Three-Month Follow-up Study of Mental Health Outcomes After a National COVID-19 Lockdown: Comparing Patients With Mood or Anxiety Disorders Living in an Area With a Higher Versus Lower Infection Incidence.

Objective: The COVID-19 pandemic and the related containment measures can represent a traumatic experience, particularly for populations living in high incidence areas and individuals with mental disorders. The aim of this study was to prospectively examine posttraumatic stress disorder (PTSD), anxiety, and depressive symptoms since the end of the first COVID-19 pandemic wave and Italy's national lockdown in subjects with mood or anxiety disorders living in 2 regions with increasing pandemic incidence.Methods: 102 subjects with a DSM-5 anxiety or mood disorder were enrolled from June to July 2020 and assessed at baseline (T0) and after 3 months (T1) with the Impact of Event Scale-Revised, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-Item, and Work and Social Adjustment Scale. At T1, subjects were also assessed by means of the Trauma and Loss Spectrum Self-Report for PTSD.Results: At T0, subjects from the high COVID-19 incidence area showed higher levels of traumatic symptoms than those from the low COVID-19 incidence area (P < .001), with a decrease at T1 with respect to T0 (P = .001). Full or partial DSM-5 PTSD related to the COVID-19 pandemic emerged in 23 subjects (53.5%) from the high COVID-19 incidence area and in 9 (18.0%) from the low COVID-19 incidence area (P < .001).Conclusions: Subjects with mood or anxiety disorders presented relevant rates of PTSD, depressive, and anxiety symptoms in the aftermath of the lockdown, and in most cases these persisted after 3 months. The level of exposure to the pandemic emerged as a major risk factor for PTSD development. Further long-term studies are needed to follow up the course of traumatic burden.

Levels of burn-out among healthcare workers during the COVID-19 pandemic and their associated factors: a cross-sectional study in a tertiary hospital of a highly burdened area of north-east Italy.

OBJECTIVE: To determine burn-out levels and associated factors among healthcare personnel working in a tertiary hospital of a highly burdened area of north-east Italy during the COVID-19 pandemic. DESIGN: Observational study conducted from 21 April to 6 May 2020 using a web-based questionnaire. SETTING: Research conducted in the Verona University Hospital (Veneto, Italy). PARTICIPANTS: Out of 2195 eligible participants, 1961 healthcare workers with the full range of professional profiles (89.3%) completed the survey. PRIMARY OUTCOME MEASURE: Levels of burn-out, assessed by the Maslach Burnout Inventory-General Survey (MBI-GS). Multivariable logistic regression analysis was performed to identify factors associated with burn-out in each MBI-GS dimension (emotional exhaustion, EX; professional efficacy, EF; cynicism, CY). RESULTS: Overall, 38.3% displayed high EX, 46.5% low EF and 26.5% high CY. Burn-out was frequent among staff working in intensive care units (EX 57.0%; EF 47.8%; CY 40.1%), and among residents (EX 34.9%; EF 63.9%; CY 33.4%) and nurses (EX 49.2%; EF 46.9%; CY 29.7%). Being a resident increased the risk of burn-out (by nearly 2.5 times) in all the three MBI subscales and being a nurse increased the risk of burn-out in the EX dimension in comparison to physicians. Healthcare staff directly engaged with patients with COVID-19 showed more EX and CY than those working in non-COVID wards. Finally, the risk of burn-out was higher in staff showing pre-existing psychological problems, in those having experienced a COVID-related traumatic event and in those having experienced interpersonal avoidance in the workplace and personal life. CONCLUSIONS: Burn-out represents a great concern for healthcare staff working in a large tertiary hospital during the COVID-19 pandemic and its impact is more burdensome for front-line junior physicians. This study underlines the need to carefully address psychological well-being of healthcare workers to prevent the increase of burn-out in the event of a new COVID-19 healthcare emergency.

Adolescent Lifestyle Behaviors, Coping Strategies and Subjective Wellbeing during the COVID-19 Pandemic: An Online Student Survey.

BACKGROUND AND OBJECTIVES: Adolescence represents a critical period for rapid psychophysical and socio-cognitive changes, with implications for health and wellbeing in later life. From this perspective, the manifestation of unhealthy lifestyles and dysfunctional behaviors may reflect a change in wellbeing requiring alertness and prompt intervention. This study investigated lifestyle behaviors and coping strategies among Italian adolescents, also in relation to the ongoing COVID-19 pandemic, and whether they would predict a change in subjective wellbeing. MATERIALS AND METHODS: In the period between 1 April and 10 April 2020, adolescents aged 15-21 filled out an online survey consisting of 33 questions investigating socio-demographic characteristics, lifestyle behaviors, coping strategies, and subjective wellbeing. RESULTS: Data was available on 306 participants. Most adolescents planned their daily routine (57.8%), engaging in structured activities (17.6-67.3%) and developing new interests (54.6%), and gave a positive reading of the ongoing period (57.8%), thus revealing adaptive coping strategies. Family wise, even though it was hard to stay at home (66%) and difficulties emerged, including self-isolation (50.7%) and quarrels (31.7%), a relevant proportion of adolescents shared their feelings (40.5%) and revaluated their family relationships (29.4-39.7%). In terms of social and school engagement, almost all adolescents kept contacts with their partner, friends, and teachers (90.2-93.5%). School commitments at home were sufficiently preserved (63.1%), however adolescents expressed preoccupations about their educational path (56.2%). A change in subjective wellbeing (49.3%) and symptoms of anxiety (39.9%) were frequently reported. A number of factors predicted a change in subjective wellbeing, including adaptive coping strategies (physical activity, OR = 2.609, 95% confidence interval (CI) 1.297-5.247; engaging in different activities than before, OR = 2.212, 95% CI 1.157-4.230), family issues (finding hard to stay at home, OR = 3.852, 95% CI 1.953-7.599; having quarrels, OR = 2.158, 95% CI 1.122-4.150), school-related behaviors (fearing a negative educational outcome, OR = 1.971, 95% 1.063-3.655), and female gender (OR = 3.647, 95% CI 1.694-7.851). CONCLUSIONS: Both personal and environmental coping resources are relevant to subjective wellbeing in adolescence and should be taken into account for prevention and early intervention in youth mental health.

Medically unexplained symptoms in the times of COVID-19 pandemic: A case-report.

In early 2020, a novel coronavirus (SARS-CoV-2) leading to a potentially fatal condition was discovered. Since then, the 2019 coronavirus disease (COVID-19) has spread worldwide becoming a pandemic. Beyond the risks strictly related to the infection, concerns have been expressed for the psychological impact that COVID-19 may have, especially on vulnerable individuals with pre-existing mental health conditions. Somatic symptom disorder (SSD) is characterized by a dysfunctional preoccupation with physical symptoms leading to excessive and unnecessary healthcare utilization. Despite being quite common, such condition remains underrecognized. We report a detailed clinical case of a 16 years old adolescent, who presented with a history suggestive of COVID-19 infection and associated psychological distress. Despite testing negative for the presence of SARS-CoV-2, his extreme and persisting health preoccupations required an inpatient admission to the Child and Adolescent Neuropsychiatric Unit. He responded rapidly to a low dose of antipsychotic and an antidepressant. Based on his medical history and current presentation, he received a diagnosis of SSD. When COVID-19-like symptoms occur, we highlight the importance of differentially diagnosing a possible exacerbation of a pre-existing SSD, triggered by fear of being infected. This may help preventing further burden to the healthcare system.