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Background: The development of depression and anxiety symptoms during long COVID may partly result from the biopsychosocial effects of COVID-19 that impact mental health, rather than from the infection alone. Aim: The present study examined the association of anxiety, depression, stress, and psychological distress levels with sociodemographic factors and symptom severity during and three months after the acute phase of COVID-19. Methods: This cross-sectional study included 119 participants with a positive SARS-CoV-2 qPCR test. Three months after the acute phase of infection, participants completed an online survey to collect clinical information and sociodemographic data, followed by completion of the Impact of Event Scale-Revised, Depression, Anxiety, and Stress scales. Results: During and after infection, fatigue was the most frequently reported symptom. After the acute phase of COVID-19, substantial numbers of participants presented moderate to severe psychological distress (28.5%), severe to extremely severe depression (26.05%), and severe to extremely severe stress (31.09%). Female patients presented higher stress scores than males, while individuals who reported having lost a loved one presented high psychological distress, anxiety, and depression. The presence of physical symptoms after COVID-19 and other factors such as being a woman, being married, having children, or living with someone who suffers from a disease increased vulnerability to depression, stress, and anxiety. Conclusions: There are psychological consequences for survivors of COVID-19 associated with sociodemographic factors. Clinical strategies are needed to provide mental health care for individuals with long COVID symptoms. © 2022 IACFS/ME.
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BACKGROUND AND AIM: Widely-implemented restricted family presence (RFP) policies/practices during the COVID-19 pandemic were counter to family centered values embraced by many PICUs. This study explored the impact of implementing and enforcing these policies on Canadian PICU clinicians. METHOD(S): Cross-sectional survey of Canadian PICU clinicians. We developed an online, self-administered, survey to assess 1. Family presence policy and practice changes;2. Experience and opinions;3. Moral distress (Moral Distress Thermometer);and 4. Impact (Impact of Event Scale [IES] and attributable stress [5-point Likert scale]). Analysis included descriptive statistics, t-tests, one-way ANOVA;biand multi-variable stepwise regression assessed correlations. RESULT(S): Of 388 respondents representing 17/19 PICUs, 368 (94.1%) indicated that they experienced RFP policies and were predominantly female (n=333, 90.7%), English speaking (n=338, 91.8%), and RN (n=240, 65.2%). Incongruence between RFP policies/practices and PICU values was perceived by 66% (n=217). Most (n=235, 71%) felt their opinions were not valued when implementing policies. Though restrictions were perceived as beneficial to clinicians (n=252, 76%) and families (n=236, 75%), and 52% (n=171) felt RFP made their work easier, 57% (n=188) disagreed that their RFP experience was mainly positive. The median (IQR) reported moral distress was 5 (2-6) (n=307, scale 0-10);the strongest predictor was perception of differential impact of RFP on families. The mean (SD) total IES score (n=290, 78.8%) was 29.7 (10.5), suggesting moderate traumatic stress. For 56% (n=176) there was increased/significantly increased attributable stress. CONCLUSION(S): PICU-based RFP rules, designed and implemented without clinician input, caused increased emotional burden.
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Background: The development of depression and anxiety symptoms during long COVID may partly result from the biopsychosocial effects of COVID-19 that impact mental health, rather than from the infection alone. Aim(s): The present study examined the association of anxiety, depression, stress, and psychological distress levels with sociodemographic factors and symptom severity during and three months after the acute phase of COVID-19. Method(s): This cross-sectional study included 119 participants with a positive SARS-CoV-2 qPCR test. Three months after the acute phase of infection, participants completed an online survey to collect clinical information and sociodemographic data, followed by completion of the Impact of Event Scale-Revised, Depression, Anxiety, and Stress scales. Result(s): During and after infection, fatigue was the most frequently reported symptom. After the acute phase of COVID-19, substantial numbers of participants presented moderate to severe psychological distress (28.5%), severe to extremely severe depression (26.05%), and severe to extremely severe stress (31.09%). Female patients presented higher stress scores than males, while individuals who reported having lost a loved one presented high psychological distress, anxiety, and depression. The presence of physical symptoms after COVID-19 and other factors such as being a woman, being married, having children, or living with someone who suffers from a disease increased vulnerability to depression, stress, and anxiety. Conclusion(s): There are psychological consequences for survivors of COVID-19 associated with sociodemographic factors. Clinical strategies are needed to provide mental health care for individuals with long COVID symptoms. Copyright © 2022 IACFS/ME.
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Introduction: The COVID pandemic had a heavy impact on the mental health of people in general and healthcare professionals in particular. Objective(s): Our study aimed to examine the the prevalence of posttraumatic stress symptoms among healthcare professionals working in COVID departments, and assess their professional quality of life. Method(s): Our sample consisted of 23 healthcare professionals who are working in the COVID departments of the Hospitals of Sfax. We collected their sociodemographic data, their medical history and COVID-related details. Their mental health was assessed by the Impact of Event scale (IES-R) and the professional quality of life scale (ProQOL-5) Results: The sex ratio in our study was 17:6, with a mean age of 31.79 years. They carried out 5.43 nightshifts per month, 57 hours of work per week including 27.38 hours of direct contact with COVID positive patients. A rate of 21.74% of the patients had a high IES-R score, indicating severe post traumatic stress symptoms. As for the subscales of the professional quality of life score, 21.73% of the participants had a low compassion satisfaction score, 65.21% of the participants had a moderate one and 13% had a high one. A rate of 91.3%of the participants had amoderate burnout score, the mean was 29.39. The secondary traumatization score was low in 26% of the cases, moderate in 60.86%, high in 13% and the mean was 27.91. Conclusion(s): COVID healthcare professionals are at a relatively high risk of developing burnout and post-traumatic stress symptoms.
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Introduction: The aim of the study was to adapt the Coping Selfefficacy Scale for research Russian population in the situation of the COVID-19 pandemic for researching positive personal resources to overcome peritraumatic COVID-19 distress. To solve this task we also used Impact of Event Scale (Horowitz) and Post-Traumatic Growth Inventory (Tadeshi & Calhoun) - both adapted by M. Magomed-Eminov. These two methods allow us to assess the connection coping self-efficacy with both the traumatic experience and the experience of post-traumatic growth. And to use the results to prevent mental health. Objective(s): 342 participants (students and masters;18,2% male, 81,8% female;age: 20-30 years). Method(s): Russian version of Coping self-efficacy scale developed in Psychological Helping and resocialization Department Lomonosov Moscow State University;Post-Traumatic Growth Inventory - PTGI (Tadeshi & Calhoun), Impact of Event Scale (Horowitz), - both adapted by M. Magomed-Eminov. Result(s): Russian version of Coping self-efficacy scale has high reliability-consistency (Cronbach's alpha = 0.916). Detected significant correlation between coping self-efficacy and post-traumatic growth (rS = 0,261, p < 0,01) and significant negative correlation between coping self-efficacy and intensity of the impact of stressful events (IES) (rS = - 0,140, p < 0,05). Conclusion(s): The obtained results confirmed the high psychometric effectiveness of the Self-efficacy Coping Scale. The connections indicate the existence of positive ways of coping to distress. The results obtained suggest that further research on the positive consequences will expand the repertoire of tools predicted the ability of a modern person to cope with adversity and use experience for deeper involvement of human resources.
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Introduction: The survey assessed changes in tobacco, alcohol and other substance use during the COVID-19 pandemic. Objective(s): The survey was carried out in Moscow and Nizhegorodskaya Oblast in December, 2020 - February, 2021 and included 650 medical organizations' employees and 344 individuals with harmful alcohol or other substances use. Method(s): The instrument included ASSIST, Kessler-10 and IES-R tests modified for self-reporting about different pandemic periods. Result(s): Among medical workers 36.8% smoked last 12 months;during the COVID-19 pandemic 13% maintained usual cigarette smoking level, 2.4% increased smoking during incidence rises. 71.2% drank alcohol last 12 months;during incidence rises 20.4% drank as usual, 15.0% drank less frequently;2.4% increased frequency of drinking, 1.8% volumes on drinking days, 1.3% frequency of heavy episodic drinking. In harmful substance use group 61.9% smoked last 12 months;during COVID-19 incidence rises 40% kept their usual level of smoking;13.4% increased their smoking during the first and 8.7% during the second 'wave' of the pandemic. 90.1% drank alcohol last 12 months;during incidence rises 49% kept drinking as usual, 20% reduced drinking and 17.3% increased drinking frequency, 21.0% volumes on drinking days, 16.4% heavy episodic drinking frequency. Wastewater-based epidemiology analysis performed in Moscow Oblast location demonstrated significant increase during COVID-19 pandemic, compared to same period 2 years earlier: inhaled nicotine use by average of 40%, ethanol consumption by average of 49%. Conclusion(s): Changes in cigarette smoking and alcohol use during the COVID-19 pandemic had significant variation. Increases were more likely to occur during the pandemic 'waves' among individual from harmful users' group.
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Background: Post-traumatic stress disorder (PTSD) has been reported in up to 15% ofgeneral population during and after the first wave of the COVID-19 pandemic. The pandemic has acted as a catalyst for the application of telemedicine in neurology. Objective(s): to evaluate the presence of PTSD symptoms as effect of the lockdown measures in people with MS (PwMS) using an e-health application specifically built for remote management of PwMS, SMcare2.0 application. Method(s): Between March 4, 2020 and July 5, 2020 (T0) PwMS who were using (n=290) the app were asked to fill in the Impact of Event Scale - Revised (IES-R) questionnaire to evaluate the presence of PTSD symptoms. The IES-R has 3 subscales: intrusion, hyperarousal, avoidance. The total IES-R score ranges from 0 to 88. A cut-off value of 33 of the total score was used to define the presence of PTSD symptoms (PTSD+). Only those PwMS who filled-in the questionnaire the first time were asked to answer again it when the lockdown measures were abolished (T1). Clinical and demographic data were extracted from the Italian MS register application and linked to the IES-R results. Baseline clinical characteristics of PwMS (classified on the basis of IES-R score) and the proportion of PTSD+, the subscales and the total score at T0 and T1 were compared. Result(s): During the lockdown 90 PwMS (31% response rate) completed the IES-R (62 F;mean (SD) age 40.1(1.0) years;median (IQR) EDSS score 2.3 (1-8);mean disease duration (SD) 10.7 (0.7)). Mean (SD) baseline subscales values were: intrusion 15.9 (7.1), hyperarousal 10.7 (5.0), avoidance 15.4 (6.7). Mean (SD) total IES-R score was 42.0 (17.0), 63 (70%) patients scored above 33 and were identified as having recently developed PTSD symptoms. No significant difference were found between PTSD+ and PTSD- patients in terms of age, EDSS and disease duration. At T1, when the lockdown measures were removed, the IES-R scores were significantly reduced in comparison to T0 scores (intrusion 8.6 (8.9), hyperarousal 6.0 (5.8), avoidance 8.4 (8.5), total score 4.8 (1.9), p<0.0001). The number of patients classified as PTSD+ was significantly reduced in comparison to T0 (16 (17.8%), p<0.0001). Conclusion(s): Our study demonstrated that PwMS during and after lockdown manifested post-traumatic stress symptoms. Furthermore, our results show how e-data collected can be useful in remotely monitoring patients and can be easily linked to clinical data collected by disease registries.
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Background: Coronavirus disease 2019 (COVID-19) emerged in December 2019 in China and exhibited as a highly contagious viral infection which led to a high level of mortality and morbidity. It is followed by a great deal of complications, such as serious psychological disorders. There are a few studies evaluating the psychological status of COVID-19 on the patients with cancer in Iran. Method: This was a cross-sectional study carried out on 94 patients with cancer who referred to Haft-e-Tir hospital for radiotherapy and chemotherapy from 20 April to 15 may, 2020. The data collection tool was the impact of events scale-revised (IES-R). Results: The prevalence of anxiety disorders and obsessive compulsive disorder based on past psychiatric history in the patients was 11.7% and 2.1%, respectively. The results revealed that age was significantly related to avoidance dimension score (B =-0. 209, 95% CI:-0.084 to-0.335). Regarding hyper arousal dimension score, the results were as follows: rural residency (B = 5.091, 95% CI: 0.610 to 9.573), past psychiatric history (PPH) (B = 8.312, 95% CI: 4.314 to 12.310), and radiotherapy (B =-2.976, 95% CI:-5.878 to-0.074) had a statistically significant relationship with the hyper arousal dimension score. Conclusion: The patients with cancer had a severe form of COVID-19. Individuals with cancer who had a previous psychiatric history are more vulnerable to post-traumatic stress disorder symptoms after trauma.
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Purpose: Post-acute sequelae of SARS-CoV-2 infection (PASC) is an increasingly recognized phenomenon manifested by long lasting cognitive, mental, and physical symptoms. We aimed to estimate the prevalence of PASC symptoms in solid organ transplant recipients (SOTRs) in the short (1- 6 months) and long-term (> 6 months) periods after SARS-CoV-2 infection. We also compared the prevalence of these symptoms between those with SARS-CoV-2 infection requiring hospitalization and those not requiring hospitalization. Method(s): We surveyed 111 SOTRs with self-reported SARS-CoV-2 infection diagnosed more than 4 weeks prior to survey administration. The survey consisted of 7 validated questionnaires ("Quick Dementia Rating System (QDRS)", "Patient Health Questionnaire (PHQ9)", "Generalized Anxiety Disorder 7 (GAD-7)", "Impact of Events Scale (IES-6)", "EuroQol- 5 Dimension (EQ-5D)", "PROMIS global physical health scale (GHS) "and "Breathlessness, Cough and Sputum Scale (BCSS)"). Result(s): Of the 111 survey participants, 32 (33%) had been hospitalized and 35 (36%) had SARS-CoV-2 infection >6 months ago. Median (IQR) age was 58 years (46, 65). Median time from SARS-CoV-2 diagnosis was 167 days (138, 221). Cognitive impairment, anxiety, depression, insomnia, feeling of trauma, fatigue, pain, breathing problems, cough, abnormal smell, abnormal taste, and diarrhea were reported by 40%, 23%, 36%, 55%, 53%, 41%, 19%, 33%, 33%, 21%, 22%, and 32% of patients respectively. Hospitalized patients had poorer scores in cognition (QDRS survey score of 2 versus 0.75, p=0.048) (Figure 1), quality of life (EQ-5D survey score of 2 versus 1, p=0.043), physical health (PROMIS GHS survey score of 10 versus 11, p=0.013), respiratory status (BCSS survey score of 1 versus 0, p=0.056), and pain (Pain score of 3 versus 0, p 0.006). Among patients who had SARS-CoV-2 infection >6 months ago, abnormal breathing, cough, abnormal smell, abnormal taste, and diarrhea continued to be reported by 31%, 31%, 29%, 32%, and 32% of patients respectively. Conclusion(s): After SARS-CoV-2 infection, SOTRs had a high prevalence of PASC symptoms. Some of the symptoms are more severe in patients who had required hospitalization and persist beyond 6 months. Further studies are needed to understand the long term sequalae of SARS-CoV-2 infection in SOTRs and to develop an evidence-based multidisciplinary approach for caring for these patients beyond the acute phase. (Table Presented).
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Introduction: The COVID-19 pandemic presents a unique set of stressors for healthcare professionals across the globe.1 The challenges facing intensive care workers in the United Kingdom (UK) have not previously been seen on this scale. There is a dearth of research establishing the psychological impact of the virus among intense care workers specifically, who may be at the greatest risk of adverse outcomes. Protecting the psychological wellbeing of healthcare workers caring for patients with COVID-19 is essential for the long-term capacity of the health workforce. Objectives: The objectives of this study were to establish the prevalence of anxiety, depression and post-traumatic stress disorder (PTSD) among a cohort of intensive care workers within the United Kingdom during the COVID-19 pandemic. Methods: An anonymous questionnaire was designed to incorporate validated screening tools for anxiety (Generalised Anxiety Disorder Scale, GAD-7),2 depression (Patient Health Questionnaire, PHQ-9)3 and post-traumatic stress disorder (Impact of Event Scale-Revised, IES-R).4 Participants were also asked to highlight any factors in particular that contributed significantly to their own perceived mental health status. Additionally, awareness of any available mental health support services was established. All intensive care workers at the Countess of Chester Hospital, UK, were eligible and data was collected over a three week period during the months of June and July 2020 Results: The majority of the 131 respondents were nurses (52.7% [69/131]) or doctors (32.8% [43/141]). Almost onethird (29.8% [39/131]) reported a significant or extreme impact of COVID-19 on their mental health. In total, 16% (21/131) had symptoms of moderate depression, 11.5% (15/131) moderately severe depression and 6.1% (8/131) severe depression. Females had a significantly higher mean PHQ-9 score than males (8.8 and 5.68 respectively, p=0.009). Furthermore, 18.3% (24/131) had moderate anxiety with 14.5% (19/131) having severe anxiety. Mean GAD-7 scores were higher among females than males (8.69 and 6.26 respectively, p=0.028). Additionally, 28.2% (37/ 131) had symptoms of PTSD (IES-R ≥33). The most commonly cited contributory factors to participants' selfrated impact on mental health, was the effect of COVID-19 on family (78.6% [103/131]) followed by being busier at work (60.3% [79/131]), the personal risk of contracting COVID-19 (56.5% 74/131]), change in working environment (51.1% [67/131]) and change in working hours (43.5% [57/131]). The majority (58% [76/131]) of participants were either unaware or only vaguely aware of available mental health support services. Surprisingly, only 3.1% (4/131) had accessed support services at the time of data collection. Conclusion: The psychological impact of COVID-19 on intensive care workers is significant. Healthcare systems are currently ill-prepared to cope with the increased demand for support5. Specific focus and attention must be directed accordingly in order to safeguard the mental health of this key sector of the workforce, who play a crucial role in the fight against COVID-19. Determining and acknowledging the scale of the problem is the first step towards achieving this.
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Introduction: Mental, physical, and cognitive impairments are common after an intensive care unit (ICU) stay. It remains unknown to what extent the extraordinary increase in bed occupancy during the pandemic could be linked to the severity and frequency of patient's impairments. Objective: To determine the frequency, severity, and risk factors for mental, physical, and cognitive impairments at ICU discharge during high and low bed occupancy periods. Methods: Prospective cohort study in seven Chilean ICUs (ClinicalTrials.gov Identifier: NCT04979897). We included adults, mechanically ventilated >48 hours in the ICU who could walk independently prior to admission. Trained physiotherapists assessed the Medical Research Council Sum-Score (MRC-SS), Montreal Cognitive Assessment (MOCA-blind), Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale-Revised (IES-R), and the World Health Organization Disability Assessment Schedule (WHODAS 2.0) at ICU discharge. Pre-admission employment status, educational level, and Clinical Frailty Scale (CFS) were also collected. We compared periods of low and high bed-occupancy, defined as less or more than 90% of staffed ICU beds occupied. We used t-test for normally distributed, Mann-Whitney for those not normally distributed, and chi-square for categorical variables. We explored risk factors for mental, physical, and cognitive impairments using logistic regression adjusted for age, sex, educational level, and bed occupancy. Analyses were performed in Stata/SE 16.0. Results: We included 192 patients with COVID-19 of which 126 [66%] were admitted during a high bedoccupancy period (January to April 2021). Majority were male (137 [71%]) and worked full-time (127 [66%]). Median [P25-P75] age was 57 [47-67], length of ICU stay was 15[ 11-27] days, and duration of mechanical ventilation (MV) was 9 [6-16.5] days. Seven (4%) patients were clinically frail, 65 (34%) had ICUacquired weakness (ICU-AW), 134(70%) had cognitive impairment, 122 (64%) had post-traumatic stress symptoms (PTSS), 53 (28%) had depressive symptoms, 106 (55%) had anxiety symptoms, and 148 (77%) had severe disability. Table 1 shows the combined prevalence of physical and mental health problems. Patients admitted during the high-occupancy period were younger (mean 54, 95% confidence interval [47, 61] vs 61 [58, 64]), more likely to have a higher education qualification(HEQ) (OR 1.67 [0.9, 3.06]), and had a shorter duration of MV (8 [6-13] vs 13 [8-34];p<0.001) and ICU stay (13 [10-19] vs 21.5 [13-42];p<0.001). Mental, physical, and cognitive impairments were similar in low and high occupancy periods. Patients with a HEQ were less likely to have ICU-AW (OR 0.23 [0.11, 0.46]), cognitive impairments (OR 0.26 [0.11, 0.6]), symptoms of depression (OR 0.45 [0.22, 0.9]) or anxiety (OR 0.26 [0.13, 0.5]), and severe disability (OR 0.4 [0.18, 0.94]). Females were more likely to have ICU-AW (OR 2.4 [1.13, 4.93]). Older patients were less likely to suffer PTSS (OR 0.97 [0.94, 0.99] per year old). Conclusions: Majority of patients had at least one mental, physical or cognitive impairment being similar by bed occupancy. Having a higher education qualification was the main protective factor for impairments at ICU discharge. Preventative treatments programmes should target patients with <12 years of education.
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Background: The COVID-19 pandemic, with its uncertainties, fears of contagion, mass lockdowns and containment measures, has dramatically impacted on people's everyday lives leading to an increased risk of mental disorders, particularly Post-Traumatic Stress Disorder (PTSD). Despite evidence in general population and healthcare workers1,2, scant data emerged on vulnerable populations, such as of patients with chronic illness, particularly rheumatic and musculoskeletal diseases (RMDs)3,4, who also underwent difficulties in the management and treatment of their disorders. Objectives: To assess PTSD and post-traumatic stress symptoms in a sample of patients with RMDs, during the COVID-19 pandemic in Italy. Methods: PERMAS is a monocentric prospective observational study led by the Rheumatology Unit, the Psychiatric Clinic and the Institute of Management of the School of Advanced Studies. Patients with a RMD diagnosis, were consecutively enrolled from May 2021 to January 2022. During the visit, sociodemographic characteristics and psychopathological data were collected through online survey, whereas clinical data were collected by physician. The survey included the Trauma and Loss Spectrum-Self Report (TALS-SR) and the Impact of Event Scale-Revised (IES-R), aimed to assess symptomato-logical PTSD and post-traumatic stress symptoms related to the impact of the COVID-19 pandemic. Results: A total of 194 eligible patients, with a mean age of 50.3±12.17 years, was included: 142 (73.19%) were females;112 (57.74%) patients reported connective tissue diseases (CTD), 63 (32.47%) arthritis and 19 (9.8%) vasculitis. A total of 33 (17%) subjects reported a symptomatological PTSD by means of the TALS-SR. The prevalence of Partial PTSD (defned by at least 2 out of the 4 criteria for DSM-5 diagnosis of the disorder) was 56.7%, with signifcant higher rates among females (90, 81.8%) with respect to males (20, 18.2%) (p=.013). Accordingly, a IES-R mean total score of 21.90 ±15.98 was found in the total sample and a gender difference emerged, with higher mean scores among females rather than males (23.42 ±16.26 vs 21.90 ±15.98, p=.031). Conclusion: The present fndings point out high prevalence rates of symptoma-tological PTSD among patients suffering from RMDs, highlighting the potentially traumatic burden of the COVID-19 pandemic in this particular population, especially among females, suggesting the need of further investigations to address tailored prevention and intervention strategies.
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Background: Mental disorders constitute a serious and underestimated problem in Latin America and they could have worse features in comparison with Europe or North America (1);that was the case even before the COVID-19 epidemic ensued in 2020. Objectives: The objective of this study was to determine the factors associated with the occurrence of mental health disorders (MHD) in patients with autoimmune rheumatic disease (ARD) from Perú, a high COVID-19 incidence country. Methods: Patients with ARD from a single center (Hospital Guillermo Almenara-EsSalud, Lima-Perú) were included during the frst and second waves of the COVID-19 pandemic (March to November 2020). Interviews, medical records reviews, and an electronic survey were performed. MHD explored were depression (assessed with the Patient Health Questionnaire 9: PHQ-9), anxiety (ascertained with the Generalized Anxiety Disorder-7: GAD-7) and post-traumatic stress disorder: PTSD (evaluated with the Event Scale-Revised: IES-R). Variables examined were sociodemographic (age, gender, educational level, marital status, living alone, job status, religiosity), previous diagnosis and treatment for mental disorders, living with a COVID-19 patient, COVID-19 diagnosis (current or past), fear of COVID-19 (assessed with the COVID-19 Scale: FCV-19S) and the ARD type. Multivariable logistic regression models using backward elimination procedure were performed to determine the variables associated with depression, anxiety, and PTSD. (See Table 1). Results: Nine hundred and thirteen ARD patients were evaluated. The most frequent diagnosis was rheumatoid arthritis in 446(48.8%) patients followed by systemic lupus erythematosus in 279 (30.6%). Depression, anxiety, and PTSD were observed in 128 (14.0%), 112 (12.30%) and 485 (53.1%) patients, respectively. In the multivariable analyses, previous treatment for mental disorders and fear of COVID-19 were associated with depression: OR=2.35 (95% CI 1.37-4.03;p=0.002) and OR=1.07 (95% CI 1.05-1.10;p<0.001) respectively;also with anxiety: OR= 2.42 (95% CI 1.37-4.26;p=0.002) and OR=1.09 (95% CI 1.06-1.12;p <0.01) and with PSTD: OR=2.42 (95% CI 1.39-4.21;p=0.002) and OR=1.41 (95% CI=1.11-1.17;p<0.001). A diagnosis of COVID-19 was associated with PTSD: OR=1.75 (95% CI 1.06-2.89, p=0.028), while being single was associated with a decreased probability of PTSD occurrence: OR=0.57 (95% CI=0.35-0.96;p=0.03). Finally, having a high educational level was associated with less anxiety: OR=0.43 (95% CI=0.82-0.21;p=0.009), for university/postgraduate studies and OR=0.52 (CI 95%=0.28-0.95;p=0.032) for secondary studies. Conclusion: Fear of COVID-19 and previous treatment for mental disorder were associated with all MHD explored on our ARD patients during the COVID-19 pandemic.
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Background: Diagnostic imaging may be a major source of distress in patients with advanced cancer, a condition known as “scanxiety”. Scanxiety represents a complex array of negative and stressful emotions linked with cancer scans, and the uncertainties and fears that may accompany them. We aimed to evaluate the prevalence and characterize risk factors for scanxiety among cancer patients and their caregivers and evaluate the impact of scanxiety on quality of life (QoL), during the COVID-era. Methods: We conducted a cross-sectional survey study of metastatic cancer patients treated at the University Hospital of Larisa and their caregivers. Eligible patients met the following inclusion criteria: age > 18 years old, ability to speak and write fluently in Greek, having had at least one imaging study during the period of the study (seven days before the survey), approval of the patient's oncologist to approach the patient. Patients/caregivers with pre-existing (prior to cancer diagnosis anxiety disorder) were excluded from the study. After completion of the informed consent process, patients/caregivers completed all survey items. We used a modified version of the Greek version of the Impact of Event Scale-Revised (IES-R-Gr) to specifically assess distress associated with scans, and QoL was measured using the EORTC QLQ-C30 questionnaire. Results: 218 patients with metastatic cancer and their caregivers were included in the study. Patient's mean age was 66 years (range 35-88). The majority were men (61%) and were diagnosed with Non-Small-Cell Lung Cancer. 71% had an IES-R-Gr score that was suggestive of scanxiety. Their symptoms were more severe symptoms while waiting for the results. Patients with a recent diagnosis (< 6 months) had higher levels. Interestingly, 16% of the patients had postponed a check-up due to scanxiety, while 77% reported that stress does not decrease over time. The majority of caregivers (81%) reported scanxiety, without a strong correlation with the score of the respective patients. Unlike patients, the majority of caregivers reported an increase in stress during the COVID-19 period. The presence of scanxiety was associated with decreased QoL in patients (p = 0.004). Conclusions: Scanxiety is a common problem among patients with metastatic cancer and is associated with impaired QoL. To our knowledge this is the first study implying that caregivers also experience scanxiety and may be a persistent problem.
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Background: Post-intensive care syndrome (PICS) affects up to half of ICU patients and comprises neuromuscular, cognitive, and psychiatric impairments that persist up to years after discharge (Inoue, 2019). PICS is often overlooked and under-diagnosed (Rawal, 2017), without clear evidence-based strategies for management. Data supporting interventions for symptoms of anxiety, depression, and post-traumatic stress after discharge is limited (Needham, 2012). Developing high-quality, evidence-based interventions for PICS would address this critical need. Methods: Shortly before discharge, patients are recruited from our neurological ICU who have been intubated for at least 24 hours and score 24–32 on the Impact of Event Scale - Revised (which indicates likely PTSD symptoms without a true diagnosis). Baseline Beck Depression Index and Telephone Interview for Cognitive Status questionnaires are also administered to each patient. Participants are then randomly assigned either to a virtual reality exposure therapy intervention or to a control group that receives no therapeutic intervention. VRET patients are given an online 360° video of an ICU room from the perspective of an intubated patient, complete with sounds and simulated clinical scenarios (rounds, intubation, suctioning, etc.). Intervention patients have unlimited access to the videos for six months, beginning one month after discharge. Follow-up IES-R, BDI, and TICS are administered at 1, 3, and 6 months to both groups. Results/Discussion: Our IRB approved this study in March 2021. Enrollment has begun with 3–5 feasibility patients, to be followed by 30 randomized patients starting in November. Our poster features a case discussion on our first patient's experiences with VRET. Given the novelty of remote VRET for post-ICU PTSD symptoms, our results will be an important contribution with the potential to change practice. Conclusion: This will be the first remote intervention for neuropsychiatric symptoms of PICS, and has far-reaching implications for inpatient and outpatient CL psychiatrists — particularly at a time when patients have grown increasingly accustomed to virtual interventions, and when ICU survivors have multiplied due to COVID-19. Should our VRET prove successful, it will open the eyes of intensivists and CL psychiatrists to a whole realm of remote, efficient, and accessible virtual reality therapies for patients who have undergone acute care. This will improve long-term outcomes, particularly for patients who may have difficulty seeing an outpatient psychiatrist or taking medications consistently. Finally, our study will help to raise awareness of the psychiatric sequelae of acute illness, and so enhance inpatient collaboration between psychiatry and many other specialties. References: 1. Inoue S et al. Post-intensive care syndrome: its pathophysiology, prevention, and future directions. Acute Med Surg. 2019;(3):233-246. 2. Needham DM et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med. 2012;40(2):502-9. 3. Rawal G et al. Post-intensive Care Syndrome: an Overview. J Transl Int Med. 2017;5(2):90-92.
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Introduction: We sought to determine whether a 6-week integrated rehabilitation program improved pulmonary function, physical and mental health outcomes in patients discharged alive after surviving a severe COVID-19 pneumonia. Methods: Parallel, open-label, feasibility randomized controlled trial in participants aged 18-75 years who were discharged for severe COVID-19 pneumonia. The intervention consisted of 12 in-person home respiratory rehabilitation sessions and 6 telephonebased, emotion-centered problem-solving therapy psychological sessions. We measured the 6- minute walk test (6MWT), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), Patient Health Questionnaire (PHQ-9), General Anxiety Disorder (GAD-7), Impact of Event Scale- Revised (IES-R) and Short Form 36 health survey (SF-36). Following the recommendation by Cocks and Torgerson, we used a one-sided 80% confidence interval to determine if this feasibility trial should proceed to a phase III trial. Results: We randomized 103 participants (mean age, 48 years;71% men). There were no differences at baseline assessments of outcomes between the two groups. Intervention participants walked 15 and 45 meters more during a 6MWT at 7 and 12 weeks, respectively, than controls after accounting for baseline distance. In both instances, the onesided 80% lower bound was above 0. Intervention participants also had a greater improvement of lung function for week 7 (mean difference FEV1, 0.05 L;95% CI, -0.14 to 0.24;mean difference FVC, 0.10 L;95% CI, -0.12 to 0.31) and at week 12 (mean difference FEV1, 0.10 L;95% CI, -0.18 to 0.37;mean difference FVC, 0.15 L;95% CI, -0.17 to 0.47). Likewise, the prevalence of depression (percentage difference PHQ-9, 24.3%;95% CI, -4.3 to 44.3), anxiety (percentage difference GAD-7, 20.7%;95% CI, 0.8 to 40.6) and post-traumatic stress (percentage difference IES-R, 14.0%;95% CI, -5.7 to 33.7) were lower in the intervention group at week 2 after hospital discharge. At week 7, the intervention group had a greater improvement of physical (mean difference, 10.8;95% CI, -1.8 to 23.4) and social (mean difference, 6.43;95% CI, -0.65 to 13.5) function on the SF-36. Conclusion: We demonstrated that an integrated rehabilitation program administered over a 6-week after discharge in Lima, Peru was both feasible and acceptable, and had positive benefits on physical and pulmonary function and on mental health during the 12 weeks of follow-up. Measured improvements in the primary outcome of 6MWT distance recommend that we consider a phase III trial to test the efficacy of our integrated rehabilitation intervention in a larger sample.
ABSTRACT
Introduction: The 2019 coronavirus disease (COVID-19) pandemic is a protracted stressor with far-reaching effects on daily life. Although most individuals exhibit resilience in the wake of adversity, it is not clear which characteristics reliably predict resilience versus longstanding distress. It is vital to delineate predictors of pandemic-related distress to highlight modifiable risk factors that can be targeted to enhance psychological resilience. Sleep reactivity may be an important predictor of pandemic reactions because it reflects a vulnerability to experience pronounced sleep disturbances in response to stress, which serve as barriers to healthy adjustment to adversity. Therefore, this study tested sleep reactivity as a prospective predictor of pandemic-related distress. Methods: Participants were recruited from a previous randomized controlled trial (RCT) comparing self-guided digital CBT-I against a sleep education control in treating insomnia and preventing depression. Participants in the RCT were enrolled between 2016-2017 and were eligible for this follow-up study conducted between April and May 2020 (N = 208;dCBT-I: n = 102;control: n = 106). Pre-treatment sleep reactivity was measured in 2016-2017 (T1) using the Ford Insomnia Response to Stress Test (FIRST). COVID-19 distress was measured in April 2020 (T2) using the Impact of Events Scale (IES) and Quick Inventory of Depressive Symptomatology (QIDS). All analyses controlled for treatment condition and COVID-19 impact. Results: T1 FIRST predicted T2 IES (b = 0.29, + 0.14 SE, p < .05) and QIDS (b = 0.16, + 0.04 SE, p < .001), such that higher sleep reactivity pre-pandemic predicted more severe stress responses and depressive symptoms during the pandemic 3-4 years later. Exploratory analyses revealed T1 FIRST was a predictor of the IES subscales arousal and intrusions (bs = 0.02, + 0.01 SEs, ps < .05), but not avoidance. Conclusion: These findings build on evidence that sleep reactivity prospectively predicts reactions to trauma and demonstrate its predictive utility generalizes to pandemic responses. Sleep reactivity is a modifiable risk factor that may be targeted using cognitivebehavioral or mindfulness-based approaches, and thus may offer a new pathway to resilience.
ABSTRACT
Introduction and Purpose of the study: COVID-19 has been associated with long-term symptoms. The aim of this study was to describe the incidence of long-term health consequences and investigate the associated risk factors. Materials and Methods: We organized a multidisciplinary assessment for Covid-19 pts discharged from Covid Department of Jesi H. All pts underwent clinical examination, laboratory and instrumental examinations (HRTC and spirometry+DLCO, walking test). All pts were interviewed with questionnaires (MMSE, IES-R and SF-36) for evaluation of cognitive order, psychiatric symptoms and health-related quality of life.Statistical tests (Fisher's exact test for qualitative variables;Wilcoxon test for quantitative) were used to evaluate the association between the long syndrome and all variables. Results: During the study (June 20-September 21) the first 358 pts had completed the post-discharge multidisciplinary assessment. Among them, 56% have experienced long Covid symptoms: 35,8% still complained fatigue, 15.4% dyspnea, 9% alopecia, and 45.2% experienced post-traumatic psychological consequences (insomnia, anhedonia and irritability the most frequent). The statistical analysis showed that “Long Covid” is significantly associated with gender (female), age (youth), employment status (employed more than unemployed), HRTC findings and the results of SF-36 and IES-R neuropsychiatric tests. Conclusions: These findings highlight the importance of following up survivors of COVID-19. A multidisciplinary approach is fundamental to respond to a complex array of “long Covid”.
ABSTRACT
Background-COVID-19 pandemic has had a negative impact on mental health. Vulnerability of individuals with pre-existing psychiatric illness was of concern but have been scarcely studied. While there has been extensive work on the effect of pandemic on the mental health of the general population, health care workers, infected persons and survivors, there has been little research on the impact of pandemic on people living with mental illness. Aims-The study aimed to ascertain Psychological impact of COVID-19 pandemic in patients with pre-existing mental illness and their current psychopathology. Methodology - 100 participants aged 18-65 years, who visited Psychiatry OPD, were assessed using semi-structured proforma that included socio-demographic and clinical variables. The psychological impact due to life stress was assessed using the Impact of Event Scale. Current Psycho-pathology was assessed by DASS-21 scale. The perceived loneliness and social isolation were assessed by De Jong Gierveld Loneliness Scale. Results-Out of 100 participants, 55% reported to have faced variable degrees of difficulties during pandemic, 64% reported to have worsened mental illness, 40% faced difficulty in accessing medications, resulting in non-compliance. 61% managed to visit hospital during pandemic, while 35% could not access consultation services. Only 4% sought teleconsultation. Psychological impact of COVID was found to be positively correlated with the perceived loneliness and social isolation during quarantine(r=11.619, p=0.01). Conclusion-These results highlight a significant impact of COVID-19 pandemic on mental health of psychiatric patients and elucidates prominent association with demographic factors and the difficulty to access mental health care. There is need to strengthen telepsychiatry services in recent times.
ABSTRACT
Background: COVID-19 pandemic presents a consequential threat to individual's mental health in addition to obvious health-related impact. Aim: To focus on prevalence as well as related factors of psychosocial impact of COVID-19 in Lahore, Pakistan. Methods: Our study design was analytical cross-sectional, and study population comprised 382 participants including healthcare workers, teachers, students, and household members. We used non-probability convenience sampling method. We built a structured self-administered questionnaire for collection of data and psychological impact was measured with Impact of Event Scale-Revised (IES-R). Results: Independent factors related to psychological impact were identified using bivariate logistic regression and all significant factors at p-value 0.25 were processed using multivariate model. AORs with 95% CIs were used to assess magnitudes of associations. Prevalence of psychological impact in Pakistan is 53.4%. Being female (β=1.517;AOR=4.561;95%CI: 2.838-7.329)and covering mouth when coughing and sneezing (β=0.486;AOR=1.626;95%CI: 1.012-2.612)are significantly associated with psychosocial impact after logistic regression. Prevalence of psychological impact in Pakistan is very high. Conclusion: Henceforth, policy makers need to consider psychological issues while planning pandemic-related interventions.