Association Between COVID-19 Pandemic and Serious Mental Illness: Systematic Review within Salutogenesis Model for Public Health Management

Background: The outbreak of the COVID-19 pandemic, the constant transformation of the SARS-COV-2 virus form, exposure to substantial psychosocial stress, environmental change, and isolation have led to the inference that the overall population's mental health could be affected, resulting in an increase in cases of psychosis. Objective(s): We initiated a systematic review to determine the impact of the SARS-COV-2 virus and its long-term effects-in both symptomatic and asymptomatic cases-on people with or without psychosis. We envisioned that this would give us an insight into effective clinical intervention methods for patients with psychosis during and after the pandemic. Method(s): We selected fifteen papers that met our inclusion criteria, i.e., those that considered participants with or without psychiatric illness and exposed to SARS-COV-2 infection, for this review and were retrieved via Google, Google Scholar, MEDLINE, PubMed, and PsychINFO Database. Key Gap: There is a dearth of research in understanding how COVID-19 affects people with or without a prior personal history of psychosis. Result(s): The systematic review summary provides insight into the state of knowledge. Insights from the systematic review have also been reviewed from the salutogenesis model's perspec-tive. There is moderate evidence of new-onset psychosis during the COVID-19 pandemic in which some antipsychotics treated the psychotic symptoms of patients while treating for COVID-19. Suggestions and recommendations are made for preventive and promotive public health strategies. Conclusion(s): The Salutogenesis model and Positive Psychology Interventions (PPI) provide another preventive and promotive public health management approach.Copyright © 2023 Bentham Science Publishers.

Stress and resilience in the workers of three health authorities of Emilia-Romagna during the COVID-19 pandemic

Aims: The aim of the present study was to study the prevalence of depression, anxiety, stress, and post-traumatic symptoms in Health-Care Workers (HCWs) of three Health Authorities of Emilia-Romagna, Italy during the COVID pandemic. Material(s) and Method(s): An online questionnaire was spread to the staff of the University Hospital of Modena and the Local Health Agencies of Modena and Romagna, including the Depression Anxiety Stress Scale (DASS-21), the Impact of Event Scale - Revised (IES-R), and the Utrecht Work Engagement Scale - Short Version (UWES-9). The scores at DASS-21 and IES-R were used as dependent variables in multivariate logistic regression models. Result(s): A total of 5868 HCWs were reached (response rate of 22.4%), 76.1% of which were women, mostly aged between 45 and 54 years. Rates of positive scores were: 27.9% DASS-21 Depression;28.4% DASS-21 Anxiety;34.7% DASS-21 Stress;21.9% IES-R. At the multivariate logistic regression, the following were statistically significant risk factors for positive scores: female sex, young age, and working at the front line. An increase in alcohol and tobacco consumption and worsening of eating habits were also strongly associated with symptoms. At UWES-9, the three samples reported lower vigor than dedication and absorption, which are at a medium-high level. Conclusion(s): HCWs have experienced high levels of emotional distress related to the COVID-19 pandemic. Significant improvements are needed not only in terms of organization and distribution of resources, but also in provision of dedicated psycho-social interventions.Copyright © 2023

Managing perceived distress to COVID-19 infection on post-COVID-19 condition

Aims: COVID-19 leaves diverse sequalae beyond the acute illness, referred to as 'long COVID'. However, the aetiology, characteristics and risk factors of Long-COVID is still lacking. COVID-19 patients experience various stressful events and suffer emotional distress which causes post-traumatic stress disorders. This study aimed to investigate association between of perceived distress to COVID-19 infection and long COVID. Method(s): Data from 56 patients who visited the psychiatric department of our post-COVID clinic between March and June 2022 were analysed. All patients completed a subjective symptom checklist [32 symptoms in eight categories], selected cognitive function tests [digit span test, trail making test (TMT), and Stroop word colour interference test], and validated neuropsychological scales [Hospital Anxiety and Depression Scale (HAS and HDS), Pittsburgh sleep quality index (PSQI) and Impact of event scale-revised (IES-R)]. We classified patients into two groups, 'High distress group'(N = 37) and 'Low distress group (N = 19) through IES-R score (cut-off = 25). The frequency and severity of long COVID-symptoms between the two groups were compared with Mann-whitney and chi-square test. Result(s): The average age of the patients was 53.34 years, and 70.53 days had passed from the SARS-CoV-2 confirmation using RTPCR. 'High distress group' showed higher HAS (284 vs. 455, p = .01), HDS (197 vs. 387, p = .032), and PSQI (238 vs. 428, p = .05) scores and suffered shortness of breath, palpitation, tingling, subjective memory deficit more frequently. Regarding neurocognitive functioning, there was no difference between two groups. Conclusion(s): Managing perceived distress due to COVID-19 could alleviate the long-covid sequalae especially in neuropsychiatric area.

Acute stress disorder and post traumatic stress disorder after ICU admission for acute respiratory failure due to COVID-19

Introduction: ICU survivors may present symptoms of acute stress disorder(ASD) or post traumatic stress disorder (PTSD) [1], as defined by the Diagnostic and Statistical Manual of Mental Disorders. Prevalence of PTSD in ARDS affects 20% of survivors but is higher in SARS/ MERS patients [2];risk factors are delirium, ICU sedation, altered memories or ICU amnesia [3]. Method(s): We enrolled patients discharged from our ICU (Pavia-Italy) after admission for acute respiratory failure due to COVID-19. Written consent was collected. Inclusion criteria: age >= 18 years, ICU admission between February 2020 and July 2021 for severe COVID-19, SARSCoV-2 infection confirmed by positive nasal swab/tracheal aspirate, available follow-up visit. Exclusion criteria: refuse to attend the follow up visit, refuse to perform the psychological tests. To assess ASD/ PTSD we used the IES-R: a total mean score >= 33 was the cut-off value for ASD/PTSD;subscale scores for avoidance, intrusion, hyperarousal were calculated. Quantitative and categorical variables are expressed as median [IQR] and number (%). Result(s): Of the 491 patients admitted to ICU, 113 patients were included (males 84(74.3%), age 61.0[52.0-66.0] years, BMI 28.2[25.8- 31.6] kg/m2, SAPS2 31.0[26.0-41.5], ICU stay 17.0[8.0-28.0] days, invasive mechanical ventilation 61(54.0%). They were assessed in median 107.0 [82.0-150.0] days after ICU discharge. 37 patients (32.7%) had ASD/PTSD, higher than the expected 20% in general ARDS population (p < 0.001). Both intrusion 11.0[5.0-17.0] and avoidance 7.0[3.0-13.0] median scores were higher than hyperarousal 5.0[2.0-9.0]. Conclusion(s): ASD/PTSD is frequent after discharge to ICU for severe COVID-19, this prevalence is higher than other ARDS population, maybe for stigma, difficulties with quarantine and isolation. Patients have higher intrusion and avoidance scores, maybe because during the pandemic isolation was unavoidable.

Physical Therapy Management of Postacute Sequelae of COVID-19 in Outpatient Settings: A Scoping Review

Purpose:The devasting effects of the coronavirus disease 2019 (COVID-19) pandemic have warranted the rapid development of evidence surrounding the physical therapy (PT) management of the disease within inpatient settings. However, the medical community is still working to define the long-term effects of COVID-19, referred to as Postacute Sequalae of SARS-CoV-2 (PASC), and ways for physical therapists to manage them in outpatient settings. The primary objective of this review was to summarize the available evidence related to the PT management of PASC in outpatient settings. Method(s):A systematic search in PubMed, Cumulative Index to Nursing and Allied Health Literature, Cochrane CENTRAL, Academic Search Complete, and MedLine yielded systematic and scoping reviews and randomized controlled trials, among others. Data extraction was performed independently by 2 reviewers with 8 studies included. Result(s):Only 3 publications were specific to the outpatient setting area, with 5 more studies that focused on outpatient practice as part of a multisetting study, or the postacute setting. Although the limited number and quality of publications creates challenges applying the interventions provided across a population, each were specific to PASC. Conclusion(s):This review supports the need for further research focused on the PT management of patients who are experiencing PASC in outpatient settings.Copyright © Cardiovascular and Pulmonary Section, APTA.

Psychological Impact Among Newly Diagnosed Covid-19 Positive Cases

Background: India was one of the worst affected countries during the second wave of COVID-19 infection. The pandemic brought in a multitude of psychological problems leading to a negative impact on the mental health of affected individuals. Several studies across the globe have assessed the psychological impact of this pandemic in general and vulnerable populations with a scanty data in the assessment of those found positive for this condition. Material(s) and Method(s): This was a cross-sectional, descriptive and observational study conducted at a tertiary health care centre involved in the management of COVID-19 cases. Cases were assessed using a semi structured proforma for socio demographic and clinical details, Impact of Events Scale Revised (IES-R) and Patient Health Questionnaire- 9 S6(PHQ-9) to assess psychological impact. Descriptive and inferential statistics were used for data analysis. Result(s): A total of 60 individuals participated in the study. The mean age of the participants was 50.8 +/- 14.10 years, with a majority of males (65%). More than half (53%) of the individuals had minimal severity on IES-R while about 9% showed moderate to severe levels. About 32% had minimal depression while 25% had moderately severe or severe depression on PHQ-9 score. A significant positive correlation was observed between number of deaths due to COVID-19 infection in the family and IES-R scores. Conclusion(s): Higher levels of stress and depression were found among those found positive for COVID-19. This highlights the need for early assessment of psychological problems and timely intervention to avoid long term psychiatric sequelae to those affected by COVID-19 infection.

Pims-Ts: The Psychological Needs of Families Admitted to Intensive Care

Background Paediatric Inflammatory Multisystem Syndrome (PIMS-TS) is a rare inflammatory condition affecting children and young people (CYP) weeks after infection with the COVID-19 virus. The aim of this study was to understand the potential psychological needs of these families. Methods PIMS-TS patients and their parents admitted to the hospital between April 2020 and May 2021 were reviewed by a psychologist 6-8 weeks post discharge as part of their clinical care. Young people over the age of 7 were asked to complete 2 measures for psychological distress and PTSD symptoms (CRIES-13 and PIED) and their parent/carer completed a measure of PTSD symptoms (IES-R). Ethical approval was not required for this study. Results 118 CYP and parents/carers who were admitted to GOSH were screened 6-8 weeks post discharge. 85 of the 118 CYP were aged 8 or over. 76.8% (n=91) of parents/carers completed the IES-R 78% (n=66) of CYPs completed the PIED and CRIES. 15% (n=10) of CYPs scores on the PIED suggested they were at risk of anxiety and depression. 24% (n=16) of CYPs reported clinically significant difficulties for PTSD on the CRIES-13 placing them in high probability of for a diagnosis of PTSD. 35% of parents/carers met the threshold for clinical concern on IES-R with 23% (n=21) scoring in the range for a likely diagnosis of PTSD. Discussion The findings of both the self-report screening questionnaires, indicate that significant number for CYP and their parent/carers are at risk of developing symptoms of psychological distress and trauma in 6-8 week period post discharge after PIMS-TS admission. Conclusion The result of this study clearly show identification of high levels of trauma and emotional distress for the CYP and their parents and carers and a potential need for ongoing psychological support to be provided as part of ongoing care.

Preliminary Efficacy of Remote, Brief Telepsychotherapy for Covid-19 Patients and Their First-Degree Relatives

Introduction: Over the last two years, the COVID-19 pandemic has negatively impacted the mental health of both COVID-19 patients and the general population. Adults with COVID-19 risked their lives, lost their loved ones, struggled with comorbid clinical conditions to manage, and have been unable to enjoy the physical presence of their families during the infection, quarantine, and lockdown periods. During hospitalization and discharge, family members often did not receive clinical updates from providers and patients, were unable to offer in-person assistance, and to receive psychological support. Incidence and prevalence of depression and anxiety among COVID- 19 older adults and their family members skyrocketed beyond the possibilities of any mental health system to address psychological aftermath of this pandemic and intervene with in-person services. In response to the urgent need for treatments that could be remotely delivered at a large scale, we designed DigiCOVID, a digital mental health approach that offered remote brief tele-psychotherapy to COVID-19 patients and/or their first-degree relatives. The main goal of this single arm, naturalistic study was to evaluate the feasibility, acceptability and usability of DigiCOVID. Additionally, we assessed the impact of DigiCOVID on psychopathology by means of self-report questionnaires. Method(s): Participants underwent an initial phonebased screening to of inclusion and exclusion criteria. Inclusion criteria were: 18-80 years old;positive nasopharyngeal swabs or serology to COVID-19 (for the patients' subgroup);absence of visual/ motor deficits that might interfere with study participation;good level of Italian;and adequate tech literacy. Participants were excluded if they had a previous or actual DSM-5 diagnosis of bipolar disorder, psychotic disorder, or substance use disorder;if they had a diagnosis of dementia;or if they presented suicidal ideation assessed through the Columbia Suicide Severity Rating Scale. Next, they completed a neuropsychological test over video to assess IQ (if lower than 70 participants were excluded), and filled out online gold-standard selfreports for depression (PHQ-9), anxiety (GAD-7), insomnia (ISI), post traumatic symptoms (IES-R) and general wellbeing (GHQ-12). Participants were then assigned to a psychotherapist who remotely conducted eight remote tele-psychotherapy sessions. After treatment, online questionnaires were filled out again to collect data on preliminary efficacy. Result(s): Since November 2021, 138 patients were recruited, 83 completed the intervention (57 patients, 26 fist-degree relatives), and 55 dropped out. At a group level, participants showed significant improvements on all clinical outcomes (PHQ-9: R2=0.12, p=.0019;ISI: R2=0.15, p=.0004;IES-R: R2=0.11, p=.0003;GHQ- 12: R2=0.23, p<.0001;GAD-7: R2=0.12, p=.0011). Given the high heterogeneity in illness severity and psychopathology, we conducted clustering on baseline data coming from the five online questionnaires: 55% of the whole sample had no psychopathology (Cluster 1), whereas 45% showed severe psychopathology (Cluster 2). When clustering was conducted on post-treatment data, three clusters emerged: no psychopathology, residual psychopathology and severe psychopathology. 71% of Cluster 1 participants remained asymptomatic;25% of Cluster 2 participants showed full symptom remission, while 48% and 28% of Cluster 2 participants showed partial symptom remission and no significant effect of treatment, respectively. Conclusion(s): Remote brief tele-psychotherapy for COVID-19 patients and their first-degree relatives is feasible and preliminary efficacious at reducing COVID-related psychopathology. Further research is needed to investigate distinct profiles of treatment response.

Effect of pulmonary rehabilitation on functional capacity and emotional status in patients with long COVID-19 syndrome: an interim analysis

Background: Patients suffering from long COVID-19 syndrome have reduced emotional status) and impaired functional capacity;the effect of pulmonary rehabilitation (PR) on emotional status and functional capacity remain inconclusive. Aim(s): To investigate the effect of a hybrid PR program on QoL, emotional status and functional capacity in patients with long COVID-19 syndrome. Method(s): 15 patients (age (mean+/-SD): 55+/-14 yrs.) with excessive fatigue due to COVID-19 syndrome (FACIT score (25+/-11) were allocated to PR (n=10) or usual care (UC) (n=5), 85+/-29 days following hospital discharge. PR consisted of 8 outpatient PR sessions (twice weekly for 4 weeks), and 24 home-based PR sessions (3 times/week for 8 weeks). Patients in the UC declined PR and instructed to be physically active. Psychological status was assessed via HADS and Impact Event Scale-Revised (IES-R). Functional capacity was assessed via SPPB, 6MWD, and steps/day. Result(s): Data are presented in table 1. Conclusion(s): PR improves QoL and functional capacity in patients with long COVID-19 syndrome. (Table Presented).

Psychological Impact of Covid-19 Pandemic in Cancer Patients at the Institute of Salah Azaiz

Introduction: The current Coronavirus disease (COVID-19) pandemic is a highly stressful event that may lead to significant psychological problems, particularly among cancer patients who are immunocompromised, thus at higher risk of contracting COVID-19. The aim of this study was to measure the level of post-traumatic stress disorder (PTSD), anxiety and depression in cancer patients during the COVID-19 pandemic. Material(s) and Method(s): Prospective and descriptive study was conducted at the medical oncology department of the Salah Azaiz institute during five months, from April to August 2021. The data collection was done via two questionnaires, one assessed the Event Scale-Revised (IES-R) and the other assessed the Hospital Anxiety and Depression Scale (HADS). Each patient was requested about this COVID-19 psychological impact during the last week. The IES-R is a questionnaire measuring a person's subjective reaction after a traumatic event. The HADS is a questionnaire investigating anxiety and depression. Results and discussion: A total of 147 patients was included. The mean age was 46,8 +/- 14,4 years, ranging from 18 to 77 years. The male/female sex ratio was equal to 1,2. The mean IES-R total score was 20,4615,4, ranging from 0 to 68. Themean IES-R intrusion was 7,966,4, ranging from 0 to 26. Themean IES-R avoidance was 866,9, ranging from 0 to 30. Themean IESR hyperarousal was 4,564,5, ranging from 0 to 20. 66%of patients had no diagnosis of PTSD, 15% of them had PTSD mild, 4,1% of them had PTSD moderate and 15% of them had PTSD severe. The mean HADS-General score was 14,6 +/- 8,2, ranging from 0 to 39. The mean HADS-Anxiety was 8,164,6, ranging from 0 to 21. Anxiety symptoms were normal in 49,7%of patients, borderline abnormal in 17,7% of them and abnormal in 32,7% of them. The mean HADS-Depression was 6,4 +/- 4,2, ranging from 0 to 21. Depression symptoms were normal in 63,9% of patients, borderline abnormal in 20,4% of them and abnormal in 15,6% of them. Conclusion(s): This study revealed high rates of distress, anxiety and depression in cancer patients during the pandemic.These results contributed to a better understanding of the psychological consequences of a global pandemic in the context of cancer and they highlighted the need to better support this vulnerable population during such a challenging time.

Impact of COVID-19 Pandemic on Mental Health among Industrial Workers- A Post-Traumatic Stress Disorder Study

Background: Post Traumatic stress disorder usually occurs after a traumatic event and the pa the COVID-19 pandemic has affected the mental health to a great extent. So this study was taken up to assess the risk of Post-traumatic stress disorder symptoms using impact of event scale-revised (IES-R), their main stressors and coping measurements among the industrial workers of Hyderabad. Material(s) and Method(s): A telephonic interview schedule was adopted to fill the online questionnaire among Industrial workers of age group 20- 55 years during the lock down period. Result(s): Depicted 20.6% at risk of post-traumatic stress disorder symptoms and 13.8% at risk of suppressed immune system functioning which is presumed to have its effect for the next 10 years. The main stressors of COVID -19 with increased IES-R score were-not staying with family members, Any acquaintance with COVID-19 infected persons and effect on daily life. Coping measurements with brief resilient coping scale found 17.4% as low resilient copers. Conclusion(s): This needs to be addressed earlier to bring up preventive strategies to improve the quality of life by including counselling services in the occupational health care centers of our industries.

Impact of Covid-19 on mental health of healthcare professionals working in Covid-19 designated clinical areas in SDMCMSH-Dharwad

INTRODUCTION Healthcare workers (HCWs), at the heart of the unparalleled crisis of COVID-19, face challenges treating patients with COVID-19 . The psychological burden and overall wellness of HCWs has received heightened awareness showing high rates of burnout, psychological stress, and suicide. HCWs experience emotional exhaustion, which may lead to medical errors, lack of empathy in treating patients, lower productivity, and higher turnover rates. AIM To determine the impact of COVID-19 on HCWs including (Consultants, Postgraduate students-both medical and naturopathy, Interns and Nursing staff) and to identify the potential risk factors . METHOD A web based cross-sectional study done in SDM, Dharwad was done among 50 participants to identify the main mental health outcomes that include Depression, Anxiety, Insomnia and Distress using Patient health questionnaire (PHQ-9), Generalized anxiety disorder (GAD-7) scale , Insomnia severity index and The impact of event scale-revised. RESULT Out of 50 participants , 38(76%) were in age group of 26-30 years,31 (62%) were females and 28(56%) were Post graduates,10 (20%) Interns and 10(24%) Nursing staff. This study found that mod-severe GAD was seen in 6 % participants,2 % had high PTSD & mod-severe Depression was seen in 3 (6%) & 1(2%) had mod Insomnia CONCLUSION It is thus very important to assess the prevalence of psychological manifestations in the HCWs and help them to adequately cope with stressors to function adequately.

Gender differences in symptoms and psychological burden in Long Covid patients: results of a comprehensive multidimensional assessment protocol

Aim: To assess impairment in health status and psychological burden, subjects with Long Covid enrolled in a multidisciplinary follow-up outpatient programme underwent a multidimensional psychological assessment including Zung's Self-rating Anxiety Scale (SAS), Impact of Event Scale-Revised (IES-R), Beck Depression Inventory-II (BDIII), Functional Assessment of Chronic Illness Therapy, Fatigue subscale (FACIT-F), 12-Item Short-Form Health Survey (SF-12). Result(s): Ninety-nine subjects (36M;age 52.6+/-14.5) participated to a self-administered multidimensional psychological evaluation from january2021 to january 2022 (5.5+/-4.4 months after acute infection). Sixty-one out of 99 (61.6%) subjects (20M, age 48.7+/-14.5y) were treated at home during acute SARS-CoV-2 infection. Thirtyfive patients (35.4%) had symptoms of post-traumatic stress disorder (PTSD), 21 patients (21.2%) had moderate to severe depressive symptoms, 47 (47.4%) exhibited clinically significative anxiety. No significant differences in symptoms and psychological evaluation were found in home treated, compared with the subgroup of 38 (38.3%) hospitalized subjects (16M, age59.0+/-13.0y). Irrespective of hospitalization, persistent asthenia was reported in 34 out of 63 females (54.0%), and in 11 males (30.6%) (p=.005);Clinically significant anxiety was found in 37(58.7%) females and in 7(19.4%) males (p=.001). Gender associated significant differences were found as well in FACIT-F, SAS, SF-12, but not in BDI-II and IES-R scores. Conclusion(s): Among a cohort of long covid subjects, gender differences were observed in symptoms reported and in psychological well-being.

Post-traumatic stress disorder, suicide risk, feeling of loneliness and life satisfaction in the general population during the COVID-19 pandemic.

Introduction: The outbreak of the COVID-19 pandemic is an extremely uncommon global epidemic crisis. The study aimed to identify changes in the severity of PTSD symptoms, suicide risk, loneliness and subjective life satisfaction level in the general population, regarding the gender differences, during the first two waves of the COVID-19 pandemic. Material(s) and Method(s): The study group included 303 general population subjects aged 16-84 (50.2% females and 49.8% males). The research was conducted in two phases. The first stage included 150 subjects, the second 153. The following diagnostic tools were used: Impact of Event Scale (IES-R), the De Jong Gierveld Loneliness Scale (DJGLS), Suicide Behavior Questionnaire-Revised (SBQ-R), the Cantril Self-Anchoring Striving Scale (CSASS) and the demographic-descriptive questionnaire. The study was conducted via the Internet. Result(s): In both waves of the COVID-19 pandemic, there was a positive correlation between the feeling of loneliness and the suicide risk, as well as the general level and symptoms intensity of PTSD (intrusion and agitation). In women we observed an increased PTSD level and higher level of intrusion and avoidance symptoms. Having children was a suicide protective factor in women in both waves of the pandemic, and only during the second wave in men. The difference in the declared life satisfaction in both waves was significantly higher in the second study phase only in terms a life satisfaction before the pandemic. Conclusion(s): It is a mental health prevention priority to implement proper crisis interventions and long-term risk assessments in terms of people exposed to the COVID-19 virus and those in social isolation.Copyright © 2022 Via Medica. All rights reserved.

The Impact of Event Scale-Revised: Examining Its Cutoff Scores among Arab Psychiatric Patients and Healthy Adults within the Context of COVID-19 as a Collective Traumatic Event.

The Impact of Event Scale-Revised (IES-R) is the most popular measure of post-traumatic stress disorder (PTSD). It has been recently validated in Arabic. This instrumental study aimed to determine optimal cutoff scores of the IES-R and its determined six subscales in Arab samples of psychiatric patients (N = 168, 70.8% females) and healthy adults (N = 992, 62.7% females) from Saudi Arabia during the COVID-19 pandemic as a probable ongoing collective traumatic event. Based on a cutoff score of 14 of the Depression Anxiety Stress Scale 8-items (DASS-8), receiver operator curve (ROC) analysis revealed two optimal points of 39.5 and 30.5 for the IES-R in the samples (area under the curve (AUC) = 0.86 & 0.91, p values = 0.001, 95% CI: 0.80-0.92 & 0.87-0.94, sensitivity = 0.85 & 0.87, specificity = 0.73 & 0.83, Youden index = 0.58 & 0.70, respectively). Different cutoffs were detected for the six subscales of the IES-R, with numbing and avoidance expressing the lowest predictivity for distress. Meanwhile, hyperarousal followed by pandemic-related irritability expressed a stronger predictive capacity for distress than all subscales in both samples. In path analysis, pandemic-related irritability/dysphoric mood evolved as a direct and indirect effect of key PTSD symptoms (intrusion, hyperarousal, and numbing). The irritability dimension of the IES-R directly predicted the traumatic symptoms of sleep disturbance in both samples while sleep disturbance did not predict irritability. The findings suggest the usefulness of the IES-R at a score of 30.5 for detecting adults prone to trauma related distress, with higher scores needed for screening in psychiatric patients. Various PTSD symptoms may induce dysphoric mood, which represents a considerable burden that may induce circadian misalignment and more noxious psychiatric problems/co-morbidities (e.g., sleep disturbance) in both healthy and diseased groups.

Mental health risk factors during the COVID-19 pandemic in the Polish population

Introduction: The level of post-traumatic stress symptoms (PTSS) associated with the early stages of the COVID-19 outbreak, stress, anxiety, and depressive symptoms was assessed. Risk factors for mental health in the Polish population have been identified. Material and methods: Nine hundred and twenty-six respondents completed a set of questionnaires consisting of questions concerning COVID-19, PTSS related to the COVID-19 outbreak (Impact of Event Scale-Revised, IES-R), and their mental health status (Depression, Anxiety and Stress Scale, DASS-21). Results: Most respondents reported severe PTSS related to the COVID-19 outbreak (44.06%), the normal intensity of depressive symptoms (52.38%), anxiety symptoms (56.05%), and stress (56.48%). Almost 20% of Polish respondents were characterized by a severe or extremely severe level of stress, anxiety, or depressive symptoms. Every seventh respondent reported an extremely severe level of depressive symptoms. Female gender, parental status, having a relationship, at least a two-person household were associated with higher PTSS or DASS-21 subscales. A few physical symptoms, a medical visit, quarantine, negative health evaluation, chronic diseases, knowledge about the increase in the number of infected people or deaths were associated with higher levels of PTSS. Some of the precautions and the need for additional information on COVID-19, the certainty of a high COVID-19 contracting probability or of a low survival rate, and concerns about the loved ones were associated with higher PTSS. Conclusions: The indicated risk factors can be used for developing psychological interventions to improve mental health. It is necessary to conduct qualitative research on the psychological reasons for the occurrence of mental symptoms during the pandemic.

Quality of Life in COVID-Related ARDS Patients One Year after Intensive Care Discharge (Odissea Study): A Multicenter Observational Study.

BACKGROUND: Investigating the health-related quality of life (HRQoL) after intensive care unit (ICU) discharge is necessary to identify possible modifiable risk factors. The primary aim of this study was to investigate the HRQoL in COVID-19 critically ill patients one year after ICU discharge. METHODS: In this multicenter prospective observational study, COVID-19 patients admitted to nine ICUs from 1 March 2020 to 28 February 2021 in Italy were enrolled. One year after ICU discharge, patients were required to fill in short-form health survey 36 (SF-36) and impact of event-revised (IES-R) questionnaire. A multivariate linear or logistic regression analysis to search for factors associated with a lower HRQoL and post-traumatic stress disorded (PTSD) were carried out, respectively. RESULTS: Among 1003 patients screened, 343 (median age 63 years [57-70]) were enrolled. Mechanical ventilation lasted for a median of 10 days [2-20]. Physical functioning (PF 85 [60-95]), physical role (PR 75 [0-100]), emotional role (RE 100 [33-100]), bodily pain (BP 77.5 [45-100]), social functioning (SF 75 [50-100]), general health (GH 55 [35-72]), vitality (VT 55 [40-70]), mental health (MH 68 [52-84]) and health change (HC 50 [25-75]) describe the SF-36 items. A median physical component summary (PCS) and mental component summary (MCS) scores were 45.9 (36.5-53.5) and 51.7 (48.8-54.3), respectively, considering 50 as the normal value of the healthy general population. In all, 109 patients (31.8%) tested positive for post-traumatic stress disorder, also reporting a significantly worse HRQoL in all SF-36 domains. The female gender, history of cardiovascular disease, liver disease and length of hospital stay negatively affected the HRQoL. Weight at follow-up was a risk factor for PTSD (OR 1.02, p = 0.03). CONCLUSIONS: The HRQoL in COVID-19 ARDS (C-ARDS) patients was reduced regarding the PCS, while the median MCS value was slightly above normal. Some risk factors for a lower HRQoL have been identified, the presence of PTSD is one of them. Further research is warranted to better identify the possible factors affecting the HRQoL in C-ARDS.

Rasch Modeling and Multilevel Confirmatory Factor Analysis for the Usability of the Impact of Event Scale-Revised (IES-R) during the COVID-19 Pandemic.

BACKGROUND: Several instruments are currently used to assess Coronavirus Disease 2019 (COVID-19) -induced psychological distress, including the 22-item Impact of Event Scale-Revised (IES-R). The IES-R is a self-administered scale used to assess post-traumatic stress disorder (PTSD). The current study aimed to examine the construct validity of the IES-R, based on the Rasch model, with COVID-19-related data, as well as to test the multilevel construct validity of the IES-R within and among countries during the pandemic crisis. METHODS: A multi-country web-based cross-sectional survey was conducted utilizing the 22-item IES-R. A total of 1020 participants enrolled in our survey, of whom 999 were included in the analyses. Data were analyzed using Rasch modeling and multilevel confirmatory factor analysis (MCFA). RESULTS: The Rasch modeling results of the IES-R demonstrated that the IES-R is a satisfactory instrument with the five-point Likert scale, asserting that its 22 items are significant contributors to assessing PTSD as a unidimensional construct covered by the items of the IES-R. The MCFA confirmed that the 22-item IES-R, with its three factors, including intrusion, avoidance, and hyperarousal, demonstrates adequate construct validity at the within- and among-country levels. However, the results of the Akaike information criterion (AIC) model determined that the 16-item IES-R is better than the 22-item IES-R. CONCLUSION: The results suggested that the 22-item IES-R is a reliable screening instrument for measuring PTSD related to the COVID-19 pandemic, and can be utilized to provide timely psychological health support, when needed, based on the screening results.

The Arabic Version of the Impact of Event Scale-Revised: Psychometric Evaluation among Psychiatric Patients and the General Public within the Context of COVID-19 Outbreak and Quarantine as Collective Traumatic Events.

The Coronavirus Disease-19 (COVID-19) pandemic has provoked the development of negative emotions in almost all societies since it first broke out in late 2019. The Impact of Event Scale-Revised (IES-R) is widely used to capture emotions, thoughts, and behaviors evoked by traumatic events, including COVID-19 as a collective and persistent traumatic event. However, there is less agreement on the structure of the IES-R, signifying a need for further investigation. This study aimed to evaluate the psychometric properties of the Arabic version of the IES-R among individuals in Saudi quarantine settings, psychiatric patients, and the general public during the COVID-19 outbreak. Exploratory factor analysis revealed that the items of the IES-R present five factors with eigenvalues > 1. Examination of several competing models through confirmatory factor analysis resulted in a best fit for a six-factor structure, which comprises avoidance, intrusion, numbing, hyperarousal, sleep problems, and irritability/dysphoria. Multigroup analysis supported the configural, metric, and scalar invariance of this model across groups of gender, age, and marital status. The IES-R significantly correlated with the Depression Anxiety Stress Scale-8, perceived health status, and perceived vulnerability to COVID-19, denoting good criterion validity. HTMT ratios of all the subscales were below 0.85, denoting good discriminant validity. The values of coefficient alpha in the three samples ranged between 0.90 and 0.93. In path analysis, correlated intrusion and hyperarousal had direct positive effects on avoidance, numbing, sleep, and irritability. Numbing and irritability mediated the indirect effects of intrusion and hyperarousal on sleep and avoidance. This result signifies that cognitive activation is the main factor driving the dynamics underlying the behavioral, emotional, and sleep symptoms of collective COVID-19 trauma. The findings support the robust validity of the Arabic IES-R, indicating it as a sound measure that can be applied to a wide range of traumatic experiences.

Psychological Distress and Signs of Post-Traumatic Stress in Response to the COVID-19 Health Emergency in a Mexican Sample.

OBJECTIVE: This study aimed to evaluate the psychological impacts of COVID-19 prevention measures, such as social isolation, on a Mexican sample. METHODS: We conducted an online sociodemographic and Impact of Event Scale-Revised (IES-R) survey during the second phase of the COVID-19 outbreak in Mexico to evaluate the presence of psychological distress, signs of post-traumatic stress, and to identify the groups at highest risk in the sample. RESULTS: Prevalence of psychological distress at moderate or severe levels in the sample were as follows: 943 (22%) intrusive thoughts, 933 (22.3%) avoidance, and 515 (12.2%) hyperarousal. Furthermore, we found the symptoms of clinically significant post-traumatic stress in 1160 (27.7%) of the participants. The variables positively correlated with higher psychological distress were as follows: age (younger), sex (female), employment (employed), relationship status (single), in social isolation, number of days in isolation, the number of people in the household (3-5), and a perception of a high risk of contracting COVID-19, change in routine, engaging in less activity, and loss of income. CONCLUSION: During phase 2 of the COVID-19 outbreak in Mexico, we observed the presence of psychological distress and post-traumatic stress symptoms in over a quarter of the population. This investigation may guide mental health interventions and policies towards the groups that are most vulnerable to the impacts of the social and lifestyle changes taking place in Mexico due to COVID-19.