Factors associated with quality of life during COVID-19 pandemic

Introduction: The worldwide lockdown in response to the COVID-19 pandemic has been reported to have an impact on many people's quality of life. This study aims to measure the quality of life for Malaysians during this time and its associated factors. Method(s): This national online survey from August to December 2021 via placement of QR codes in public places such as shopping malls, vaccination centres, and hospital outpatient clinics. The QR code is linked to a google form in Malay, which consists of four sections, including: socio-demographic;validated Fear of COVID-19 Scale;validated Brief COPE scale to assess coping strategies as well as regulating cognition in response to stressors coping mechanisms, and quality of life, measured using a validated WHOQOL-BREF questionnaire. The data collected were analysed via linear regression to obtain the final model. Result(s): There were 4904 Malaysian adults who participated in this survey with a mean of age 32(SD=9.2), and the majority being female (83.7%). Based on the finding, 59.1% claim to have had a low overall quality of life during the pandemic. Age, education status, and income as well as psychological related predictors (fear of COVID-19, coping strategies, and psychological distress) are the predictors that explain 69% of the total variance in quality of life among Malaysians. Conclusion(s): Targeting modifiable factors such as psychoeducation on fear of COVID-19, and coping strategies can potentially improve the quality of life during the COVID-19 pandemic among Malaysians.

Fear of covid-19, stress and coping strategies among nurses during the covid-19 pandemic's second wave: A quasi-intervention study

Background: The COVID-19 pandemic and its related consequences caused a higher risk of mental health problems for nurses. Hence, this study aims to reduce the level of fear and stress related to the COVID-19 pandemic and promote active coping among Egyptian nurses. Method(s): This quasi-intervention study was conducted on 125 nurses working at Benha's University hospitals, who were selected by a systematic random sampling technique within the time interval of March 2021 to July 2021. The study was conducted using the fear of COVID-19 scale, the stress scale of depression, anxiety and stress scales, and the Brief (COPE) inventory scale. Result(s): The mean ages of the studied nurses were 36.70 +/- 9.50. Almost half of the studied nurses were males and married. Before the intervention, 47.2% of nurses had severe stress levels while 82.4% had a high level of fear of COVID-19. Experience years, type of department, and worries about vaccine side effects were the predictors of the fear of COVID-19. A significant difference (p =.000) was found between both mean stress and fear scores pre-intervention (15.27 +/- 5.47 and 25.56 +/- 6.13) and post-intervention (4.87 +/- 2.14 and 11.92 +/- 2.43). The most prevalent coping strategies among nurses before the intervention were self-distraction (5.03 +/- 1.53), followed by behavioral disengagement and self-blaming. However, after the intervention, religion was found to be the utmost coping mechanism (6.12 +/- 1.17), followed by positive reframing and acceptance. Conclusion(s): The majority of the nurses in the study reported a significant fear of COVID-19, and around half of the nurses had severe stress as a result. After the intervention, the stress and fear scores were reduced by half or even less. Age, longer work experience, and worries about the vaccine were the predictors of fear of COVID-19. The coping strategies used after the intervention shifted toward active coping strategies.Copyright © 2023 Omar et al.

Factors Related to Psychological Distress Among Nursing Students Volunteering in Covid-19 Frontline Prevention In Vietnam

The aim of the study to examine the level of psychological distress among nursing students volunteering in Covid-19 frontline prevention in Vietnam and related factors. Nursing students volunteering in frontline prevention presented emotional effects, including positive and negative effects on their psychological well-being. A cross-sectional study design was used and four hundred seventy-one students who volunteered for frontline prevention were randomly selected in the study using inclusion criteria. Data were collected from October to December 2021. A demographic questionnaire, the General Self-Efficacy Scale, the 6-item Kessler Psychological Distress Scale, the Brief Coping Orientation to Problems Experienced Inventory Questionnaire, and the Quality of life EQ-5D-5L were used to measure the variables. The data analysis was conducted by using descriptive statistics and linear regression. The research found that students presented a high risk of psychological distress. There was a significant correlation between problem-and emotional-coping strategies, quality of life, and psychological distress. Moreover, family support and psychological distress among nursing students had a strong relationship. Lecturers and high education institutions responsible for nursing students should pay more attention to developing psychological interventions in enhancing coping strategies and quality of life and various supports to reduce distress among nursing students fighting the epidemic.Copyright © 2022 Mohan R, et al.

Coping Strategies used by Health Care Workers to Cope with Psychological Distress at NSCB Medical College, Jabalpur, during the COVID-19 Outbreak

Background: COVID-19 (Coronavirus Disease 2019), which is spreading domestically and internationally and has had a significant impact on the world, was first reported in December 2019 in Wuhan City, Hubei Province, China. Following the worldwide emergency of COVID-19, health care workers faced several issues, including an increase in workload. Many of them became infected and died as a result of close contact with COVID-19 patients. The continuing epidemic of COVID-19 is inducing fear, anxiety, and fatigue in them, and there's an urgent need to determine their mental health status. Aim(s): To assess the psychological distress and identify various coping strategies among the health care workers Methods: One hundred seventy health worker were selected. Following the candidates' informed consent, information about their socio-demographics and COVID-19 duties was gathered in a semistructured performa. All selected health care workers were assessed for psychological distress with the help of the General Health Questionnaire-12 and The coping strategies were measured by a brief cope questionnaire. Result(s): The mean score on GHQ-12 scale was 13.69(SD= 6.26) indicating that the professionals' mental health was poor condition. The most frequently used coping strategies were Emotion Focused Coping, followed by Problem Focused Coping. Meanwhile, the least used coping strategies were Avoidant Coping. Conclusion(s): Health-care professionals reported poor mental health during covid-19 outbreak and majority of professionals coped with adaptive coping strategies in this adverse situation.

To Compare The Coping Strategies, Emotional Reactions, Burnout And Resilience In Doctors Caring And Not Caring For Covid19 Patients

Background: Rapid transmission of novel coronavirus (COVID-19) causing severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) occurred all across the world in few months causing a pandemic. Frontline medical staff as a result of heavy workload, insufficient protective equipment, a lack of information of the pathogen, and direct contact with patients faced the fear of getting infected themselves and their family. Anxiety, stress, and other negative emotions have led to a series of psychological crises in them. Aim(s): To compare the coping strategies, emotional reactions, burnout and resilience in doctors caring and not caring for COVID19 patients. Materials And Methods: Total 304 Doctors in tertiary care hospitals out of which 163 were caring and 141 were not caring for COVID19 patients participated in our study. Both groups were assessing and compared using The Fear of COVID-19 Scale, the coronavirus anxiety scale (CAS), Patient Health Questionnaire-2 (PHQ-2), Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), Brief COPE, Connor-Davidson Resilience Scale abbreviated, Abbreviated Maslach Burnout Inventory, Two-Item Conjoint Screen (TICS) Results: All participants those who did COVID duty and those who did not do it showed high level of resilience though on comparison no significant different was found between two groups. Those who did not do COVID duty were scored higher in emotion focused coping strategies whereas who did not do COVID duty scored higher in avoidant coping strategies. Abbreviated version of Maslach Burnout Inventory indicated a great personal accomplishment, less depersonalization and low emotional exhaustion in all the participants irrespective of their duty status. Conclusion(s): On comparing those who did COVID duties against those who haven't, it was found that those who did not do COVID duty used more emotion-focused ways to cope and those who were doing COVID duties were using harmful avoidant coping to manage their daily chores. All the doctors participating in study showed high resilience irrespective of whether they did COVID duty or not.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Investigating Financial Toxicity among Breast Cancer Patients Diagnosed during the Pandemic: The Role of Cancer Care Disruptions and Social Isolation

Background: Financial toxicity (FT) is a multi-faceted construct, encompassing material hardship, psychological responses, and coping behaviors. FT adversely impacts patient-reported outcomes by decreasing mental health, affecting health-related quality of life (HRQOL), and deteriorating healthcare adherence. Few studies have assessed the relationship between financial toxicity, distress, coping, self-efficacy, and HRQOL within the context of cancer care disruptions resulting from the pandemic. Method(s): In the COVID-19 Breast Cancer Care Survey, 46 women with primary breast cancer were cross-sectionally evaluated for financial hardship (FACIT-COST), distress (Perceived Stress Scale), coping behaviors (Brief COPE), self-efficacy (Cancer Behavior Inventory-Brief) and HRQOL using the Functional Assessment of Cancer Therapy General (FACT-G) measure. Cancer care disruptions were measured with a series of questions investigating the impact of COVID-19 guidelines on access to healthcare services, treatment, and transition to telemedicine. Given the role of informal caregivers for patients' outcomes, social isolation was additionally included (PROMIS Social Isolation Scale). Descriptive statistics were computed, and bivariate correlations examined. Then, a subsequent regression model investigated predictors of FT in the present sample. Statistical analyses were performed using SAS 9.4 and significance level was set at p< 0.05. Result(s): Overall, participants were adult (Mage= 46.3+/-10.9) women diagnosed with early-stage breast cancer (75.61% Stage I/II). Approximately half of the participants were in active treatment (51.2%) and received multiple types of treatment (85.4% surgery;61% chemotherapy, and 36.5% radiation). Although all participants were insured at time of the study, the mean score of FT was 22.75 (SD=4.10, range: 0-44). Correlation analyses indicated that cancer care disruptions (r= -0.57, p<.001), health-related quality of life (r=-0.51, p=0.0007), coping behaviors (r=-0.33, p=0.037), well-being (r=0.56, p=0.0001), social isolation (r=-0.40, p=0.0096), and psychological distress (r=-0.42, p=0.0064) were significantly correlated with FT. That is, women who reported greater disrupted cancer care delivery, greater difficulties managing the illness, reduced physical and mental health, and those experiencing more social isolation reported worse financial toxicity. Results of the final regression model showed that women who experienced greater COVID19-related cancer care disruptions (beta=-2.82, p=0.0013) and isolation (beta=-0.44, p=0.0196) from supportive networks were more likely to indicate elevated FT scores. Conclusion(s): A multidisciplinary and patient-centered FT management approach can be implemented to extend current financial navigation models to address psychosocial and behavioral factors exacerbated by altered care delivery protocols.

A Structural Validation of the Brief COPE Scale among Outpatients with Alcohol and Opioid Use Disorders.

Recovery from substance use disorder requires access to effective coping resources. The most widely self-reported questionnaire used to assess coping responses is the Brief COPE; however, different factorial structures were found in a variety of samples. This study aimed to examine across outpatients with substance use disorders the factor structure of the short dispositional French version of the Brief Coping Orientation to Problem Experienced (COPE) inventory. The French version of the Brief COPE was administered in a sample of 318 outpatients with alcohol or opioid substance use disorder. A clustering analysis on latent variables (CLV) followed by a confirmatory factorial analysis (CFA) was conducted to examine the factor structure of the scale. The internal consistency of the Brief COPE and its subscales were also studied. The analysis revealed a nine-factor structure with a revised 24-item version consisting of functional strategies (four items), problem-solving (four items), denial (two items), substance use (two items), social support seeking (four items), behavioral disengagement (two items), religion (two items), blame (two items), and humor (two items) that demonstrated a good fit to the data. This model explained 53% of the total variance with an overall McDonald's omega (ω) of 0.96 for the revised scale. The present work offers a robust and valid nine-factor structure for assessing coping strategies in French outpatients with opioid or alcohol substance use disorder. This structure tends to simplify its use and interpretation of results for both clinicians and researchers.

Humor Coping Reduces the Positive Relationship between Avoidance Coping Strategies and Perceived Stress: A Moderation Analysis.

Humor is considered an adaptive coping strategy as it could reduce the burden of perceived stress and increase positive emotional states when dealing with stressful situations. Humor has been reported in several models as a rather independent strategy that can be correlated with both approach-based coping strategies and avoidance-based coping strategies. Humor can be defined as a hedonistic escapism strategy that would work better in the presence of unpredictable or uncontrollable stressors, such as the spread of the COVID-19 pandemic and its related confinement measures. Therefore, during such a stressful event, humor would have increased the positive effect of the approach coping style on mental health and reduced the negative effect of the avoidance coping style. Based on this hypothesis, we conducted a cross-sectional study with a moderation analysis in which we assessed the interaction of humor with both approach-based and avoidance-based coping styles on perceived stress in a large sample of Italian participants collected in April and May 2021. Despite some limitations related to sampling and study design, the results obtained partially support our hypothesis, as we observed that humor had a significant moderating effect on the relationship between avoidance coping and psychological distress, with a reduction of perceived stress while using such a coping style in the presence of a medium to high level of humor. On the other hand, we did not observe a significant moderating effect of humor on the relationship between the approach coping style and perceived stress. In general, our results support the beneficial effect of humor on mental health and highlight a special role for humor as a moderator of other coping strategies.

Anxiety, depression and stress among female medical students during the second wave of the COVID-19 pandemic and their association with family functioning, coping and personality

Background and Aims: This research examined anxiety, depression, and stress levels in female medical students during the second wave of coronavirus disease 2019 (COVID-19) and the association between these variables and family functioning, coping, and personality factors. Material(s) and Method(s): The cross-sectional online observational study was conducted using Google Forms. Anxiety, depression, and stress were assessed using the Depression, Anxiety, and Stress Scale (DASS-21), family functioning using Family Adaptability, Partnership, Growth, Affection, and Resolve, coping using Brief COPE, and personality using the Big Five Inventory 10-item version. Result(s): Out of 750 students, 500 thoroughly responded to the online survey. Based on the DASS-21 scores, 57.6% of participants had some stress, 63.4% had some anxiety, and 54.8% had some degree of depression. Anxiety, depression, and stress were highly correlated with each other. Stress, anxiety, and depression were weakly linked with problem-focused coping, moderately correlated with emotion-focused coping, and strongly correlated with avoidant coping. Better family functioning was associated with lesser self-reported stress, anxiety, and depression. Neuroticism was associated with higher anxiety, depression, and stress, while agreeableness and conscientiousness were with lower psychological distress. Conclusion(s): High level of psychological suffering was prevalent among medical students during the COVID-19 pandemic. Their anxiety, depression, and stress must be adequately managed. Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.

The Dimensionality of the Brief COPE Before and During the COVID-19 Pandemic.

The Brief COPE (Coping Orientation to Problems Experienced) is a frequently used questionnaire assessing 14 theoretically derived coping mechanisms, but psychometric research has suggested inconsistent results concerning its factor structure. The aim of this study was to investigate primary and secondary order factor structures of the Brief COPE during the COVID-19 pandemic by testing 11 different models by confirmatory factor analyses and to assess differences between sex, age groups, and relationship status. Altogether, 529 respondents from Austria and Germany participated in a web-based survey. Results supported the originally hypothesized 14-factor structure but did not support previously described higher-order structures. However, bass-ackwards analyses suggested systematic overlap between different factors, which might have contributed to different factor solutions in previous research. Measurement invariance across sex, age groups, and relationship status could be confirmed. Findings suggest that cultural and situational aspects as well as the functional level should be considered in research on theoretical framing of coping behavior.

Mental health problems and coping strategy among pulmonary resident physicians during the COVID-19 pandemic in a tertiary respiratory hospital in Indonesia: a serial cross-sectional study

BACKGROUND Pulmonary resident physicians are part of the frontline workers for COVID-19 in the hospital and might require a suitable coping strategy to manage stress. Here, we described their mental health status and coping strategy during the COVID-19 pandemic. METHODS A cohort study was done to evaluate stress, anxiety, depression, and coping strategies among pulmonary resident physicians in a tertiary referral hospital. Questionnaires were administered in 4 time points between August 2020 and June 2021. The DASS-21 questionnaire measured depression, anxiety, and stress, while Brief COPE instrument qualified the coping strategy. RESULTS The total respondents who filled the questionnaire in 4 time points in August 2020, October 2020, February 2021, and June 2021 were 60, 93, 96, and 94 resident physicians with mean stress levels of 4.3, 6.1, 5.4, and 6.3, respectively. Depression, stress, and anxiety were less frequent during the study period, mostly mild or moderate. However, moderate anxiety slightly increased in June 2021 when the pandemic reached its peak. Most of them (95.8%) had effective coping strategies related to religious beliefs. CONCLUSIONS Effective coping strategies might preserve the pulmonary resident physicians' mental health during the pandemic. Furthermore, the sociodemographic and cultural background might affect the coping strategy. Practicing religion and praying or meditating might be essential factors in coping with psychological distress and a key to adapt to the COVID-19 pandemic. Copyright © 2022 Authors.

Psychological Impact and Coping Style Among Students of National Defence University of Malaysia during the COVID-19 Pandemic

Introduction: The outbreak of COVID-19 has caused a significant impact on the world's population. This study examines the impact of COVID-19 on the level of depression, anxiety and stress among students of National Defence University of Malaysia (NDUM), and to assess coping styles during this critical time. Method(s): This was a cross-sectional study conducted during the Conditional Movement Control Order (CMCO) on May 2020 during the COVID-19 pandemic. DASS-21 and BRIEF COPE were used as the assessment toolsfor this study. Data was analysed using descriptive statistics, Independent T-test and One-way ANOVA with comparisons of multiple variables using post-hoc Tukey's test. Result(s): A total of 603 participants were included in the study. Respondents' mean age was 21.06 +/- 1.75. They consisted of 52.6% male, 86.9% Malays and 76.9% non-cadets. The prevalence of depression, anxiety and stress were 51.9%, 46.9% and 18.7% respectively. Female, those who are from the Language Centre and non-cadet students, showed a statistically significant higher score of depression, anxiety and stress. A high-stress score was seen in Bachelor degree students compared to Foundation students. Those with no financial sponsorship showed the highest anxiety score. The most common coping style used among the respondents was religion and the least is substance abuse. Conclusion(s): This study has identified the risk groups for developing psychological distress during times of crisis. Thus, there is an urgent need to address the concern on mental health and provide a structured support for them. Copyright © 2023, Ibn Sina Trust. All rights reserved.

Depression among frontline medical and paramedical staff during the coronavirus pandemic

Introduction: The current coronavirus pandemic is a unique and unusual situation. It is putting the general population under severe strain. However, frontline medical and paramedical staff remain particularly vulnerable to depression because of its close contact with patients. Objective(s): The aim of this work was to screen and evaluate depression in the frontline professionals during the pandemic and to study their associated factors . Method(s): In this study , we conducted a national descriptive and analytical cross-sectional study over a 2-month period from September to October 2020. We used "Beck Depression Inventory" to assess depression and "Brief Cope Scale" to detect a possible correlation between depression and coping mechanisms. Result(s): We collected 78 professionals. The mean age was 29.86 years. 2/3 of workers were women. 67.9% of the staff were residents. 39.7% worked in Covid units. 7.7% had personal psychiatric history. 56.4% of the staff worked daily and 76.9% of them provided direct care to patients with Coronavirus. 52.6% of workers did not receive adequate training of protection against Covid-19. The staff reported 66.7% of death among their patients. 42.3% suffered from minor depression and only 2.3% suffered from severe depression. During this period we objectified an increase of 14.1% in the psychoactive substances use. Stigma affected 57.7% of professionals. We didn't objectify a significant correlation between Depression and coping mechanisms . Conclusion(s): Screening depression among healthcare professionals should be considered in order to prevent it, ensure continuity of care and avoid sick leaves.

Coping strategies among medical and paramedic frontline healthcare workers during the coronavirus pandemic

Introduction: The epidemic of COVID-19 has affected the psychological health of people, especially frontline medical and paramedical staff. Several coping strategies have been used to combat the impact of this virus on their lives. Objective(s): Describe the impact of coronavirus on mental health and identify coping strategies Methods: We carried out a cross-sectional, descriptive and analytical study, conducted over a period of two months ( september and october 2020), in 22 hospitals in Tunisia, including frontline medical and paramedical staff. Toevaluate anxiety and depression, we used the Beck Inventory.To identify coping strategies, we used the Brief COPE. Result(s): We collected 78 professionals. The mean age was 29.86+-5.4. The majority were medical residents (67.9%) working in covid units in 39.7% of cases. The rythm of work was daily in almost half of the cases, giving direct care to the patients tested positive in 76.9%. More than half had not received adequate training, and protective equipment was available in only 50% of cases. We found 35.9% of the staff who had to move for fear of infecting their families. More than half of the frontline staff were victims of stigma (57.7%). Depression and anxiety were tested minor in 40%. The most used coping strategy in the face of this distressing virus was social support (64.1%) followed by emotion-focused mechanisms (53,8%). Social support strategy was significantly correlated with prevention of anxiety (p=0.048) Conclusion(s): Participants practiced and recommended various coping strategies to deal with stress, depression and anxiety emerging from COVID-19 pandemic.

Anxiety among frontline healthcare professionals during the coronavirus pandemic

Introduction: Anxiety has become a topical issue since the arrival of the coronavirus pandemic, especially for frontline healthcare professionals as they deal with patients affected by the Covid-19. Objective(s): Objectify anxiety in frontline medical and paramedical staff and study its associated factors. Method(s): We conducted a national descriptive and analytical cross-sectional study via a survey over a 2-month period from September to October 2020. We used "Beck Anxiety Inventory" to screen anxiety as well as "Brief Cope Scale" to detect probable correlations between anxiety and coping mechanisms. Result(s): We collected 78 persons. The mean age was 29.86 years. 35.9% moved out of home. 39.7% worked in Covid units. 7.7% had personal psychiatric history. 76.9% provided direct care to patients with Coronavirus. The frontline staff reported that only 29.5% of patients were stables. Only 48.4% received adequate training of protection against Covid-19. 64.1% of professionals did PCR test and only 16.7% of them tested positive. We objectified an increase of 6.4% in the anxiolytics use. Stigma affected 57.7% of professionals. We highlighted a link between anxiety and social support strategy (p=0.048). 92.3%of the staff suffered from anxiety according to Beck Anxiety Inventory. Conclusion(s): Screening anxiety among frontline medical and paramedical staff might enhance their productivty and thus provide patients with the best care.

Secondary Traumatic Stress and Vicarious Posttraumatic Growth among nurses during three COVID-19 lockdowns in Greece

Introduction: Since the onset of the pandemic, nurses have been repeatedly exposed to their patients' COVID-19-related traumatic experiences. Therefore, they are at high risk for Secondary Traumatic Stress (STS), the stress syndrome resulting from helping others who are suffering. Positive psychological outcomes following this vicarious exposure are also likely. Vicarious posttraumatic growth (VPTG) refers to the positive changes from working with patients who themselves have coped with traumatic experiences. Objective(s): This study aims to examine STS and VPTG among 429 nurses during three lockdowns of the COVID-19 pandemic in Greece. Method(s):A repeated cross-sectional survey with a convenience and snowball sampling procedure was conducted. The Secondary Traumatic Stress Scale (STSS), the Post-Traumatic Growth Inventory (PTGI), the Brief Resilience Scale, and the Brief Cope (BC) were used to measure STS, VPTG, resilience, and coping strategies, respectively. Result(s): Nurses in Greece demonstrated high levels of STS at the first lockdown, significantly lower in the second one, which raised again -but not significantly- in the third lockdown. Resilience significantly decreased, whereas VPTG significantly increased across the three lockdowns. Following the escalation of the pandemic nurses in general used significantly more adaptive and less maladaptive coping strategies to deal with the crisis. Conclusion(s): Further research is needed to clarify the longitudinal course of the negative and positive psychological effects of the pandemic on healthcare staff. Conclusions can guide the development of interventions to safeguard nurses from the deleterious impacts of the COVID-19 and support them in their process of growth. (Figure Presented).

Psychological impact of COVID19 outbreak and coping strategies among Tunisian medical students

Introduction: The COVID19 pandemic came with unprecedented measures that impacted every aspect of the student's life making them vulnerable to psychological distress. Objective(s): The aim of this study was to assess anxiety and depressive symptoms in relation to the coping strategies during the COVID19 pandemic among medical students. Method(s): We conducted a web-based cross-sectional study among Tunisian medical students. We used an anonymous survey comprising sociodemographic characteristics, the Hospital Anxiety and Depression scale and the brief COPE. Result(s): A total of 216 students participated in the study;78% were female and most respondents were enrolled in first and second year of medical studies (53%). The frequency of depressive and anxiety symptoms were respectively 28% and 40%;females experienced significantly higher depression and anxiety scores (p<10-3 and p=0.02 respectively). Most used coping strategies were self-blame, planning, acceptance, distraction, positive reframing, active coping and religion (99%-96%). The least used coping strategies were substance use (13%) and denial (52%). We found that gender was associated with a significant difference in the coping styles where females scored higher on religious coping and denial whereas males used more humor coping. Depression and anxiety were significantly associated with denial coping. Humor, acceptance, positive reframing and active coping were significantly associated with lower depression rates. Humor coping and active coping were associated with lower anxiety rates. Conclusion(s): Our study shows alarming rates of depression and anxiety among Tunisian medical students during the COVID19 pandemic. A targeted intervention to promote mental health using the coping styles might be useful in this population.

Resilience And Coping: The Chicken and The Egg Paradox

Introduction: Since the outbreak of the 2019 coronavirus, healthcare workers found themselves on the front lines of an unprecedented battle. Being characterized by adversity, this experience represents a fertile ground for the study of resilience. Objective(s): Our study aims to clarify the phenomenon of resilience through its influence on perceived stress level and its connection with coping strategies. Method(s): A cross-sectional study was conducted involving 254 healthcare professionals in the region of Sousse during the pandemic. In addition to socio-demographic and professional characteristics, Resilience, perceived stress, and coping strategies were assessed using the Connor-Davidson Resilience Scale (CD-RISC), the PSS10 scale, and the Brief Cope questionnaire, respectively. Result(s): The overall mean [+/-standard deviation (SD)] age of the participants was 32.9 +/- 8.76 years with a sex ratio (M / F) of 0.51. The assessment of resilience among participants revealed a mean score of 64.99 +/- 14.72. The majority of participants evinced a score> 50 (82.68%) and 39.76% had a score >70. Our results revealed that, on the one hand, problem-focused coping strategies were positive predictors of resilience (p<10-3), accounting for 3.6% of its variance. On the other hand, coping strategies (problemfocused strategies and avoidance strategies) are also an integral part of the process by which resilience significantly influences the level of perceived stress (mediating factor). Conclusion(s): Despite its complexity, the relationship between resilience and coping strategies is undeniable and it is a part of an important line of intervention opening the way to better identifications and care.

PTSD symptoms and coping before and during COVID-19 pandemic among help-seeking veterans: prospective cohort study

Introduction: The COVID-19 pandemic has threatened the mental health of individuals around the world. Ex-combatants have been repeatedly shown to be increased risk of experiencing social and psychological problems during emergencies. Objective(s): To compare the severity of overall posttraumatic stress disorder (PTSD) symptoms and PTSD clusters among help-seeking veterans before and during the COVID-19 pandemic. The second aim was to identify coping strategies used and track possible changes during the timeline. Method(s): Male war veterans receiving outpatient treatment at the Referral Center for PTSD were assessed at baseline (t1=12-18 months before the COVID-19 pandemic), during the first lockdown (March-June 2020) and 12 months after the beginning of the COVID-19 pandemic (March-June 2021). A total of 132 veterans participated in all three measurements. The Life Events Checklist for DSM-5 (LEC-5), PTSD Checklist for DSM-5 (PCL-5), and The Brief COPE were used. Result(s): Exposure to COVID-19 pandemic related stressors increased over time. The great majority of participants (91.0%) followed the preventive measures. The severity of the overall PTSD symptoms significantly decreased during timeline (t1=56.9, 11.15;t2= 47.24, SD=12.87;t3= 44.1, SD=14.09). At t2, all participants still fulfilled the PTSD diagnostic criteria, and at t3, 23 participants (17.42%) did not meet all of the criteria for PTSD. The participants used adaptive coping rather than dysfunctional coping during the pandemic. Conclusion(s): Despite the expectations of worsening the symptoms, help-seeking veterans with PTSD appeared to develop adaptive adjustment to the COVID-19 pandemic stressors, which is in line with the results of the recent longitudinal research and will be discussed.

Perceived posttraumatic growth and its psychosocial predictors during two consecutive COVID-19 lockdowns

This study seeks to expand previous research by examining (a) the prevalence rates of posttraumatic growth (PTG) and its potential predictors (posttraumatic stress symptoms [PTSS], perceived stress, adaptive coping strategies, social support) during the first and second lockdown in the general population of Greece, and (b) the mediating role of the stress indicators (PTSS/perceived stress) in the relationship between positive reframing and PTG. A sample of 1,361 participants (1.009 in the first lockdown and 352 in the second lockdown) completed the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), The Perceived Stress Scale (PSS-10), the Posttraumatic Growth Inventory, the Brief Coping Orientation to Problems Experienced Inventory and the ENRICHD Social Support Instrument (ESSI). Moderate levels of PTG were found during both lockdowns. PTG did not significantly increase during the second lockdown. PTG was associated with PTSS during the first lockdown and with perceived stress during the second one;these two stress indicators partially mediated the positive reframing-PTG relationship in the first and second lockdown, respectively. Both adaptive and maladaptive coping strategies predicted PTG during the first lockdown, whereas only adaptive coping strategies predicted PTG during the second lockdown. Perceived social support, emotional during the first lockdown and instrumental during the second one, predicted PTG during the two lockdowns, respectively. The results of this study may enhance our understanding of PTG and its predictor to inform the design of interventions moving beyond growth cognitions into growth actions.