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1.
Front Med (Lausanne) ; 8: 760265, 2021.
Article in English | MEDLINE | ID: covidwho-1595608

ABSTRACT

The COVID-19 pandemic affected regular health care for patients with chronic diseases. However, the impact of the pandemic on primary care for patients with coronary artery disease (CAD) who are enrolled in a structured disease management program (DMP) in Germany is not clear. We investigated whether the pandemic affected primary care and health outcomes of DMP-CAD patients (n = 750) by using a questionnaire assessing patients' utilization of medical care, CAD symptoms, as well as health behavior and mental health since March 2020. We found that out of concern about getting infected with COVID-19, 9.1% of the patients did not consult a medical practitioner despite having CAD symptoms. Perceived own influence on infection risk was lower and anxiety was higher in these patients compared to symptomatic CAD patients who consulted a physician. Among the patients who reported chest pain lasting longer than 30 min, one third did not consult a medical practitioner subsequently. These patients were generally more worried about COVID-19. Patients with at least one worsening CAD symptom (chest pain, dyspnea, perspiration, or nausea without apparent reason) since the pandemic showed more depressive symptoms, higher anxiety scores, and were less likely to consult a doctor despite having CAD symptoms out of fear of infection. Our results provide evidence that the majority of patients received sufficient medical care during the COVID-19 pandemic in Germany. However, one in ten patients could be considered particularly at risk for medical undersupply and adverse health outcomes. The perceived infection risk with COVID-19 might have facilitated the decision not to consult a medical doctor.

2.
Alzheimer's & Dementia ; 17(S10):e055294, 2021.
Article in English | Wiley | ID: covidwho-1589227

ABSTRACT

Background The coronavirus disease-19 (COVID-19) pandemic presents challenges to the conduct of randomized clinical trials of lifestyle interventions. Method World-Wide FINGERS is an international network of clinical trials to assess the impact of multidomain lifestyle intervention on cognitive decline in at-risk adults. Individual trials are tailoring successful approaches from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) to local cultures and environments. The network convened forums for researchers to discuss statistical design and analysis issues they faced during the pandemic. We will provide an updated report on experiences of trials that, at various stages of conduct, altered designs and analysis plans to navigate these issues. We provide recommendations for future trials to consider as they develop and launch behavioral intervention trials. Result The pandemic led researchers to change recruitment plans, interrupt timelines for assessments and intervention delivery, and move to remote intervention and assessments protocols. The necessity of these changes add emphasis to the importance, in study design and analysis, of intention to treat approaches, flexibility, within site stratification, interim power projections, and sensitivity analyses. Conclusion Robust approaches to study design and analysis are critical to negotiate issues related to the intervention. The World Wide Network of similarly oriented clinical trials will allow us to evaluate the effectiveness of responses to the pandemic across cultures, local environments, and phases of the pandemic.

3.
Int J Environ Res Public Health ; 18(13)2021 07 05.
Article in English | MEDLINE | ID: covidwho-1295850

ABSTRACT

Little is known about resilience in old age and its manifestation during the COVID-19 pandemic. This study aims to estimate the prevalence of high resilience in the German old age population. We further examine the socio-demographic correlates and whether high resilience reflects on older adults' perception of the threat posed by COVID-19. The data were derived from a representative telephone survey of n = 1005 older adults (≥65 years) during the first COVID-19 lockdown. Assessments included socio-demographic variables, the perceived threat of COVID-19, and high resilience (Brief Resilience Scale; cutoff: ≥4.31). The association between high resilience and threat from COVID-19 was analyzed using ordinal logistic regression. The study sample had a mean age (SD) of 75.5 (7.1) years, and n = 566 (56.3%) were female. The estimated prevalence of high resilience was 18.7% (95% CI = [16.3; 21.2]). High resilience was more prevalent in the younger age group and participants with higher education levels. High resilience was significantly associated with a lower perception of threat from COVID-19. The results of the representative survey in the German old age population showed that one out of five adults aged 65 years and older had high resilience. Older adults with high resilience tended to feel less threatened by COVID-19. Further research on resilience in old age is needed to support vulnerable groups in the context of care.


Subject(s)
COVID-19 , Aged , Communicable Disease Control , Female , Humans , Pandemics , Prevalence , SARS-CoV-2
4.
Int J Environ Res Public Health ; 18(7)2021 03 31.
Article in English | MEDLINE | ID: covidwho-1160297

ABSTRACT

Lockdowns during the COVID-19 pandemic increase the risk of social isolation and loneliness, which may affect mental wellbeing. Therefore, we aimed to investigate associations between social isolation and loneliness with depressive symptoms in the German old-age population during the first COVID-19 lockdown. A representative sample of randomly selected individuals at least 65 years old (n = 1005) participated in a computer-assisted standardized telephone interview in April 2020. Sociodemographic data, aspects of the personal life situation, attitudes towards COVID-19 and standardized screening measures on loneliness (UCLA 3-item loneliness scale), depression (Brief Symptom Inventory/BSI-18), and resilience (Brief Resilience Scale/BRS) were assessed. Associations were inspected using multivariate regression models. Being lonely, but not isolated (ß = 0.276; p < 0.001) and being both isolated and lonely (ß = 0.136; p < 0.001) were associated with higher depressive symptoms. Being isolated, but not lonely was not associated with depressive symptoms. Thus, the subjective emotional evaluation, i.e., feeling lonely, of the social situation during lockdown seems more relevant than the objective state, i.e., being isolated. Normal (ß = -0.203; p < 0.001) and high resilience (ß = -0.308; p < 0.001) were associated with lower depressive symptoms across groups. Therefore, strengthening coping skills may be a support strategy during lockdowns, especially for lonely older individuals.


Subject(s)
COVID-19 , Depression , Aged , Communicable Disease Control , Depression/epidemiology , Humans , Loneliness , Pandemics , SARS-CoV-2 , Social Isolation
5.
Alzheimers Dement (N Y) ; 7(1): e12143, 2021.
Article in English | MEDLINE | ID: covidwho-1135133

ABSTRACT

INTRODUCTION: The coronavirus disease-19 (COVID-19) pandemic presents challenges to the conduct of randomized clinical trials of lifestyle interventions. METHODS: World-Wide FINGERS is an international network of clinical trials to assess the impact of multidomain lifestyle intervention on cognitive decline in at-risk adults. Individual trials are tailoring successful approaches from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) to local cultures and environments. The network convened a forum for researchers to discuss statistical design and analysis issues they faced during the pandemic. We report on experiences of three trials that, at various stages of conduct, altered designs and analysis plans to navigate these issues. We provide recommendations for future trials to consider as they develop and launch behavioral intervention trials. RESULTS: The pandemic led researchers to change recruitment plans, interrupt timelines for assessments and intervention delivery, and move to remote intervention and assessment protocols. The necessity of these changes add emphasis to the importance, in study design and analysis, of intention to treat approaches, flexibility, within-site stratification, interim power projections, and sensitivity analyses. DISCUSSION: Robust approaches to study design and analysis are critical to negotiate issues related to the intervention. The world-wide network of similarly oriented clinical trials will allow us to evaluate the effectiveness of responses to the pandemic across cultures, local environments, and phases of the pandemic.

6.
Eur Psychiatry ; 64(1): e20, 2021 03 09.
Article in English | MEDLINE | ID: covidwho-1123674

ABSTRACT

BACKGROUND: Public health measures to curb SARS-CoV-2 transmission rates may have negative psychosocial consequences in youth. Digital interventions may help to mitigate these effects. We investigated the associations between social isolation, COVID-19-related cognitive preoccupation, worries, and anxiety, objective social risk indicators, and psychological distress, as well as use of, and attitude toward, mobile health (mHealth) interventions in youth. METHODS: Data were collected as part of the "Mental Health And Innovation During COVID-19 Survey"-a cross-sectional panel study including a representative sample of individuals aged 16-25 years (N = 666; Mage = 21.3; assessment period: May 5, 2020 to May 16, 2020). RESULTS: Overall, 38% of youth met criteria for moderate or severe psychological distress. Social isolation worries and anxiety, and objective risk indicators were associated with psychological distress, with evidence of dose-response relationships for some of these associations. For instance, psychological distress was progressively more likely to occur as levels of social isolation increased (reporting "never" as reference group: "occasionally": adjusted odds ratio [aOR] 9.1, 95% confidence interval [CI] 4.3-19.1, p < 0.001; "often": aOR 22.2, CI 9.8-50.2, p < 0.001; "very often": aOR 42.3, CI 14.1-126.8, p < 0.001). There was evidence that psychological distress, worries, and anxiety were associated with a positive attitude toward using mHealth interventions, whereas psychological distress, worries, and anxiety were associated with actual use. CONCLUSIONS: Public health measures during pandemics may be associated with poor mental health outcomes in youth. Evidence-based digital interventions may help mitigate the negative psychosocial impact without risk of viral infection given there is an objective need and subjective demand.


Subject(s)
COVID-19 , Internet-Based Intervention/statistics & numerical data , Mental Health , Quarantine , Social Isolation/psychology , Stress, Psychological , Anxiety/prevention & control , Anxiety/psychology , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Cross-Sectional Studies , Female , Germany/epidemiology , Humans , Male , Quarantine/methods , Quarantine/psychology , SARS-CoV-2 , Stress, Psychological/etiology , Stress, Psychological/prevention & control , Telemedicine/methods , Young Adult
7.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz ; 64(3): 334-341, 2021 Mar.
Article in German | MEDLINE | ID: covidwho-1118203

ABSTRACT

BACKGROUND: The SARS-CoV-2 pandemic led to a general uncertainty about risk and consequences of the disease. Older adults are specifically vulnerable with regard to severe courses of the disease and have been particularly encouraged to self-isolate during the pandemic. Subsequently, expressions of concern have been raised regarding the negative impact of disease risk and quarantine on the mental health of older people. OBJECTIVES: Assessment of psychosocial stress, coping strategies, need for support, and sense of coherence of older people during the COVID-19 pandemic. MATERIALS AND METHODS: The study follows a qualitative research design. Between May and June 2020 N = 11 guided telephone interviews were conducted with older adults (70+ years). Telephone interviews were recorded by audio tape and fully transcribed. A qualitative content analysis was performed according to Mayring and Fenzl (2019) using MAXQDA. RESULTS: Participants were 74.8 years old on average. Participants showed predominantly good psychosocial health and functional coping strategies. Life experience, an optimistic attitude, understanding of the necessity of restrictions, and previous crises that have been mastered were the most important resources during the COVID-19 pandemic for older adults. Offers of support were rarely used. Participants were critical of the closing of centers or meeting points for older people. CONCLUSION: Older adults appear to be able to preserve their mental wellbeing during the COVID-19 pandemic. The relevance of mental resources of older adults for supporting younger generations seems to be unrecognized.


Subject(s)
COVID-19 , Pandemics , Aged , Aged, 80 and over , Germany/epidemiology , Humans , Pandemics/prevention & control , Qualitative Research , SARS-CoV-2 , Social Isolation , Stress, Psychological/epidemiology
8.
J Med Internet Res ; 23(3): e23365, 2021 03 10.
Article in English | MEDLINE | ID: covidwho-1090466

ABSTRACT

BACKGROUND: Accumulating evidence suggests the COVID-19 pandemic has negative effects on public mental health. Digital interventions that have been developed and evaluated in recent years may be used to mitigate the negative consequences of the pandemic. However, evidence-based recommendations on the use of existing telemedicine and internet-based (eHealth) and app-based mobile health (mHealth) interventions are lacking. OBJECTIVE: The aim of this study was to investigate the theoretical and empirical base, user perspective, safety, effectiveness, and cost-effectiveness of digital interventions related to public mental health provision (ie, mental health promotion, prevention, and treatment of mental disorders) that may help to reduce the consequences of the COVID-19 pandemic. METHODS: A rapid meta-review was conducted. The MEDLINE, PsycINFO, and CENTRAL databases were searched on May 11, 2020. Study inclusion criteria were broad and considered systematic reviews and meta-analyses that investigated digital tools for health promotion, prevention, or treatment of mental health conditions and determinants likely affected by the COVID-19 pandemic. RESULTS: Overall, 815 peer-reviewed systematic reviews and meta-analyses were identified, of which 83 met the inclusion criteria. Our findings suggest that there is good evidence on the usability, safety, acceptance/satisfaction, and effectiveness of eHealth interventions. Evidence on mHealth apps is promising, especially if social components (eg, blended care) and strategies to promote adherence are incorporated. Although most digital interventions focus on the prevention or treatment of mental disorders, there is some evidence on mental health promotion. However, evidence on process quality, cost-effectiveness, and long-term effects is very limited. CONCLUSIONS: There is evidence that digital interventions are particularly suited to mitigating psychosocial consequences at the population level. In times of physical distancing, quarantine, and restrictions on social contacts, decision makers should develop digital strategies for continued mental health care and invest time and efforts in the development and implementation of mental health promotion and prevention programs.


Subject(s)
COVID-19/psychology , COVID-19/therapy , Mental Disorders/psychology , Mental Disorders/therapy , Public Health/methods , Telemedicine/methods , Humans , Mental Disorders/virology , Pandemics , SARS-CoV-2/isolation & purification
9.
Int J Environ Res Public Health ; 18(2)2021 01 07.
Article in English | MEDLINE | ID: covidwho-1024574

ABSTRACT

Targeting dementia prevention, first trials addressing multiple modifiable risk factors showed promising results in at-risk populations. In Germany, AgeWell.de is the first large-scale initiative investigating the effectiveness of a multi-component lifestyle intervention against cognitive decline. We aimed to investigate the recruitment process and baseline characteristics of the AgeWell.de participants to gain an understanding of the at-risk population and who engages in the intervention. General practitioners across five study sites recruited participants (aged 60-77 years, Cardiovascular Risk Factors, Aging, and Incidence of Dementia/CAIDE dementia risk score ≥ 9). Structured face-to-face interviews were conducted with eligible participants, including neuropsychological assessments. We analyzed group differences between (1) eligible vs. non-eligible participants, (2) participants vs. non-participants, and (3) between intervention groups. Of 1176 eligible participants, 146 (12.5%) dropped out before baseline; the study population was thus 1030 individuals. Non-participants did not differ from participants in key sociodemographic factors and dementia risk. Study participants were M = 69.0 (SD = 4.9) years old, and 52.1% were women. The average Montreal Cognitive Assessment/MoCA score was 24.5 (SD = 3.1), indicating a rather mildly cognitively impaired study population; however, 39.4% scored ≥ 26, thus being cognitively unimpaired. The bandwidth of cognitive states bears the interesting potential for differential trial outcome analyses. However, trial conduction is impacted by the COVID-19 pandemic, requiring adjustments to the study protocol with yet unclear methodological consequences.


Subject(s)
Cognitive Dysfunction/prevention & control , Life Style , Patient Selection , Aged , Female , Germany , Healthy Aging , Humans , Male , Middle Aged , Neuropsychological Tests
10.
BMC Geriatr ; 20(1): 489, 2020 11 23.
Article in English | MEDLINE | ID: covidwho-940010

ABSTRACT

BACKGROUND: Older individuals are at increased risk of a severe and lethal course of COVID-19. They have typically been advised to practice particularly restrictive social distancing ('cocooning'), which has sparked much debate on the consequences for their mental wellbeing. We aimed to provide evidence by conducting a representative survey among the German old population during COVID-19 lockdown. METHODS: A computer-assisted standardized telephone interview was conducted in a randomly selected and representative sample of the German old age population (n = 1005; age ≥ 65 years) during the first lockdown in April 2020. Assessments included sociodemographic factors, aspects of the personal life situation during lockdown, attitudes towards COVID-19, and standardized screening measures on depression, anxiety, somatization, overall psychological distress (Brief Symptom Inventory/BSI-18) and loneliness (UCLA 3-item loneliness scale). Sampling-weighted descriptive statistics and multiple multivariable regression analyses were conducted. RESULTS: Participants were M = 75.5 (SD = 7.1) years old; 56.3% were women. At data collection, COVID-19 lockdown had been in force for M = 28.0 (SD = 4.8) days. Overall, older individuals were worried about COVID-19, but supportive of the lockdown. Mean BSI-18 scores were 1.4 for depression, 1.6 for anxiety and 2.2 for somatization as well as 5.1 for global psychological distress. These figures did not indicate worse mental wellbeing, given normative values established by studies before the pandemic (2.0, 1.6, 2.4, 6.0, respectively). The prevalence of loneliness was 13.1%, which also fell within a range of estimates reported by studies before the pandemic. There were only few significant associations of aspects of the personal life situation during lockdown and attitudes towards COVID-19 with mental wellbeing. Resilience explained a large amount of variance. CONCLUSIONS: In the short-term, the mental wellbeing of the German old age population was largely unaltered during COVID-19 lockdown, suggesting resilience against the challenging pandemic situation. Our results refute common ageist stereotypes of "the weak and vulnerable older adults" that were present during the pandemic. Long-term observations are needed to provide robust evidence.


Subject(s)
COVID-19/psychology , Mental Health , Physical Distancing , Aged , Aged, 80 and over , Female , Germany , Humans , Male , Pandemics , Surveys and Questionnaires
11.
Psychiatr Prax ; 47(4): 179-189, 2020 May.
Article in German | MEDLINE | ID: covidwho-138955

ABSTRACT

OBJECTIVE: Review of the evidence on the psychosocial impact of quarantine measures during serious coronavirus outbreaks before COVID-19. Such information is highly relevant in regard to the COVID-19 pandemic. METHODS: Search of the MEDLINE database for relevant studies related to SARS-CoV and MERS-CoV outbreaks. RESULTS: Across 13 identified studies, quarantine measures were consistently associated with negative psychosocial outcomes, including depressive symptoms, anxiety, anger, stress, posttraumatic stress, social isolation, loneliness and stigmatization. Determinants comprised duration of quarantine measures and income losses. Health care workers constituted a particularly vulnerable group. CONCLUSION: Quarantine measures during serious coronavirus outbreaks have extensive negative consequences for mental health. Prevention and intervention approaches to attenuate the psychosocial impact should be an integral component of crisis response during pandemic conditions.


Subject(s)
Coronavirus Infections/psychology , Coronavirus , Health Personnel/psychology , Pneumonia, Viral/psychology , Quarantine/psychology , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Disease Outbreaks , Emotions , Germany , Humans , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Social Isolation , Stress Disorders, Post-Traumatic , Stress, Psychological
12.
Psychiatr Prax ; 47(4): 214-217, 2020 May.
Article in German | MEDLINE | ID: covidwho-134185

ABSTRACT

AIM: To date, to our knowledge there are no studies regarding attitudes and experiences of outpatient medical personnel during a pandemic. This study's aim was to evaluate the impact of the COVID-19 pandemic in March 2020 on German psychiatrists and neurologists. METHODS: An e-mail and fax-based short survey of 2,072 practice-based psychiatrists and neurologists was performed including Likert-type questions on personal burden and concerns, anticipated risk of infection, practice management as well as anxiety and sleep problems. RESULTS: 396 physicians returned the questionnaire (19 %). More than 60 % of the participants felt restricted strongly or very strongly, more than 30 % were strongly and very strongly concerned. They anticipated a high own risk of infection. However, 91 % did not report any contact with patients positively screened for COVID-19, which they were aware of. One third felt financially threatened and loss of business volume was anticipated. 18 % reported, that the pandemic triggers substantial anxiety. Sleep problems, which occur at least almost every night, were rarely reported (9 %). CONCLUSION: Practice-based psychiatrists and neurologists are negatively affected by the COVID-19 pandemic.


Subject(s)
Coronavirus Infections/psychology , Neurologists/psychology , Pneumonia, Viral/psychology , Practice Management , Psychiatry , Betacoronavirus , COVID-19 , Germany , Humans , Income , Infection Control , Infectious Disease Transmission, Patient-to-Professional , Pandemics , SARS-CoV-2 , Surveys and Questionnaires
13.
Psychiatr Prax ; 47(4): 190-197, 2020 May.
Article in German | MEDLINE | ID: covidwho-134184

ABSTRACT

AIM: Review of studies on the psychological stress of healthcare workers caused by the COVID-19 pandemic. METHODS: A literature search of PubMed was performed using the terms "COVID-19", "stress", "mental health", "healthcare worker", "staff", "psychiatry". Quantitative studies (including letters to the editor) published from January to March 2020 were included. RESULTS: 14 studies on healthcare workers in departments of infectiology, internal medicine, and fever wards including intensive care wards as well as surgery and psychiatry, were included. The Patient Health Questionnaire 9 (PHQ9), Self-rating-Anxiety Scale (SAS) and Impact of Event Scale (IES-R) were the most often used test instruments. The sample size ranged between 37 and 1257 participants consisting of mostly nursing and medical personnel. The fraction of COVID-19-associated activities varied from 7.5 % to 100 %. An extensive strain was reported due to stress experience as well as depression and anxiety symptoms. Severe degrees of those symptoms were found in 2.2 % to 14.5 % of all participants. The severity of mental symptoms was influenced by age, gender, occupation, specialization, type of activities performed and proximity to COVID-19 patients. As mediator variables selection of personnel, preventive interventions, resilience, and social support were reported. CONCLUSION: Considering the frequency of mental symptoms occurring in healthcare workers, accompanying mental health informed interventions to facilitate coping are necessary. Further research in this field is needed.


Subject(s)
Coronavirus Infections/psychology , Health Personnel/psychology , Pandemics , Pneumonia, Viral/psychology , Stress, Psychological , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Germany , Humans , Mental Health , Pneumonia, Viral/epidemiology , SARS-CoV-2
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