Stress and sleep: impact of the main contributing factors to poor sleep experiences during the COVID-19 pandemic

Introduction: The COVID-19 (Coronavirus Disease 2019) pandemic is associated with several stressful factors that can negatively affect peoples' sleep quality and mental health. Objective(s): The aim of the current study was to prospectively identify decreased sleep quality and associated risk factors in general population during COVID-19 pandemic. Method(s): We conducted a prospective, observational online study on a Romanian sample of 667 respondents aged >18 years. Sleep quality and quantity was evaluated with Athens Insomnia scale (AIS) and the main concerns associated with the pandemic context were evaluated through a multiple-choice question. Result(s): The data collected identified important evidence regarding the prevalence and intensity of insomnia. The average score for AIS was 6.13 (cut-off point for was set at 8). However, it is worth noting that 179 respondents (26.8%) meet the criteria for insomnia. Of the 8 self-assessment items, daytime sleepiness was the criterion evaluated with the highest average score (1.01), all other items getting subunit values. A low quality of sleep was linearly related with fear of illness/death (p=0.053), fear of illness/death of close people (p=0.032), social isolation (p<0.001), economic impact (p=0.003), losing the job (p<0.001) and social stigma associated with COVID-19 infection (p=0.009). Conclusion(s): More than a qurter of respondes scored above the threshold of 8 at the insomnia scale, while losing the job, social stigma associated with COVID-19 infection and social isolation are the main risk factors for a low quality and quantity of sleep.

Psychological resilience and anxiety in response to COVID-19

Introduction: In Romania, the first case of COVID-19 was detected on 26 February 2020 and the number of cases has been rising afterward. Objective(s): The goal of this study was to assess anxiety and resilience regarding the COVID-19 pandemic and to analyse possible protective measures and risk factors. Method(s): This is a cross-sectional study and data were collected March and April 2021. Participants filled in the Zung Self-Rating Anxiety Scale and the Connor-Davidson Resilience Scale. Result(s): The sample consisted of 440 participants who presented to the general practitioner (female-65.7%) and the most representative age group was 35-64 years old;18.4% of the participants stated that they were infected;56.6% reported that they do not know anyone in their entourage who was infected/ has died of COVID- 19 (group A), 32.9% knowing people with an infection in their close social environment (group B) and 10.5% had close people who died (group C). Almost half of the respondents (49,3%) scored above the cut-off point of the anxiety index (mild 38.6%, moderate 9.9%, severe 0.8%). As we expected, there is a strong negative correlation between anxiety levels and resilience (Pearson Correlation=-.551, p<0.01). If groups A and B had similarities regarding anxiety levels (44.97 and 44.23), those knowing someone who died of COVID-19 (group C) had a higher anxiety level (47.81%) (p<0.05). Conclusion(s): The recent COVID-19 pandemic has caused an understandable surge in anxiety among the general population. Low level of resilience is predictive of the phenomenon of having high anxiety in the face of the death of others.

COVID-19-related information sources and anxiety levels

Introduction: Timely and accurate information is foundational to moderating and curing the COVID-19 for both the public and the scientific community, while repeated media exposure to crisis-related information raises stress and anxiety among general population. Objective(s): The main goal of the current study was to evaluate the associations between the COVID-19-related information sources and anxiety levels. Method(s): An online web-survey recruited participants who were >=18 years old and lived in Romanian through an online campaign in May 2021. Participants were asked whether they received COVID-19-related information frequently from the following sources: the Internet, traditional media, medical staff in health care settings or from friends, co-workers, or family members. We also assessed participants' level of anxiety with Zung Self-Rating Anxiety Scale (SAS) and the cut-off point for anxiety index was set at 45. The associations of each information source with anxiety were examined using multiple regression analyses to control for sex, age, education and other demographic characteristics. Result(s): In total, the data of 1559 respondents (1224 female;mean age = 37.03 years and standard deviation (SD)=12.90 years) were analysed. The mean index score for SAS were 44.28 (SD=10.6). The major source of information on COVID-19 was the Internet (59.20%) and medical stuff (58.27%), almost in equal measure, followed by traditional media (48.17%) and friends, co-workers, and family members (30.72%). Conclusion(s): Receiving COVID-19 information from the Internet and traditional media was positively correlated with anxiety level (p=0.01), while receiving COVID-19 information from medicalstuff was associated with low levels of anxiety (p=0.03).

Prevalence of anxiety and depression among students and employees during the COVID-19 pandemic

Introduction: Facing the COVID-19 pandemic, individuals are experiencing severe mental distress. Following social distancing and economic insecurity, significant increases in mental health concerns have developed. Objective(s): The aims of this study was to report the levels of depressive and anxiety within active population in Romania, and to identify possible risk and protective factors for mental health. Method(s): Data collection occurred between February-March 2021. The online survey included questions regarding socio-demographic characteristics and Hospital Anxiety and Depression Scale (HADS). 620 responses were validated (331 students and 289 workers). Result(s): Among active population, risk of anxiety symptoms is lower in those who already were infected with SARS-Cov2 (p=0.026, df=2, Phi=0.109), while positive screening for anxiety or depression in this study was statistically significant associated with younger age (p=0.026, df=4, Phi=0.134) and female gender (p=<0.001, df=2, Phi=0.166). Even though anxiety and depression scores are similar among students and employees, there are different aspects regarding symptomatology between these two groups. Students have experienced more frequently tendency to worry and sudden feelings of panic (p=0.004, df=3, Phi=0.146). Also, their ability to laugh and see the funny side of things is affected (p=0.019, df=3, Phi=0.127) and they feel less enthusiasm about future (p=0.001, df=3, Phi=0.159). Participants living with someone else scored lower on anxiety and depression subscales and those are not influenced by the person with whom they are cohabitating or residing (p=0.020, df=3, Phi=0.138). Conclusion(s): Findings from the current study offer initial insights into the rates of anxiety and depression within active population in Romania, one year after the onset of the COVID-19 pandemic.

P.0187 Impact of covid-19 pandemic on sleep quality in students and employees

Introduction: Facing the COVID-19 pandemic, individuals are experiencing severe mental distress [1]. Thus, during the last year, drastic changes occurred in everyday life of every human being. Following social distancing and economic insecurity, significant increases in mental health concerns (loneliness, anxiety, depression, or insomnia) have developed [2]. Aims: The objective of this study was to explore the sleep quality in students and employees, during the COVID-19 pandemic. Methods: Data collection occurred between February and March 2021. The online survey included questions regarding socio-demographic characteristics, COVID-19 status, and Athens Insomnia Scale (AIS) [3]. Snowball sampling was conducted to recruit participants and the survey was shared through social media networking. 620 responses were validated. The analysis was carried out using SPSS Statistics. The Chi-Square test, the corresponding corrections (when the criteria were not met - Likelihood ratio, Fisher test) and Phi and Cramer V parameters were used to verify the interval combinations;the t-independent test with the reporting of the degrees of release, the difference of the means, the Levene′s test for the homogeneity test, the Kolmogorov-Smirnov and Shapiro-Wilk normality tests for the subgroups under 30 respondents and the confidence interval set at 95%. Results: 74.8% of the respondents were female and most of them were young adults (18 and 35 years - 82.4%). 53.4% were students, while 46.6% were employees. 91.8% lived in urban areas. The average working hours per week was 20-40 hours (32.9%). Regarding COVID-19 disease, 16% were infected, of which 65% had a mild form. Women reported more frequent by impairment of total sleep duration (p=0.032, df=3, Phi=0.119, moderate correlation) and overall poorer quality of sleep (p=0.042, df=3, Phi=0.115, moderate correlation). AIS scores were significantly higher for women, (Mean Differences-1,027: women's mean score=6.39, men’ s mean score =5.37), p=0.007. The frequency of awakenings during night increase with age (p<0.001, df=6, Phi=0.248, strong correlation), as well as awakenings earlier than the desired time (p=0.004, df=6, Phi=0.202, strong correlation). Drowsiness during the day is more prevalent at younger ages (p<0.001, df=6, Phi=0.251, large association). In student population, the sleep induction is more affected (p=0.013, df=3, Phi=0.132, moderate association). Also, the perception of physical and mental functioning (p<0.001, df=3, Phi=0.206, strong association) and sleepiness during daytime (p<0.001, df=3, Phi=0.189, strong association) are more prevalent. In contrast, awakenings during the night are more prevalent among employees (p<0.001, df=3, Phi=0.185, strong association). The final awakening was found to be earlier than desired (p=0.002, df=3, Phi=0.155, strong association). Overall, the AIS results are not significant by different between groups (p=0.140, df=1). Conclusion: Students have experienced more frequently next day consequences of insomnia, while for workers awakenings during the night and early morning awakening were more prevalent. Regarding sociodemographic factors, AIS score was significantly higher among women and awakenings during the night were a sleep disturbance associated with ageing. This online survey suffers from two methodological limitations: limited access to certain portals, and participation biases (respondents may select themselves into the sample), thus more research on insomnia during a pandemic crisis is necessary. No conflict of interest

P.838Coronavirus information to psychiatric patients

Background: While the Coronavirus-19 pandemic is apparently receding, a second wave is still well possible. Patients diagnosed with a severe mental illness (SMI) have an excess mortality and their lifespan is between 10 to 30 years shorter compared to general population [1]. There are also discrepancies in healthcare access and its utilization in patients with SMI compared to general population [2]. People with SMI are more vulnerable to infectious diseases. What is more, Cov19 mortality seems to be double in males compared to females [3]. Therefore, male SMI patients represent a particularly vulnerable group susceptible to both Cov-19 infection and a severe course of illness. Aims: Our study aims to examine the level of information regarding the new Coronavirus-19 in SMI patients compared to general population. Methods: We applied two questionnaires to male patients with severe mental illness. One of the them was based on the five important affirmations from WHO [4]. There were two possible answers for each question, true or false, with a maximum score of 5 points for each questionnaire. The higher the score, the better the knowledge of preventive measures against infection with coronavirus. Our sample consisted of 42 male inpatients from “Alexandru Obregia Psychiatric Hospital” admitted between March and June 2020 and 42 controls matched by gender, age and education. Prior to filling the questionnaires, patients did not receive any formal information or education upon this topic, other than the instructions from the media. Scores were compared using Mann Whitney test and results were considered statistically significant al alpha 0.05,2-tailed. Results: Mean and median scores for the questions evaluating general information were: 6.95 (±1.75) and 7 (IQR 6-8.25) for SMI patients and 9.07 (±1.46) and 10 (IQR 8.75-10) for controls (U=315, Z=-5.21, p<.001). Mean and median scores for level of knowledge about WHO prevention measures were and 4.38 (±0.96) and 5 (IQR 4-5) for SMI patients and 4.76 (±0.62) and 5 (IQR 5-5) for controls (U=685.5, Z=2.25, p=.025). For fictitious information about COVID-19, SMI patients had a mean score of 2.52 (±1.63) and a median one of 3 (IQR 1-4) while controls had 4.33 (±1.16) and a median of 5 (IQR 4-5) (U=324, Z=-5.19, p<.001). Conclusion: To our best knowledge this is the first study evaluating Cov-10 information in SMI patients. Patients with SMI had a lower knowledge of prevention methods against coronavirus. There are multiple factors that can contribute to these results as the severity of the pathology, cognitive capacities, insight and it might be possible that some patients do not understand simple statements. In addition, the SMI group was less likely to discern erroneous information from genuine advice. For this matter, traditional ways of offering information to SMI patients may need altering and personalization since is of vital importance for infectious prevention and spreading of the virus. No conflict of interest