this study, we aimed to evaluate the sleep quality of WHS during the pandemic and compare frontline WHS to those who are not directly engaged in the care of COVID-19 patients. This cross-sectional, self-reported online survey assessed the sleep quality of WHS in Austria using the Pittsburgh Sleep Quality Index (PSQI). The same questionnaire was sent out two times. Due to the unequal sample and anonymity of the study participants, we analyzed the data of each time point separate from each other. The first study was conducted in April/May 2020, during the first lockdown in Austria (Study1), and the second study was conducted in July/August 2020, when the social restrictions were loosened (Study2). T-test was used to compare the mean values of PSQI scores between frontline vs. non-frontline WHS, while two two-way ANCOVAs were used to analyze differences in the PSQI mean scores (controlled for age) for male vs. female between frontline vs. non-frontline WHS. During the first lockdown in Austria (Study1) we identified a shorter sleep duration of frontline WHS compared to the non-frontline group, however the difference in global PSQI score between these groups was statistically not significant. In the period after loosened restrictions (Study2) the sleep quality, sleep latency, sleep duration, sleep efficiency and global PSQI score was worse in frontline WHS compared to the non-frontline WHS. Furthermore, female WHS scored higher in the PSQI indicating a worse sleep than male WHS. In addition, nurses and nursing assistants had a higher prevalence of poor sleep quality than other occupational groups. Our results indicate that the COVID-19 pandemic negatively impacts the sleep of WHS, affecting particularly frontline WHS. Preventive interventions aiming to promote good sleep quality in WHS during a healthcare crisis like this pandemic are essential to enhance resilience and mitigate the vulnerability of this specific population.

Believing processes during the COVID-19 pandemic in individuals with bipolar disorder: An exploratory study.

BACKGROUND: Believing or "credition" refers to psychological processes that integrate the cognitions and emotions that influence our behavior. In the credition model by Angel and Seitz, four parameters are postulated: proposition, certainty, emotion and mightiness. It is assumed that believing processes are influenced by both the individual as well as socio-cultural factors and external circumstances. External or environmental circumstances can include threatening situations such as the ongoing pandemic. It has been hypothesized that believing processes related to the pandemic differ between individuals with bipolar disorder (BD) and healthy controls (HC). AIM: To investigate credition in individuals with BD during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Psychiatrically stable individuals with BD (n = 52) and age- and sex matched HC (n = 52) participated in an online survey during the first lockdown of the COVID-19 pandemic. The survey took place between April 9th and June 4th, 2020, in Austria. Participants completed the Brief Symptom Inventory-18, the Beck Depression Inventory-II, the Altman Self-Rating Mania Scale, the Pittsburgh Sleep Quality Index and a dedicated Believing Questionnaire assessing four parameters of credition (proposition, certainty, emotion and mightiness). The MAXQDA software was used to analyze the qualitative data. Statistical analyses included analyses of variance, a multivariate analysis of variance and a multivariate analysis of co-variance. RESULTS: Individuals with BD reported significantly more negative propositions [F (1,102) = 8.89, P = 0.004, η2 p = 0.08] and negative emotions [Welch´s F (1,82.46) = 18.23, P < 0.001, η2 p = 0.18], while HC showed significantly more positive propositions [F (1,102) = 7.78, P = 0.006, η2 p = 0.07] and emotions [F (1,102) = 14.31, P < 0.001, η2 p = 0.12]. In addition, individuals with BD showed a higher incongruence between their propositions and their emotions [F (1,102) = 9.42, P = 0.003, η2 p = 0.08] and showed strong correlations between the parameters of the Believing Questionnaire and their psychiatric symptoms (r = 0.51-0.77, all P < 0.001). Positive as well as negative emotions and propositions were associated with scores measuring symptoms of depression, anxiety and sleep quality. CONCLUSION: Believing parameters were associated with psychiatric symptoms in BD during the pandemic. Findings broaden knowledge about the susceptibility of believing processes for ambient challenges in individuals with BD.

Anxious Temperament Predicts Poor Acceptance of Self and Life in Bipolar Disorder during the COVID-19 Pandemic

The coronavirus disease (COVID-19) pandemic and the social distancing resulting thereof are having a great impact on psychological well-being. Studies investigating resilience found that it impacts mental health during crises. This study aimed to evaluate the influence of pre-crisis temperament on resilience in individuals with bipolar disorder during the COVID-19 pandemic. An online survey was conducted in Austria between April and June 2020, including 36 individuals with bipolar disorder and 39 healthy controls. Resilience was assessed with the 13-item resilience scale, and temperament was measured with the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire (TEMPS-A). The bipolar disorder group showed lower resilience than the control group, and scored higher on the TEMPS-A for depressive, cyclothymic, and anxious temperaments. Resilience could be predicted by anxious temperament in individuals with bipolar disorder, and correlated negatively with depressive symptoms in both groups. The results suggest that anxious temperament influences the resilience of individuals with bipolar disorder, likely more than temporary hardships, such as the first months of the COVID-19 crisis. It is therefore important to improve the resilience of individuals with bipolar disorder not only by short-term interventions, but by strengthening resilience and reducing anxious temperament in the long term.

Greater Emotional Distress Due to Social Distancing and Greater Symptom Severity during the COVID-19 Pandemic in Individuals with Bipolar Disorder: A Multicenter Study in Austria, Germany, and Denmark.

Throughout the COVID-19 pandemic, mental health of individuals with bipolar disorders (BD) is potentially more vulnerable, especially regarding COVID-19-related regulations and associated symptomatic changes. A multicentric online study was conducted in Austria, Germany, and Denmark during the COVID-19 pandemic. Overall, data from 494 participants were collected (203 individuals with BD, 291 healthy controls (HC)). Participants filled out questionnaires surveying emotional distress due to social distancing, fear of COVID-19, and the Brief Symptom Inventory-18 to assess symptom severity at four points of measurement between 2020 and 2021. General linear mixed models were calculated to determine the difference between the groups in these pandemic specific factors. Individuals with BD reported higher distress due to social distancing than HC, independently of measurement times. Fear of COVID-19 did not differ between groups; however, it was elevated in times of higher infection and mortality due to COVID-19. Individuals with BD reported higher psychiatric symptom severity than HC; however, symptom severity decreased throughout the measured time in the pandemic. Overall, individuals with BD experienced more distress due to the COVID-19 situation than HC. A supportive mental health system is thus recommended to ensure enhanced care, especially in times of strict COVID-19-related regulations.

Willingness to be vaccinated against COVID-19 is equal in individuals with affective disorders and healthy controls.

Affective disorders such as major depressive disorder and bipolar disorder are associated with higher infection rates and a more severe course of coronavirus disease (COVID-19). In turn, COVID-19 could trigger mental disease relapse. Vaccinations lead to a reduction of infections and the prevention of severe courses. This work aims to survey the willingness of individuals with affective disorders to get vaccinated and concerns about vaccinations. METHODS: An online study (April-May 2021) assessed the current infection and vaccination rate amongst individuals with affective disorder in Austria by surveying attitudes towards the vaccination, the willingness to get vaccinated soon and possible reasons for decision. The analyses included 59 individuals with affective disorders and 59 healthy controls, matched for sex and age. RESULTS: There was an overall high willingness to get vaccinated against COVID-19. Individuals with affective disorders were more skeptical about vaccinations in general but there was no significant difference between the groups in the willingness to get vaccinated against COVID-19. In both groups reasons for waiting were mainly fears of acute and/or long-term side effects and the fast development of the vaccines. LIMITATIONS: It was a cross sectional design. Due to the online design, no objective rating of current psychopathological symptoms was assessed. Willingness to get vaccinated in general and against COVID-19 in particular were self-created variables, whereas item statistics and factor analysis were conducted. DISCUSSION: Because of the higher risk for individuals with affective disorders, preventive strategies like vaccinating should be promoted in this group. It is important to help individuals with AD to overcome barriers such as negative beliefs and concerns about acute and/or long-term side effects.

Psychological and behavioral response on the COVID-19 pandemic in individuals with bipolar disorder: A multicenter study.

The COVID-19 pandemic affects both mentally healthy and ill individuals. Individuals with bipolar disorder (BD) constitute an especially vulnerable group. A multicentric online study was conducted in Austria, Denmark, and Germany after the first lockdown phase in 2020. In total, 117 healthy controls (HC) were matched according to age and sex to 117 individuals with BD. The survey included the Brief Symptom Inventory-18, Beck Depression Inventory-2, Pittsburgh Sleep Quality Index, and a self-constructed questionnaire assessing COVID-19 fears, emotional distress due to social distancing, lifestyle, and compliance to governmental measures. In individuals with BD, increased symptoms of depression, somatization, anxiety, distress due to social distancing, and poorer sleep quality were related to emotional distress due to social distancing. The correlation between emotional distress due to social distancing and anxiety showed 26% of shared variance in BD and 11% in HC. Negative lifestyle changes and lower compliance with COVID-19 regulatory measures were more likely to be observed in individuals with BD than in HC. These findings underscore the need for ongoing mental health support during the pandemic. Individuals with BD should be continuously supported during periods of social distancing to maintain a stable lifestyle and employ strategies to cope with COVID-19 fears.

Physical Health Profile and Associated Behavior During the COVID-19 Pandemic in Patients With Bipolar Disorder.

Background: The COVID-19 pandemic has led to an increased psychological strain on public mental health and may impact behavioral, mental, and physical health, presumably with effects on patients with severe mental disorders. This study examines pandemic-related physical and mental health and (compensatory) behavioral changes, in patients with BD as compared to healthy control individuals. Method: Physical and mental health and self-reported changes in daily structure and behavior due to the pandemic were assessed using a self-constructed questionnaire and the brief symptom inventory (BSI) in Germany, Austria, and Denmark in individuals with BD and a healthy control group. Results: The present study included 118 individuals with BD and 215 healthy controls. Individuals with BD reported statistically significant higher physical risk burden, increased weight gain, more physical comorbidities, and a decrease in physical activity and they further reported higher rates of COVID-19 testing, had more worries concerning health, and experienced more anxiety but less social distancing. Conclusion: The COVID-19 pandemic seems to have a greater impact on physical health in individuals with BD than in healthy controls. Individuals with BD appear to be having more difficulties compensating their behavior due to the pandemic which could amplify the effect of risk factors associated with poorer physical health. This highlights the necessity for optimizing and targeting the overall treatment of both mental and physical health in patients with BD during periods with far-reaching changes such as the COVID-19 pandemic. Limitations: Sampling issues and self-report forms, selectivity (missing elderly, and those lacking access or knowledge of technology).

COVID-19-related fears and information frequency predict sleep behavior in bipolar disorder.

INTRODUCTION: The coronavirus disease (COVID-19) pandemic and consequent restrictions including social distancing had a great impact on everyday life. To date, little is known about how the restrictions affected sleep, which is commonly disturbed in bipolar disorder (BD). The aim of this study was to elucidate sleep patterns during the pandemic in Austrian BD individuals. METHODS: An online survey assessed sleep with the Pittsburgh Sleep Quality Index (PSQI) and COVID-19-associated attitudes, fears, and emotional distress of 20 BD individuals and 19 controls (HC) during the pandemic. The survey was conducted in April 2020, when very strict regulations were declared, and repeated in May, when they were loosened. RESULTS: Individuals with BD reported overall poor sleep according to PSQI sum at both time points. Subjective sleep quality, sleep latency, daytime sleepiness, and PSQI sum were worse in individuals with BD than in HC. Individuals with BD informed themselves more frequently about pandemic-related topics. Higher information frequency and more COVID-19 fears (about the virus, own infection, contracting others) correlated with worse PSQI values. Regression models found in BD group that higher information frequency as well as higher COVID-19 fears in April predicted worse sleep characteristics in May, in particular subjective sleep quality, sleep duration, sleep efficiency, and daytime sleepiness. CONCLUSION: As sufficient sleep duration and quality are essential for well-being and particularly important for vulnerable BD individuals, it is important that information about the pandemic is gathered to a reasonable extent and mental health professionals include COVID-19-related fears when currently treating BD.

COVID-19 Pandemic Stress-Induced Somatization in Transplant Waiting List Patients.

Background: The coronavirus disease 2019 (COVID-19) pandemic has resulted in widespread socioeconomic restrictions including quarantine, social distancing and self-isolation. This is the first study investigating the psychological impact of the pandemic on patients waiting for liver or kidney transplantation, a particularly vulnerable group. Methods: Twenty-seven patients on the transplantation waiting list and 43 healthy controls took part in an online survey including the Beck Depression Inventory (BDI-2), the Brief Symptom Inventory-18 (BSI-18), the Pittsburgh Sleep Quality Index (PSQI), the Alcohol Use Identification Test (AUDIT-C), the 12-item Operationalized Psychodynamic Diagnosis Structure Questionnaire (OPD-SQS) and a questionnaire to determine cognitions and beliefs, attitude and fear related to COVID-19. Results: BSI-18 Somatization was increased in waiting list patients compared to controls. Correlation analyses indicated a relationship between Somatization and the fear of contracting the coronavirus in the patient group; however this association was weak. In patients and controls, other psychologicial symptoms (depression, anxiety) correlated highly with emotional distress due to social distancing. There were no differences between patients and controls in depression scores and sleep disturbances. Alcohol consumption and personality structure were not related to COVID-19 fears. Conclusion: In times of the first lockdown during the COVID-19 pandemic, patients on the transplantation waiting list have high somatization symptoms associated with COVID-19 fears. As vulnerable group, they need psychological counseling to improve mental well-being during times of crisis.

Psychological symptoms during and after Austrian first lockdown in individuals with bipolar disorder? A follow-up control-group investigation.

BACKGROUND: The coronavirus disease (COVID-19) pandemic, a global health crisis, has resulted in widespread socioeconomic restrictions including lockdown, social distancing, and self-isolation. To date, little is known about the psychological impact of the COVID-19 pandemic and lockdown on patients with bipolar disorder as a particularly vulnerable group. METHODS: An online survey was conducted in Austria at two points of measurement (T1 April 2020 during the first lockdown vs. T2 May 2020 at post-lockdown). The sample comprises 20 patients with bipolar disorder (mean age = 49.4 ± 15.6 years) and 20 healthy controls (mean age = 32.7 ± 9.6 years). A 2 × 2 factorial design to compare two time points (T1 vs. T2) and two groups (patients vs. healthy controls) was used. Main outcome measures included the Brief Symptom Inventory-18 (BSI-18) and a (non-validated and non-standardized) assessment to determine COVID-19 fears and emotional distress due to social distancing. Multiple linear regression analyses were used to assess the longitudinal association of COVID-19 fears/emotional distress due to social distancing during lockdown (T1) and psychological symptoms after lockdown (T2). RESULTS: At T1, results demonstrated higher scores in BSI-18 subscales depression, anxiety and global severity index as well as emotional distress due to social distancing in bipolar patients compared to controls. There was a significant time x group interaction in the BSI-18 subscale somatization showing a decreasing trend in patients with BD compared to controls. No time effects in BSI-18 subscales or COVID-19 fears/emotional distress due to social distancing were observed. Regression analyses showed that COVID-19 fears during lockdown predicted somatization, only in patients. CONCLUSIONS: There was a connection between the lockdown measures and somatization symptoms observed in patients. When the first steps of easing the social restrictions in May 2020 took place, somatization decreased only in the bipolar compared to the control group. Higher COVID-19 fears during lockdown predicted later symptoms at post-lockdown. Long-term impacts of the COVID-19 pandemic need further investigations to improve current therapeutic approaches and prevent fears and distress during lockdown in individuals with bipolar disorder in times of crisis.