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Introduction/Aim: Post COVID conditions are highly heterogenous and pose significant challenges to healthcare systems. The aim of this study was to identify and characterise symptom clusters at 6-months following COVID illness. Method(s): Symptom burden was assessed in a COVID respiratory clinic 6-months following diagnosis. K-mean cluster analysis was utilised to identify clusters and validated assessment tools for dyspnoea [MMRC], mood [PHQ-4], fatigue [FSS] and pain [WPI]were used to characterise clusters. Result(s): 58 patients (median age 59 years, 31 males) attended 6-month follow up. Cluster 4 represented patients experiencing high symptom burden with high fatigue, pain, depression and anxiety scores. A high proportion of Cluster 2 reported no symptoms but had high dyspnoea scores. Results for PHQ-4, FSS and WPI are presented as means (95%confidence interval) Cluster (n) Symptoms MMRC >1 (n%) PHQ-4 FSS WPI 1(8) anosmia, headache, fatigue, memory, concentration 3(5.1) 1(1,2) 31(17,45) 5(-1,10) 2(42) Isolated Dyspnoea 15(25.9) 1(1,2) 22(18,26) 1(0,1) 3(3) fatigue, nasal congestion, chest pain 3(5.1) 5(-10,21) 36(-26,98) 7(-11,24) 4(4) high symptom burden 4(6.9) 7(0,13) 51(36,66) 12(2,21) Conclusion(s): This exploratory analysis identified 4 possible post COVID condition phenotypes with unique symptom profiles. Larger scale phenotyping may facilitate a streamlined and customised approach to managing this evolving chronic and highly heterogenous clinical condition.
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Background: Although smoking is associated with more severe outcomes of COVID-19, little is known about smoking habits during the COVID pandemic. Healthcare professionals (HCPs) are significant role models for the society and their smoking habits are critical concerning the general public attitudes. Aim(s): to determine the smoking levels of HCPs, to assess the effect of the pandemic on their smoking attitude and to evaluate possible associations with their psychological status. Method(s): An anonymous online survey was conducted among HCPs of Northern Greece in 2020 by emails delivered from the local medical and nursing stuff associations including basic information (age, gender, marriage, education level, etc.), smoking status (Heaviness of Smoking Index (HSI)) contact with COVID-19 patients, quarantine status, current physical condition, Sleep Condition Indicator (SCI), DAR-5 (anger), PHQ-4(depression and anxiety), Loneliness scale (LS). Result(s): 1057 HCPs answered (males 45.3%) 79% doctors with mean age 45.2+/- 11.7years and HIS 2.4+/-1.7. 32% of HCPs smoked: 24.9% smoked more cigarettes during the pandemic, 14.2% smoked less, 7% stopped smoking and 54% did not change their smoking habits. There was an association between alcohol use and smoking (p=0.002). A weak but significant correlation was found between LS and HIS (r=0.22, p=0.02) and especially with 'how soon after you wake up do you have your first cigarette' (r=0.28, p=0.001). SCI, LS and PHQ-4 of HCPs that smoked more were significantly higher compared with the other groups. Conclusion(s): During the pandemic, most of the HCPs that smoked continued their smoking habits as before, 25% increased their cigarettes and only 7% stopped.
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The COVID-19 pandemic has changed the operation of healthcare systems worldwide reducing hospital based services, and increasing telemedicine solutions for the diagnosis and treatment of obstructive sleep apnoea (OSA). Aim(s): to evaluate the opinion of OSA patients concerning their disease during the COVID pandemic,their treatment and follow up. Method(s): A telephone questionnaire based survey was conducted on OSA patients treated with CPAP including basic information (age, gender, marriage, education level, etc.), opinion towards the changes of medical practice during the pandemic, history of OSA, Epworth Sleepiness Scale (ESS), Athens Insomnia Scale (AIS), DAR-5 (anger), PHQ-4(depression and anxiety), Heaviness of Smoking Index (HSI) and Loneliness scale (LS). Adherence on CPAP was assessed objectively by telemonitoring. Result(s): 100 OSA patients 54.3+/-12.5 years (72% males) were evaluated presenting with ESS: 4.3+/-2.95, AIS: 3.14+/-3.3, PHQ-4: 2.29+/-1.72, DAR-5: 6.7+/-1.95 and HSI 3.5+/-.1.7. Mean CPAP use was 5.8+/-1.65 with 2.9+/-2.5years OSA history (96% used CPAP the same as before the pandemic). 41% considered themselves as high risk group for severe disease due to COVID because they suffered from OSA, and 25% believed CPAP could be protective from COVID. Patients infected with COVID (31%) did not change their CPAP use. 30% believed they received worse healthcare facilities than before and 16% presented worse sleep quality. Conclusion(s): During the pandemic, OSA patients continued to use their CPAP as before;however they believed that they should have better healthcare facilities. They considered themselves as a high risk group for COVID infection.
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Background: Globally, the coronavirus disease-19 (COVID-19) pandemic has had a devastating psychological impact on people, especially the healthcare workers/students, in many different community settings. Limited research has been reported on the mental health issue of healthcare students in Vietnam. Objective(s): This study investigated and quantified depression, anxiety, and psychological distress levels among healthcare students, with an emphasis on comparing those studying pharmacy to students in other healthcare-related disciplines, in Vietnam during the COVID-19 pandemic. Method(s): A cross-sectional study recruited 2246 respondents between September 7 and October 7, 2021, in which 230 were pharmacy students with a mean age of 20.0 +/- 1.6 years and most of them had a low COVID-19 fear level. The standardized Patient Health Questionnaire-4 (PHQ-4) scale, consisting of two subscales of PHQ-2 and Generalized Anxiety Disorder-2 (GAD-2), was utilized for the screening of depression and anxiety levels. Result(s): Pharmacy students scored significantly higher on the PHQ-4 psychological distress measure than non-pharmacy students (mean 2.23 vs. 1.90, p = 0.039). Compared to non-pharmacy students, pharmacy students had higher rates of anxiety (10.4% vs. 6.5%, p = 0.028). Conclusion(s): The prevalence of anxiety was higher among pharmacy students in comparison to non-pharmacy students. These findings present a need to recognize and conduct early intervention measures for mental health problems in healthcare students, especially pharmacy students, during recovery from the COVID-19 pandemic.Copyright © 2022 Pharmacotherapy Publications, Inc.
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Background and Aim: This study aimed to understand the impact of breathlessness on quality of life, productivity loss and healthcare use of Australian adults. Method(s): The National Breathlessness Survey was a nationwide cross-sectional web-based survey in Oct 2019, recruiting Australians aged >=18 years stratified by age-group, gender and state of residence. Severity of breathlessness using the modified Medical Research Council (mMRC) dyspnoea scale (0-5), quality of life (QoL) using EQ-VAS and EQ-5D-5L, and healthcare use (HCU) and productivity loss associated with having a "breathing problem" in the past 12 months were analysed. Quintile regression was conducted to analyse QoL and binary logistic regression for HCU and productivity loss outcomes. Effect sizes were adjusted for age, gender, Indigenous background, self-reported heart and lung disease, high PHQ-4 score, multimorbidity and smoking. Result(s): 10,072 adults completed the survey. The prevalence of clinically important breathlessness (mMRC>=2) was 9.54%. mMRC>=2 was associated with worse QoL, and greater healthcare use and productivity loss compared with mMRC=1 (Table). Despite COVID-19 impacts, similar prevalence (8.15%) and associations were seen in a repeat cross-sectional survey in December 2020 (n=10,024). Conclusion(s): Breathlessness carries a significant burden for patients, the healthcare system, and the economy.
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Background: Young adults in Hong Kong are subject to elevated psychological distress given the societal stressors such as civil unrest and COVID-19 pandemic and suicide is a leading cause of death among them. The present study aimed to evaluate the psychometric properties and measurement invariance of the 4-item Patient Health Questionnaire-4 (PHQ-4) as a brief measure of psychological distress and its associations with meaning in life and suicidal ideation (SI) in young adults. Materials and methods: A mobile survey recruited a large and random sample of 1,472 young adults (Mean age = 26.3 years, 51.8% males) in Hong Kong in 2021. The participants completed the PHQ-4 and Meaning in Life Questionnaire-short form (MLQ-SF) for presence of meaning in life (MIL), SI, COVID-19 impact, and exposure to suicide. Confirmatory factor analysis was conducted to examine the factorial validity, reliability, and measurement invariance of PHQ-4 and MLQ-SF across gender, age, and distress subgroups. Multigroup structural equation model evaluated and compared the direct and indirect effects of latent MIL factor on SI via latent PHQ-4 factor across distress groups. Results: Both MIL and PHQ-4 supported a 1-factor model with good composite reliability (Ω = 0.80-0.86) and strong factor loadings (λ = 0.65-0.88). Both factors showed scalar invariance across gender, age, and distress groups. MIL showed significant and negative indirect effects (αß = -0.196, 95% CI = -0.254 to -0.144) on SI via PHQ-4. PHQ-4 showed a stronger mediating role between MIL and SI in the distress group (Δ = -0.146, 95% CI = -0.252 to -0.049) than the non-distress group. Higher MIL predicted higher likelihoods of help-seeking (Odds ratios = 1.46, 95% CI = 1.14-1.88). Conclusion: The present results support adequate psychometric properties in terms of factorial validity, reliability, convergent validity, and measurement invariance for the PHQ-4 in young adults in Hong Kong. The PHQ-4 demonstrated a substantial mediating role in the relationship between meaning in life and SI in the distress group. These findings support clinical relevance for using the PHQ-4 as a brief and valid measure of psychological distress in the Chinese context.
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Objectives: The aim of this study was to summarize the available evidence on the prevalence of stress, burnout, anxiety and depression among healthcare providers in the Gulf Cooperation Council (GCC) countries (KSA, Bahrain, Kuwait, Oman, Qatar, and the United Arab Emirates) during the COVID-19 pandemic. Methods: We searched PubMed, PsycINFO, Scopus, and Google scholar for related studies published between January 2020 and April 2021 and conducted a systematic review and meta-analysis. Results: Of the 1815 identified studies, 29 met the inclusion criteria, and 19 studies were included in the meta-analysis. The pooled estimate of prevalence for moderate to severe anxiety as reported using GAD-7 was 34.57% (95% CI = 19.73%, 51.12%), that for moderate to severe depression using PHQ-9 was 53.12% (95% CI = 32.76%, 72.96%), and that for moderate to severe stress using the 10-item Perceived Stress Scales was 81.12% (95% CI = 72.15%, 88.70%). Meta-analysis was not performed for burnout due to the small number of identified studies and the different tools used;however, the highest prevalence was reported at 76% (95% CI = 64%, 85%). Overall, a positive trend was observed over time for moderate to severe anxiety and depression, p = 0.0059 and 0.0762, respectively. Of note, the heterogeneity was significant among the studies, and many studies were of poor quality. Conclusion: The prevalence of mental health disorders during the current pandemic among healthcare workers in GCC countries is high. However, the results could be affected by the high heterogeneity and low quality studies. © 2022 [The Author/The Authors]
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The COVID-19 pandemic limited health care access for individuals with multiple chronic medical conditions. Our aim was to evaluate the impact of COVID-19 on mental health and quality of health care in patients with chronic comorbidities such as DM, HTN and CKD. An online survey was sent to patients over the age of 18 years who have been seen at Joslin during the last 24 months. Surveys were sent to participants by Redcap or conducted through telephone. The survey consisted of 92 items that included COVID diagnosis, General Health, Home self-care, Vaccines, Exposure to COVID, Health- care access and delivery, Perceptions of healthcare quality during the COVID-19 Pandemic, Pregnancy, Mental well-being, Diet and lifestyle, and demographics. Anxiety and depression symptoms were assessed using the Patient Health Questionnaire-4 (PHQ-4). As of November 1, 2021, 1189 had completed the survey. The mean age of participants was 54.2 ± 17.3 years. Half were women, and 89.2% were White. One hundred-six reported to have had COVID-19 infection;94% had diabetes, 36% had HTN, and 8% had CKD. An income of < $50,000 was reported in 9% and 39% were college graduates. While half of the CKD participants felt COVID-19 made their quality of healthcare “worse or a lot worse”, 81% of the participants with CKD felt that their doctors were available to meet their healthcare needs. In addition, the majority of the CKD participants reported to have access to all of their medications during the pandemic. About 48% reported COVID-19 outbreak has negatively affected their mental health with 21% and 11% screened positive for anxiety and depression respectively. Results were similar in patients with CKD. Individuals with depression and anxiety were, more likely to be women and obese. Fifteen percent of the participants with depression and 10.6% with anxiety responded that COVID-19 made the quality of healthcare a lot worse compared to 3.6% in individuals with no depression and 3.3% with no anxiety respectively (p<0.001). The COVID-19 pandemic has made an impact on mental health and quality of healthcare in individuals with CKD.
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Background/Purpose: The ongoing COVID-19 pandemic has impacted psychosocial experiences of cancer patients due to factors such as delayed treatments, decreased medical resources and fear of treatment availability, as well as need for social distancing and reduced availability of social support during cancer treatment and inpatient hospitalizations. This program evaluation was conducted to understand how the frequency of positive inpatient distress screening (DS) scores changed during March 2020 to August 2021 in the context of the U.S. COVID-19 pandemic. Methods: The Patient Health Questionnaire-4 (PHQ-4) was used to assess distress and was administered by oncology nurses 36 h postadmission. Within institutional DS guidelines, positive scores were ≥4 on the PHQ-4 or ≥3 on anxiety or depression subscales. Results: In the 12 months prior to the U.S. COVID-19 pandemic (March 2019-February 2020), there were 1343 inpatient oncology DS, of which 137 (10.2%) were positive. In the first 12 months of the pandemic (March 2020-February 2021), there were 1309 inpatient oncology DS, of which 177 (13.5%) were positive. In months 13-18 of the pandemic (March 2021-August 2021), there were 941 inpatient oncology DS, of which 144 (15.3%) were positive. Conclusions and Implications: Inpatient oncology DS data suggested an increased frequency of distress among oncology patients hospitalized during the pandemic, rising from 10.2% of total screens in the pre-pandemic year to 13.5% during the first year of the pandemic and 15.3% in the following 6 months. Given the ongoing pandemic and particular challenges faced by oncology patients, it is important to consider both the short- and long-term potential impacts among oncology patients in acute care settings. Psychosocial Oncology programs and clinicians should maintain awareness of the multiple factors, both collective (e.g., pandemic, systemic racism/racial injustice) and personal (i.e., diagnosis/treatment, psychosocial) impacting distress in acute care settings and consider scalable, longitudinal assessment and intervention strategies to support patients.
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Introduction: The SARS-CoV-2 pandemic fundamentally changed school life as well as the professional life of teachers (TE). For example, organizational processes changed (e.g., increase in workload), pedagogical challenges emerged (e.g., distance learning) and hygiene plans had to be implemented and realized. The leading question was: did psychological stress in TE increase during the pandemic? If so, what sociodemographic and work-related variables were associated with this stress? Material and Methods: TE throughout Germany were surveyed online in March 2021. Data on psychological stress and strains were assessed using established (e.g., PHQ-4) and specially developed (e.g., corona-associated anxiety) instruments. After data cleaning, 31,090 participants were included in the analysis. Descriptive and inferential statistics were used to analyze the relationship between psychological stress (e.g., depressiveness) and sociodemographic (e.g., gender) and work-related variables (e.g., work schedule). Results: A significant increase in likely stress induced psychological symptoms was found compared to pre SARS-CoV-2 pandemic samples. Analyses are currently in progress. Results will be presented at the ICOH conference in 2022. Conclusions: The observed increase in psychological stress of TE during the SARS-CoV-2 pandemic represents a call for interventions especially for highly stressed subgroups of TE. These stress reactions in TE have to be interpreted against the background of a likewise increased mental stress in the general population and their relative changes have to be identified in order to provide demand-oriented help.