The role of the COVID-19 pandemic and economic crisis in insomnia and post-traumatic stress symptoms in the Lebanese population: A cross-sectional assessment

Based on an online cross-sectional survey, this study aimed to evaluate the role of the coronavirus disease 2019 (COVID-19) pandemic and economy-related factors in post-traumatic stress symptoms (PTSSs) and sleep in a sample of the general Lebanese population using the post-traumatic stress disorder checklist. The online survey was conducted between May 10, and May 20, 2020, and 502 Lebanese adults who have access to the internet were enrolled. Results highlighted that positive correlates of PTSS were fear of COVID-19, female gender, and waterpipe smoking;negative correlates were higher family satisfaction, higher financial wellness, older age, having access to healthcare, and never having to work. When including insomnia as an independent variable to explain PTSS, the model did not substantially change. Positive correlates of insomnia included fear of poverty, fear of COVID-19, violence at home, the number of dependent children, having a job, and having a chronic disease. Conversely, higher family satisfaction and financial wellness were associated with lower likelihood of insomnia. When entering PTSS, insomnia remained positively associated with fear of poverty, PTSS, and violence at home. However, fear of COVID-19 was no longer associated with insomnia. We concluded that both the fear of COVID-19 and the economic crisis are correlated with PTSS and insomnia. © 2023 Author(s).

The Psychological Effect of COVID-19 on Home-Quarantined Nursing Students in China.

Coronavirus disease 2019 (COVID-19) has significantly caused socioeconomic impacts. However, little is known about the psychological effect of COVID-19 on home-quarantined nursing students. The present study aimed to identify the prevalence and major determinants of anxiety, depression and post-traumatic stress symptoms (PTSS) in Chinese nursing students during the COVID-19 pandemic quarantine period. An online survey was conducted on a sample of 6,348 home-quarantined nursing students. Mental health status was assessed by the Generalized Anxiety Disorder 7-Item Scale (GAD-7), the Patient Health Questionnaire 9-Item Scale (PHQ-9) and the Post Traumatic Stress Disorder Check List-Civilian version (PCL-C), respectively. Logistic regression analyses were performed to identify risk factors of anxiety, depression and PTSS. The overall prevalence of anxiety was 34.97%, and the rates of "mild," "moderate," and "severe" anxiety were 26.24, 7.04, and 1.69%, respectively. Depression was detected in 40.22% of the nursing students, and the prevalence of "mild," "moderate," "moderately severe," and "severe" depression was 27.87, 7.18, 4.08, and 1.09%, respectively. The overall prevalence of PTSS was 14.97%, with the prevalence of "mild" and "moderate-to-severe" PTSS reported at 7.04 and 7.93%, respectively. Male gender and insufficient social support were common risk factors for anxiety, depression and PTSS. In conclusion, about one-third, two-fifths, and one-seventh of Chinese nursing students had anxiety, depression and PTSS during the period of home quarantine, respectively. Timely and appropriate psychological interventions for nursing students should be implemented to reduce the psychological harm caused by COVID-19 pandemic.

Associations between post-traumatic stress symptoms and quality of life among psychiatric healthcare personnel in China during the COVID-19 pandemic: A network approach.

Background: Post-traumatic stress symptoms (PTSS) are commonly reported by psychiatric healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic and negatively affect quality of life (QOL). However, associations between PTSS and QOL at symptom level are not clear. This study examined the network structure of PTSS and its connection with QOL in psychiatric healthcare personnel during the COVID-19 pandemic. Methods: This cross-sectional study was carried out between March 15 and March 20, 2020 based on convenience sampling. Self-report measures including the 17-item Post-Traumatic Stress Disorder Checklist - Civilian version (PCL-C) and World Health Organization Quality of Life Questionnaire - Brief Version (WHOQOL-BREF) were used to measure PTSS and global QOL, respectively. Network analysis was used to investigate the central symptoms of PTSS and pattern of connections between PTSS and QOL. An undirected network was constructed using an extended Bayesian Information Criterion (EBIC) model, while a directed network was established based on the Triangulated Maximally Filtered Graph (TMFG) method. Results: Altogether, 10,516 psychiatric healthcare personnel completed the assessment. "Avoidance of thoughts" (PTSS-6), "Avoidance of reminders" (PTSS-7), and "emotionally numb" (PTSS-11) were the most central symptoms in the PTSS community, all of which were in the Avoidance and Numbing domain. Key bridge symptoms connecting PTSS and QOL were "Sleep disturbances" (PTSS-13), "Irritability" (PTSS-14) and "Difficulty concentrating" (PTSS-15), all of which were within the Hyperarousal domain. Conclusion: In this sample, the most prominent PTSS symptoms reflected avoidance while symptoms of hyper-arousal had the strongest links with QOL. As such, these symptom clusters are potentially useful targets for interventions to improve PTSS and QOL among healthcare personnel at work under pandemic conditions.

Posttraumatic Stress Symptoms in Patients With Cancer During the COVID-19 Pandemic: A One-Year Longitudinal Study.

BACKGROUND: Patients with cancer may be particularly vulnerable to psychological consequences of the COVID-19 pandemic. We studied the prevalence and evolution of posttraumatic stress symptoms (PTSS) in patients with cancer during the pandemic waves, and we investigated factors associated with high symptoms. METHODS: COVIPACT is a 1-year longitudinal prospective study of French patients with solid/hematologic malignancies receiving treatment during the first nationwide lockdown. PTSS were measured every 3 months from April 2020 using the Impact of Event Scale-Revised. Patients also completed questionnaires on their quality of life, cognitive complaints, insomnia, and COVID-19 lockdown experience. RESULTS: Longitudinal analyses involved 386 patients with at least one PTSS assessment after baseline (median age, 63 years; 76% female). Among them, 21.5% had moderate/severe PTSS during the first lockdown. The rate of patients reporting PTSS decreased at lockdown release (13.6%), increased again at second lockdown (23.2%), and slightly declined from the second release period (22.7%) to the third lockdown (17.5%). Patients were grouped into 3 trajectories of evolution. Most patients had stable low symptoms throughout the period, 6% had high baseline symptoms slowly decreasing over time, and 17.6% had moderate symptoms worsening during the second lockdown. Female sex, feeling socially isolated, worrying about COVID-19 infection, and using psychotropic drugs were associated with PTSS. PTSS were associated with impaired quality of life, sleep, and cognition. CONCLUSIONS: Approximately one-fourth of patients with cancer experienced high and persistent PTSS over the first year of the COVID-19 pandemic and may benefit from psychological support. CLINICALTRIALS: gov identifier: NCT04366154.

PTSD trajectories across different mental disorders in the second year of the COVID-19 pandemic in Italy: a naturalistic, longitudinal, multicenter study.

The potentially traumatic impact of the COVID-19 pandemic in subjects with pre-existing mental disorders is still unclear, especially regarding its long-term consequences. The aim of this study was to prospectively assess post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms (PTSS) in patients with mental disorders, during the 3rd wave of the infection (T0, March-April 2021) while strict containment measures were applied in Italy, and after 3 months (T1, June-July 2021), with reduced restrictive measures. A total sample of 527 subjects, with different DSM-5 diagnoses, was consecutively enrolled at nine Italian psychiatric outpatient services. Assessments at T0 included: the Trauma and Loss Spectrum-Self Report (TALS-SR), the Impact of Event Scale-Revised (IES-R) and the Work and Social Adjustment Scale (WSAS). These two latter were repeated at T1. Results showed that at T0, 43.6% of the sample reported symptoms of PTSD, with females (p = .004), younger subjects (p = .011), unemployed/students (p = .011), and living with their parental families (p = .017), resulting more affected. Differences in PTSD rates emerged across diagnostic groups ranging from 10% in patients with psychoses up to 59% in those with feeding and eating disorders. An improvement at T1 emerged in all diagnostic groups for the IES-R scores, while WSAS scores improved only in subjects with mood disorders. In conclusions, subjects with mental disorders presented relevant rates of PTSD and PTSS at 1-year into the pandemic. Further long-term studies are needed to follow-up the course of pandemic traumatic burden especially in patients with severe mental disorders.

Persistent emotional stress, fatigue and impaired neurocognitive function in recovered COVID-19 patients: a longitudinal prospective study

Introduction: Several surveys report that post-COVID-19 patients (pts) could be at risk of persistent emotional distress, fatigue and impaired neurocognitive function (NCF). Objective(s): The aim was to assess emotional distress, fatigue and NCF in order to provide adequate care. Method(s): Patients with persistent physical or mental symptoms, at least 8 weeks post-COVID-19, were eligible for this ongoing prospective longitudinal single center trial. Data on depression, anxiety, cognition, post-traumatic stress symptoms (PTSS) and fatigue were collected using 4 validated questionnaires at study entry (T0) and at 6 months (T1). Result(s): Ninety-three pts were recruited between November 2020- March 2021. Test results from 64 eligible pts (15 male pts) were analyzed at T0;63 pts (98%) were treated in outpatient settings. Median age was 47 years [range 27-75]). Median time since COVID-19 was 29 weeks [range 8-53]. Twenty-two pts (34%) had a history of psychiatric disorders. According to the Hospital Anxiety Depression Scale (HADS), 44 pts (73%) reported anxiety symptoms and 26 pts (41%) reported depressive symptoms;48 pts (69%) reported cognitive complaints according to the Cognitive Failure Questionnaire and 29 pts (45%) suffered from PTSS, according to the Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL-C). Fifty-five pts (86%) had an elevated score on the Fatigue Severity Scale, indicating severe fatigue. Twenty-seven pts (42%) were still on sick leaf. Diminished social support and psychiatric history were predictive factors for neurocognitive dysfunction and PTSS. Conclusion(s): A majority of patients who recovered physically from COVID-19, are at risk for suffering from persistent anxiety, PTSS and neurocognitive dysfunction.

A Statistical Learning Approach to Evaluate Factors Associated With Post-Traumatic Stress Symptoms in Physicians: Insights From the COVID-19 Pandemic

Physicians facing the COVID-19 pandemic are likely to experience acute and chronic, and often unpredictable, occupational stressors that can incur post-traumatic stress symptoms (PTSS), prevention of which is of utmost importance to enhance healthcare workforce efficiency. Unlike previous studies, in this paper we developed a generalized data-driven framework to generate insights into the complex, nonlinear associations of cognitive/occupational factors with physicians' PTSS-risk. Data were collected from practicing physicians in the 18 states with the largest COVID-19 cases by deploying a cross-sectional, anonymous, web-based survey, following the second COVID-19 peak in the US. Analyses revealed that physicians directly treating COVID-19 patients (frontline) were at higher occupational risk of PTSS than those who didn't (secondline). We implemented a suite of eight statistical learning algorithms to evaluate the associations between cognitive/occupational factors and PTSS in frontline physicians. We found that random forest outperformed all other models, in particular the traditionally-used logistic regression by 6.4% (F1-score) and 9.6% (accuracy) in goodness-of-fit performance, and 4.8% (F1-score) and 4.6% (accuracy) in predictive performance, indicating existence of complex interactions and nonlinearity in associations between the cognitive/occupational factors and PTSS-risk. Our results show that depression, burnout, negative coping, fears of contracting/transmitting COVID-19, perceived stigma, and insufficient resources to treat COVID-19 patients are positively associated with PTSS-risk, while higher resilience and support from employer/friends/family/significant others are negatively associated with PTSS-risk. Insights obtained from this study will help to bring new attention to frontline physicians, allowing for more informed prioritization of their care during future pandemics/epidemics.

Burnout and post-traumatic stress disorder symptoms among medical staff two years after the COVID-19 pandemic in Wuhan, China: Social support and resilience as mediators.

BACKGROUND: Evidence on the relationship between burnout and post-traumatic stress disorder (PTSD) is limited. We aimed to evaluate the association between burnout and PTSD symptoms among medical staff two years after the coronavirus disease 2019 (COVID-19) pandemic in Wuhan, China, and explore the mediating roles of social support and psychological resilience. METHODS: A multicenter survey was conducted online from January to March 2022 among healthcare professionals from six general hospitals. Hierarchical linear regression was used to detect the predictors of PTSD symptoms. Structural equation modeling (SEM) was used to analyze the pathways from burnout to PTSD symptoms. RESULTS: Hierarchical linear regression showed that burnout, social support, and psychological resilience were significant predictors of PTSD symptoms among medical staff. In the SEM, the standardized total effect of burnout on PTSD symptoms was 0.336(bias-corrected 95 % confidence interval [0.303, 0.367], P < 0.001). Social support and psychological resilience partially mediated the relationship between burnout and PTSD symptoms (indirect effects accounted for 22.3 % of the total effect). LIMITATIONS: Owing to the cross-sectional design, only clues to causal explanations can be provided. CONCLUSIONS: Burnout has significant direct and indirect effects on PTSD symptoms. Furthermore, social support and psychological resilience might be effective ways to reduce the impact of burnout on PTSD symptoms in medical staff after a major public health outbreak.

Psychological Consequences of Social Isolation and its Link with Positive Psychological Functioning

Objective. Evaluate the psychological effects of social isolation (post-traumatic stress symptoms) associated with the global pandemic situation and the possible association with positive psychological functioning. Method. The design was a cross-sectional study with 440 participants between 18 and 65 years old (M = 35.25) selected through convenience sampling. Sociodemographic, coexistence and occupation data were collected. The information was collected online, between April and July 2020. A descriptive and comparative analysis of the variables was carried out. Results. A relationship between Social Isolation and Post Traumatic Stress Symptoms was observed. Positive psychological functioning was inversely correlated with social isolation and post-traumatic stress symptoms, which are more evident in the middle and older age ranges (36-50 and 51-65). Positive psychological functioning showed higher levels in the 51-65 age group and in participants from the interior of the country. Symptoms of anxiety and depression were greater in young people (18-25 years old), women, city residents, and people living with their parents. These data can inform treatment strategies that attempt to reduce the psychological symptoms of COVID-19 isolation, based on psychological resources. Copyright © 2020 Xiaohan Yang et al.

Post-pandemic stress of COVID-19 among high-risk groups: A systematic review and meta-analysis.

BACKGROUND: Post-Traumatic Stress Disorder (PTSD) is considered as a prevalent outcome of the COVID-19 pandemic. This study aimed to present a global picture of the prevalence of PTSD in high-risk groups for COVID-19 (HRGs-COVID19) and determine its risk factors. METHODS: Cross-sectional studies published between March 11, 2020, and October 11, 2021, in English, were searched in seven databases on the prevalence of PTSD in HRGs-COVID19. After screening the retrieved records, their quality was assessed, and the required data were extracted. R-4.1.3 software and random effect model with 95 % confidence interval (CI) were used to synthesize and analyze the data. RESULTS: The pooled prevalence of PTSD in HRGs-COVID19 was 30 % (95 % CI: 21-39 %). The pooled prevalence of PTSD was significantly different in terms of the variables of data collection during the lockdown, gender, and data collection season (P < 0.05). Subgroup analyses could not identify sources of heterogeneity. LIMITATIONS: The included studies did not cover all HRGs-COVID19 such as smokers and the elderly. CONCLUSION: Considering the higher pooled prevalence of PTSD in HRGs-COVID19 than the general population, COVID-19 patients, and health care workers, prioritizing this subgroup for prevention and treatment of psychological outcomes is highly recommended. Predicting and implementing psychological interventions early in the pandemic is more critical when applying restrictive measures and among HRGs-COVID19 women.

Psychological Distress in Breast Cancer Patients during the Italian COVID-19 Pandemic.

BACKGROUND: The emergency caused by the SARS-CoV-2 pandemic exacerbated psychological distress. Our aim was to investigate the impact of breast cancer on patients' lives during the Italian lockdown. METHODS: Sixty-five female breast cancer patients were studied, assessing the level of psychological distress with the Hospital Anxiety and Depression Scale (HADS) and the impact of the cancer diagnosis (Impact of Event Scale-Revised-IES-R). In addition, we compared these data with a matched group of breast cancer patients enrolled in 2019. RESULTS: Patients enrolled in 2020 had statistically higher levels of anxious symptomatology and higher levels of traumatic symptomatology due to the cancer diagnosis. A mediation analysis was performed to determine how the experience of distress due to COVID-19 negatively impacted the level of anxiety and amplified the impact of the diagnosis with a significant increase in traumatic symptoms. CONCLUSIONS: Considering the vulnerability of these patients and the serious and novel situation that the healthcare system is currently facing, we would like to point out the importance of structured and organised psychological support for these patients.

Family Conflict, Physical Symptoms, and Post Traumatic Stress among Sexual Minorities during the COVID Pandemic: A Moderated Mediation Model.

Sexual minorities experience health disparities compared to heterosexuals due to their stigmatized identies. The COVID- 19 pandemic has further exacerbated these disparities. Sexual minorities were surveyed about their experiences during the pandemic and asked about family conflict and minority stress as predictors of Post Traumatic Stress Symptoms (PTSS) and physical health symptoms, as well as psychological symptoms as a mediator of these relationships. We surveyed 435 sexual minorities who were recruited from Mechanical MTurk. Participants completed questionnaires that included demographics, PTSS in response to the pandemic, family conflict, minority stress, psychological symptoms, and physical health outcomes. Our findings support a moderated mediational model, explaining the relationships between family conflict, minority stress, PTSS and physical symptoms. Specifically, those participants who are high in minority stress are vulnerable to family conflict resulting in increased PTSS and physical symptoms. Psychological symptoms mediated these relationships.

Sex differences in the experience of COVID-19 post-traumatic stress symptoms by adults in South Africa

Background: The COVID-19 pandemic has created multiple mental health challenges. Many residents in South Africa face pre-existing elevated levels of stress and the pandemic may have had varying impacts on sub-populations. The aims of this study were to determine: 1) the factors associated with post-traumatic stress symptoms (PTSS) and 2) sex differences in the factors associated with PTSS in adults residing in South Africa during the COVID-19 pandemic. Methods: Study participants aged 18 years and above, were recruited for this cross-sectional study through an online survey implemented from June 29, 2020 to December 31, 2020. The outcome variable was PTSS;explanatory variables were sex at birth, COVID-19 status, social isolation and access to emotional support. Confounders considered were age, education level completed and current work status. Logistic regressions were used to determine the association between the outcome and explanatory variables after adjusting for confounders. Outcomes: There were 489 respondents. Among all respondents, those who were older (AOR: 0.97;95% CI: 0.95 - 0.99) and had access to emotional support from family and relatives (AOR: 0.27;95% CI: 0.14 - 0.53) had significantly lower odds of PTSS. Respondents who felt socially isolated had higher odds of PTSS (AOR: 1.17;95% CI: 1.08 - 1.27). Females had higher PTSS scores and higher odds of PTSS compared to males (AOR: 2.18;95% CI: 1.41-3.39). Females (AOR: 0.27;95% CI: 0.08 - 0.95) and males (AOR: 0.26;95% CI: 0.11, 0.59) who had access to emotional support had significantly lower odds of PTSS than those who had no support. Females (AOR: 1.15;95% CI: 1.04 -1.27) and males (AOR: 1.19;95% CI: 0.11, 0.59) who felt socially isolated had higher odds of PTSS compared to those who did not feel socially isolated. Interpretation: Compared to males, females had higher scores and higher odds of reporting PTSS during the COVID- 19 pandemic. Access to emotional support ameliorated the odds of having PTSS for both sexes, while feeling socially isolated worsened the odds for both sexes. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Prevalence and Associated Factors of PTSD Symptoms After the COVID-19 Epidemic Outbreak in an Online Survey in China: The Age and Gender Differences Matter.

Introduction: The COVID-19 is a highly contagious disease belonging to the family of coronaviruses which can affect a great deal of people shortly. As a devastating event in the world, many people suffer the PTSD from this severe disease. The aim of study is to explore the prevalence and severity of post-traumatic stress disorder (PTSD) symptoms, and discuss the possible factors among the general public in China after the COVID-19 epidemic outbreak. Methods: This is a cross-sectional study. We used the self-designed demographic questionnaire and the Posttraumatic Stress Checklist-Civilian Version (PCL-C) of Chinese version as our screening tools to investigate 4872 subjects living in the communities in China from Nov. 8th, 2020 to Dec. 8th, 2020. Results: Finally, we received 3705 effective respondents. The response rates of the questionnaire can reach 76.97 percentage. Peculiarly, the prevalence of PTSD mild and severe symptoms after the COVID-19 epidemic outbreak was 53.2%. Mild PTSD symptoms accounted for 24.9%, and severe PTSD symptoms (scores above 38) accounted for 28.3%. PCL-C mean scores were 41.4±14.7. The females accounted for 67.7% of the total samples. Participants' mean age was 30.5±11.2 years old. The PCL-C gross scores of females were all higher than males in four subject groups. Meantime, gender and age made differences not only in total PCL-C points but also in the four aspects of PCL-C (P<0.001). The middle-aged group (ages from 45 to 60) got the lowest scores among the four groups. Conclusion: COVID-19 brought tremendous psychological pressure on the public in many ways, including people's work, social contact, study, and daily life. Results of our research discover that symptoms of the PTSD are severe, including the re-experiencing, avoidance/numbing, flashbacks, and hyper-arousal. Actions should be taken at society level to prevent and protect individuals from PTSD suffering. Special attention should be paid to females and young people. Further studies should be conducted to explore the dynamic and other risk and protection factors to prevent PTSD.

Prevalence and predisposing factors of post-traumatic stress symptoms in anaesthetists during the second wave of COVID-19 in South Africa

Background: Post-traumatic stress symptoms (PTSS) have been described in healthcare workers after disease outbreaks. Anaesthetists are at high risk of exposure to COVID-19 due to the nature of the airway procedures they perform. Anaesthetists are also at increased risk of mental health disorders, substance abuse and suicide. When the occurrence of PTSS is great in both number and severity, these become the key elements of the diagnostic criteria for post-traumatic stress disorder (PTSD). This study explores the prevalence and predisposing factors of PTSS in anaesthetists during the second wave of COVID-19 in South Africa. Methods: Members of the South African Society of Anaesthesiologists (SASA) completed an electronic questionnaire regarding their sociodemographic information as well as COVID-19 exposure. The PTSD checklist for DSM-5 (PCL-5) was used to measure PTSS. The resulting score gave an indication of symptom severity, with a score of 33 or higher indicating a provisional diagnosis of PTSD. Results: A total of 483 participants completed the questionnaire (23.8% response rate). Of these, 391 participants were included in the study and 69 participants (17.6%) received a provisional PTSD diagnosis. Participants who are younger and have less experience, who are female, who are single or who do not have children exhibited a greater prevalence of PTSD. Also, those participants who had pre-existing mental health conditions (p = 0.009), and those who reported loneliness (p < 0.001) and poor social support (p = 0.018) were more likely to receive a provisional PTSD diagnosis. Personal protective equipment (PPE) shortages were also associated with the development of PTSD (p = 0.009). Conclusion: The prevalence of PTSS is unacceptably high among South African anaesthetists, especially those with pre-existing mental health conditions and poor social support. This calls for support of vulnerable healthcare workers during disease pandemics. © 2022 The Author(s).

A comparison between healthcare workers and non-healthcare workers' anxiety, depression and PTSD during the initial COVID -19 lockdown.

Objective: Several studies have found that Healthcare workers are vulnerable to mental health problems during the COVID-19 pandemic. However, few studies have made comparisons of healthcare workers (HCWs) and non-HCWs. The current study aimed to compare mental health problems among HCWs with non-HCWs during the initial lockdown of COVID 19. Study design: A population-based cross-sectional survey. Methods: The survey was conducted by means of an open web link between April and May 2020. Data were collected by self-report. The PTSD Checklist for DSM-5 (PCL-5) was used to assess posttraumatic stress. Results: A total of 4527 citizens answered the questionnaire and 32.1% were HCWs. The majority were female, under 60 years of age, and lived in urban areas. Among the HCWs, the majority were registered nurses working in hospitals. The prevalence were 12.8% vs 19.1% for anxiety, 8.5% vs 14.5% for depression and 13.6% vs 20.9% for PTSD among HCWs and non-HCWs respectively. The highest prevalence's for anxiety and PTSD among HCWs were found for those under 40 years of age and having low education level (<12 years). Conclusion: Mental health problems was significantly lower among HCWs compared to non-HCWs. However, the COVID-19 poses a challenge for HCWs, especially young HCWs and those with low level of education. Providing support, appropriate education, training, and authoritative information to the different members of the HCWs could be effective ways to minimize the psychological effect.

Optimism as a protective factor against the psychological impact of COVID-19 pandemic through its effects on perceived stress and infection stress anticipation.

The 2019 coronavirus disease (COVID-19) and the recommended social isolation presented a challenge to people's mental health status. Optimism is a psychological factor that plays a key role in the evaluation of stressful situations. The purpose of this study was to investigate the mediating role of perceived stress and Covid-19-related stress anticipation in the relationship between optimism and post-traumatic stress symptoms. Our sample included 1015 participants ranging in age from 18 to 79 years, 80% of whom were Spaniards. At the beginning of the worldwide pandemic, participants were confined to their homes for at least seven days and completed an online survey measuring various sociodemographic and psychological variables. We found an indirect effect of optimism on intrusion and hyperarousal through perceived stress and stress anticipation. In addition, we observed an indirect effect of optimism on avoidance through perceived stress. Finally, the results showed a significant indirect effect of optimism on the total post-traumatic stress symptoms score through perceived stress and stress anticipation. Our results indicate that positive beliefs inherent to optimism are related to less psychological impact of the COVID-19 outbreak.

Association between Structural Determinants of Health and Post-traumatic Stress Symptoms during the COVID-19 Pandemic

Background: Psychological problems, such as post-traumatic stress symptoms (PTSS), are among the most important complications associated with the COVID-19 pandemic in people. Studying the social determinants of health (S DH) and its impact on the populations during the crisis will help governments deal better with health emergencies so that every person can have an equal opportunity to stay healthy. Objective: To determine what factors affect PTSS, we conducted a study to investigate the association between structural determinants of health and PTSS during the COVID-19 pandemic. Methods: We conducted a cross-sectional study on 370 people referred to a selected laboratory between June and July 2020 in Karaj province, Iran. Post -traumatic stress disorder (PTSD) 8-item inventory was used to evaluate the PTSS and its subscales, including intrusion, avoidance, and hypervigilance in the participants. Results: Overall, 51.2% of participants were male, and 17.3% were positive for the IgM or IgG COVID-19 test. The most common symptoms in these patients were weakness, myalgia, cough, anosmia, and fever. The prevalence of total PTSS, intrusion, avoidance, and hypervigilance symptoms were 7.1%, 25.7%, 41.6%, and 16.2%, respectively. In univariable regression analysis, female gender (p-value=0.01, 95%CI (2.25-0.31)), un-employment (p-value=0.011, 95%CI (0.37-2.81)), having symptoms of COVID-19 disease (p-value=0.000, 95%CI (.82-2.75)), underlying chronic disease, were directly associated with PTSS. Conclusion: Results showed that sex and occupation as structural determinants of health could affect PTSS in the COVID-19 pandemic. However, in the multi variable model, having symptoms of the COVID-19 disease and underlying disease affected PTSS.