Prioritizing Multidimensional Interdependent Factors Influencing COVID-19 Risk.

COVID-19 has significantly affected various industries and domains worldwide. Since such pandemics are considered as rare events, risks associated with pandemics are generally managed through reactive approaches, which involve seeking more information about the severity of the pandemic over time and adopting suitable strategies accordingly. However, policy-makers at a national level must devise proactive strategies to minimize the harmful impacts of such pandemics. In this article, we use a country-level data-set related to humanitarian crises and disasters to explore critical factors influencing COVID-19 related hazard and exposure, vulnerability, lack of coping capacity, and the overall risk for individual countries. The main contribution is to establish the relative importance of multidimensional factors associated with COVID-19 risk in a probabilistic network setting. This study provides unique insights to policy-makers regarding the identification of critical factors influencing COVID-19 risk and their relative importance in a network setting.

Chain Mediation Model of Perceived Stress, Resilience, and Social Support on Coping Styles of Chinese Patients on Hemodialysis During COVID-19 Pandemic Lockdown.

BACKGROUND The recurrence of COVID-19 and the continuous escalation of prevention and control policies can lead to an increase in mental health problems. This study aimed to investigate the perceived stress, coping style, resilience, and social support among patients on maintenance hemodialysis (MHD) during the COVID-19 epidemic lockdown in China. MATERIAL AND METHODS This cross-sectional observational study enrolled 197 patients on MHD from the Guangdong Province Traditional Chinese Medical Hospital and the Hedong Hospital of Guangzhou Liwan District People's Hospital during July 2021. AMOS 24.0 and PROCESS Macro 3.1 model 6 were used for analyses of moderating mediating effects. RESULTS Perceived stress was negatively correlated with positive coping style (r=-0.305, P<0.001) and resilience (r=-0.258, P<0.001), whereas resilience (r=0.631, P<0.001) and social support (r=0.300, P<0.001) were positively correlated with positive coping style among patients on MHD. In the moderated mediating model, perceived stress had significant direct predictive effects on positive coping style (95% CI -0.33, -0.07), and perceived stress had significant indirect predictive effects on positive coping styles through resilience (95% CI -0.26, -0.06) or social support (95% CI 0.01, 0.06). Perceived stress had significant indirect predictive effects on positive coping style through both resilience and social support (95% CI -0.04, -0.01). CONCLUSIONS Perceived stress not only predicted coping style directly, but also indirectly predicted coping style through resilience and social support. Coping style was affected by internal and external factors during the COVID-19 pandemic lockdown period.

Coping With Stress: The Mitokine GDF-15 as a Biomarker of COVID-19 Severity.

Growth differentiation factor 15 (GDF-15) is a transforming growth factor (TGF)-ß superfamily cytokine that plays a central role in metabolism regulation. Produced in response to mitochondrial stress, tissue damage or hypoxia, this cytokine has emerged as one of the strongest predictors of disease severity during inflammatory conditions, cancers and infections. Reports suggest that GDF-15 plays a tissue protective role via sympathetic and metabolic adaptation in the context of mitochondrial damage, although the exact mechanisms involved remain uncertain. In this review, we discuss the emergence of GDF-15 as a distinctive marker of viral infection severity, especially in the context of COVID-19. We will critically review the role of GDF-15 as an inflammation-induced mediator of disease tolerance, through metabolic and immune reprogramming. Finally, we discuss potential mechanisms of GDF-15 elevation during COVID-19 cytokine storm and its limitations. Altogether, this cytokine seems to be involved in disease tolerance to viral infections including SARS-CoV-2, paving the way for novel therapeutic interventions.

Surviving SARS and living through COVID-19: Healthcare worker mental health outcomes and insights for coping.

OBJECTIVE: Explore how previous work during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak affects the psychological response of clinical and non-clinical healthcare workers (HCWs) to the current COVID-19 pandemic. METHODS: A cross-sectional, multi-centered hospital online survey of HCWs in the Greater Toronto Area, Canada. Mental health outcomes of HCWs who worked during the COVID-19 pandemic and the SARS outbreak were assessed using Impact of Events-Revised scale (IES-R), Generalized Anxiety Disorder scale (GAD-7), and Patient Health Questionnaire (PHQ-9). RESULTS: Among 3852 participants, moderate/severe scores for symptoms of post- traumatic stress disorder (PTSD) (50.2%), anxiety (24.6%), and depression (31.5%) were observed among HCWs. Work during the 2003 SARS outbreak was reported by 1116 respondents (29.1%), who had lower scores for symptoms of PTSD (P = .002), anxiety (P < .001), and depression (P < .001) compared to those who had not worked during the SARS outbreak. Multivariable logistic regression analysis showed non-clinical HCWs during this pandemic were at higher risk of anxiety (OR, 1.68; 95% CI, 1.19-2.15, P = .01) and depressive symptoms (OR, 2.03; 95% CI, 1.34-3.07, P < .001). HCWs using sedatives (OR, 2.55; 95% CI, 1.61-4.03, P < .001), those who cared for only 2-5 patients with COVID-19 (OR, 1.59; 95% CI, 1.06-2.38, P = .01), and those who had been in isolation for COVID-19 (OR, 1.36; 95% CI, 0.96-1.93, P = .05), were at higher risk of moderate/severe symptoms of PTSD. In addition, deterioration in sleep was associated with symptoms of PTSD (OR, 4.68, 95% CI, 3.74-6.30, P < .001), anxiety (OR, 3.09, 95% CI, 2.11-4.53, P < .001), and depression (OR 5.07, 95% CI, 3.48-7.39, P < .001). CONCLUSION: Psychological distress was observed in both clinical and non-clinical HCWs, with no impact from previous SARS work experience. As the pandemic continues, increasing psychological and team support may decrease the mental health impacts.

Risk perception and coping response to COVID-19 mediated by positive and negative emotions: A study on Chinese college students.

This study aimed to assess the mediating roles of positive and negative emotions on the relationship between COVID-19-related risk perception and coping behaviours adopted by Chinese college students in response to the COVID-19 pandemic. We conducted an internet-based questionnaire survey from mid February-late October 2020, among 1038 college students, from six Chinese universities (females = 73.41%), ranging within 17-26 years. The survey questionnaire included three major components-the COVID-19-Related Risk Perception Scale (CRPS), the Positive and Negative Affect Scale (PANAS-Revision), and Coping Response of COVID-19 Scale (CRCS). Descriptive statistics and a mediated model were used to analyse the collected data. A partial mediation relationship was found between COVID-19-related risk perception and 1) active-response behaviour (ß = 0.05, 95% Confidence Interval [CI: 0.03, 0.08]), 2) self-protection behaviour through positive emotions (ß = 0.03, CI [0.01, 0.04]), and 3) risk-taking behaviour through negative emotions (ß = -0.04, CI [-0.07, -0.02]). This study's double-mediation model has been shown to detect the effect coping mechanisms to COVID-19. Furthermore, it implies that public health managers should consider the differences in coping mechanisms and the diverse mediating roles of positive and negative emotions for coping with public health emergencies.

COVID-19 pandemic related excessive electronic media exposure and mental health in Saudi Arabia.

OBJECTIVE: Due to the continued spread of COVID-19 and the emergence of novel mutated viral variants, families all over the world are experiencing wide-ranging stressors that threaten not only their financial well-being but also their physical and mental health. The present study assessed the association between excessive electronic media exposure of pandemic-related news and mental health of the residents of Ha'il Province, Saudi Arabia. The present study also assessed the prevalence of perceived stress, fear of COVID-19, anxiety, depression, and loneliness due to COVID-19-related restrictions in the same population. MATERIALS AND METHODS: A total of 490 residents of Ha'il Province participated in a cross-sectional online survey during a two-month period (March to April 2021). A validated 38-item self-report survey was used to collect the data. RESULTS: Significant associations were reported between excessive electronic media exposure and the prevalence of perceived stress (χ2=140.56; p<.001), generalized anxiety (χ2=74.55; p<.001), depression (χ2=71.58; p<.001), COVID-19-related fear (χ2=24.54; p<.001), and loneliness (χ2=11.46; p<.001). It was also found that participants without depressive symptoms were 0.28 times less likely to have been exposed to excessive electronic media exposure (AOR: 0.28; C.I. 0.16-0.48; p<.001). Similarly, participants with no stress/mild stress were 0.32 times less likely to have been exposed to excessive electronic media exposure (AOR: 0.32; C.I. 0.19-0.52; p<.001). CONCLUSIONS: The findings of the present study suggest an urgent need for educational resilience programs (online and in-person) for susceptible individuals (females, unemployed, urban residents, etc.). Such programs would help them to develop skills to cope with the psychological impact of the COVID-19 pandemic.

Teachers' mental health during the first two waves of the COVID-19 pandemic in Poland.

BACKGROUND: Teaching work is stressful, moreover during the pandemic teachers' stress might have been intensified by distance education as well as by limited access to social support, which functions as a buffer in experiencing stress. The aim of the research was to investigate the relation between distance education and teachers' well-being, and their close relations and other social relations during the first two waves of the COVID-19 pandemic. METHODS: The research was conducted in two stages on 285 Polish primary and secondary school teachers who were recruited by means of the chain referral method. The following measures were used: The Depression Anxiety & Stress Scales-21, Berlin Social Support Scales, The Relationship Satisfaction Scale and The Injustice Experience Questionnaire. RESULTS: The teachers experienced at least mild levels of stress, anxiety and depression, both during the first as well as the second waves of the COVID-19 pandemic in Poland. It has been confirmed that there is a negative relation between relationship quality change and social relations quality change, and stress, anxiety and depression. The variables taken into consideration in the research have provided the explanation for the variation of stress-from 6% in the first stage of the research to 47% in the second stage; for the variation of anxiety-from 21% to 31%; and for the variation of depression-from 12% to 46%, respectively. CONCLUSIONS: The research results show that due to distance work the distinction between professional work and family life might have been blurred, and as a consequence teachers' well-being could have been worsened. The isolation put on to stop the spreading of the virus might have contributed to changes in social relations, in close relations in particular, and at the same time negatively influenced teachers' abilities to effectively cope with the crisis situations.

COVID-19 related posttraumatic stress disorder in children and adolescents in Saudi Arabia.

INTRODUCTION: The COVID-19 pandemic resulted in quarantine/lockdown measures in most countries. Quarantine may create intense psychological problems including post-traumatic stress disorder (PTSD) especially for the vulnerable critically developing children/adolescents. Few studies evaluated PTSD associated with infectious disasters but no Saudi study investigated PTSD associated with COVID-19 in children/adolescents. This study was undertaken to screen for PTSD in children/adolescent in Saudi Arabia to identify its prevalence/risk factors during COVID-19 pandemic and its quarantine. METHODS: A cross-sectional survey was conducted after 2 months form start of quarantine for COVID-19 pandemic utilizing the original English version and an Arabic translated version for the University of California at Los Angeles Brief COVID-19 Screen for Child/Adolescent PTSD that can be parent-reported or self-completed by older children/adolescents. Participants (Saudi citizens/non-Saudi residents) were approached online via social media. RESULTS: Five hundred and thirty seven participants were enrolled. The participants were 262 boys and 275 girls with a mean age of 12.25±3.77 years. Symptoms of no, minimal, mild and potential PTSD were identified in 15.5%, 44.1%, 27.4% and 13.0% of children/adolescents, respectively. The age, gender, school grade, and residence were not predictive of PTSD symptoms. Univariate analysis of risk factors for PTSD revealed that work of a close relative around people who might be infected was significantly different between groups of PTSD symptoms, but this difference disappeared during multivariate analysis. Children/adolescents of Saudi citizens had significantly lower median total PTSD score than children/adolescents of expatriate families (p = 0.002). CONCLUSION: PTSD associated with the COVID-19 and its resultant quarantine shouldn't be overlooked in different populations as it is expected in a considerable proportion of children/adolescents with variable prevalence, risk factors and severity. Parents/healthcare providers must be aware of PTSD associated with COVID-19 or similar disasters, so, they can provide children/adolescent with effective coping mechanisms.

To comply or not comply? A latent profile analysis of behaviours and attitudes during the COVID-19 pandemic.

How and why do people comply with protective behaviours during COVID-19? The emerging literature employs a variable-centered approach, typically using a narrow selection of constructs within a study. This study is the first to adopt a person-centred approach to identify complex patterns of compliance, and holistically examine underlying psychological differences, integrating multiple psychology paradigms and epidemiology. 1575 participants from Australia, US, UK, and Canada indicated their behaviours, attitudes, personality, cognitive/decision-making ability, resilience, adaptability, coping, political and cultural factors, and information consumption during the pandemic's first wave. Using Latent Profile Analysis, two broad groups were identified. The compliant group (90%) reported greater worries, and perceived protective measures as effective, whilst the non-compliant group (about 10%) perceived them as problematic. The non-compliant group were lower on agreeableness and cultural tightness-looseness, but more extraverted, and reactant. They utilised more maladaptive coping strategies, checked/trusted the news less, and used official sources less. Females showed greater compliance than males. By promoting greater appreciation of the complexity of behaviour during COVID-19, this research provides a critical platform to inform future studies, public health policy, and targeted behaviour change interventions during pandemics. The results also challenge age-related stereotypes and assumptions.

Psychological adjustment of Spanish adolescents and their parents during COVID-19 lockdown: A mixed method approach.

Previous literature on the psychological impact of COVID-19 has shown a direct relationship between family conflicts and psychological distress among parents and their children during the domestic lockdown and social isolation; but there are also opportunities to enhance family bonding, encourage collective problem-solving and improve personal relationships. This study aimed to explore psychological adjustment processes of Spanish adolescents and their parents during the first month of lockdown by analyzing their narratives, perceived outcomes, protection and risk factors. A total of 142 people agreed to participate in this study. Of all participants, 61 were adolescents (M = 13.57; SD = 1.74; 57% women) and 81 were parents (M = 46.09; SD = 4.72; 91% mothers). All were Spanish residents and completed an online survey during the domestic lockdown in March 2020. From a qualitative design, methodology followed a mixed approach to analyze data. The results showed three different types of adaptation to lockdown and social isolation in both adolescents and their parents: 1) positive adjustment, 2) moderate adjustment, and 3) maladjustment. Most participants reported a good adjustment and only a 20% of parents and a 16% of adolescents stated that they had not been able to achieve a positive psychological adjustment. There are few significant quantitative differences between adolescents and their parents. The qualitative analysis of data showed that adolescents reported less psychological distress than their parents. The two most important protective factors were social support and keeping busy during lockdown. The most significant risk factors were loss of mobility and social isolation. The conclusions stressed that regarding psychological maladjustment, parents experienced feelings of uncertainty whereas adolescents experienced a kind of mourning process. These findings can be used to design and implement effective intervention measures for mental health and psychological well-being in such a difficult situation as domestic lockdown.

Persistent behavioral and neurobiological consequences of social isolation during adolescence.

Meaningful social interactions are a fundamental human need, the lack of which can pose serious risks to an individual's physical and mental health. Across species, peer-oriented social behaviors are dramatically reshaped during adolescence, a developmental period characterized by dynamic changes in brain structure and function as individuals transition into adulthood. Thus, the experience of social isolation during this critical developmental stage may be especially pernicious, as it could permanently derail typical neurobiological processes that are necessary for establishing adaptive adult behaviors. The purpose of this review is to summarize investigations in which rodents were isolated during adolescence, then re-housed in typical social groups prior to testing, thus allowing the investigators to resolve the long-term consequences of social adversity experienced during adolescent sensitive periods, despite subsequent normalization of the social environment. Here, we discuss alterations in social, anxiety-like, cognitive, and decision-making behaviors in previously isolated adult rodents. We then explore corresponding neurobiological findings, focusing on the prefrontal cortex, including changes in synaptic densities and protein levels, white matter and oligodendrocyte function, and neuronal physiology. Made more urgent by the recent wave of social deprivation resulting from the COVID-19 pandemic, especially amongst school-aged adolescents, understanding the mechanisms by which even transient social adversity can negatively impact brain function across the lifespan is of paramount importance.

Coping With Craving and Withdrawal Due to Substance Use Disorders During the COVID-19 Lockdown.

OBJECTIVE: Substance use disorder (SUD) is a chronic remitting and relapsing disorder, and abrupt discontinuation of the substance due to nonavailability in the absence of treatment precipitates withdrawals and craving. The objective of this study was to assess the craving and withdrawal coping mechanisms used by patients with SUDs as a result of disruption in availability of substances and medications due to sudden lockdown in response to coronavirus disease 2019. METHODS: A survey was administered via telephone from June 25, 2020, to July 15, 2020, to patients who had previously attended the substance use clinic of a tertiary care teaching hospital in North India from January 1, 2020, to March 21, 2020 (up to the time of lockdown). Sociodemographic and clinical details were obtained from case record files. A 16-item questionnaire was developed to collect information on coping with craving and withdrawal symptoms. A total of 215 patients were registered in the substance use clinic during this period for the treatment of SUDs, and of those, 43 could not be contacted due to various reasons such as wrong contact numbers, patient expired (not related to substance withdrawal), or not willing to talk. The mean age of the subjects was 37.05 (SD = 13.22) years, and men outnumbered women. The remaining 172 patients were contacted via telephone, and responses were gathered regarding withdrawal symptoms and coping with craving. RESULTS: More than two-thirds of the patients were still maintaining abstinence from their primary substance of abuse during lockdown. A large number of patients (n = 41, 43.2%) reported difficulty in obtaining prescribed medication for detoxification without renewal of their prescription. More than 66% of patients reported that they were able to control their craving, and many kept themselves busy with household activities. CONCLUSIONS: The majority of patients who had completed the acute phase of withdrawals were able to maintain abstinence in the absence of renewal of prescribed medication and substance of abuse due to sudden disruption in supply. The patients were able to use certain strategies to control their craving.

Changes in Alcohol Use and Drinking Context due to the COVID-19 Pandemic: A Multimethod Study of College Student Drinkers.

BACKGROUND: In spring 2020, U.S. universities closed campuses to limit the transmission of COVID-19, resulting in an abrupt change in residence, reductions in social interaction, and in many cases, movement away from a heavy drinking culture. The present mixed-methods study explores COVID-19-related changes in college student drinking. We characterize concomitant changes in social and location drinking contexts and describe reasons attributed to changes in drinking. METHODS: We conducted two studies of the impact of the COVID-19 pandemic on drinking behavior, drinking context, and reasons for both increases and decreases in consumption among college students. Study 1 (qualitative) included 18 heavy-drinking college students (Mage  = 20.2; 56% female) who completed semi-structured interviews. Study 2 (quantitative) included 312 current and former college students who reported use of alcohol and cannabis (Mage  = 21.3; 62% female) and who completed an online survey. RESULTS: In both studies, COVID-19-related increases in drinking frequency were accompanied by decreases in quantity, heavy drinking, and drunkenness. Yet, in Study 2, although heavier drinkers reduced their drinking, among non-heavy drinkers several indices of consumption increased or remained stable . Both studies also provided evidence of reductions in social drinking with friends and roommates and at parties and increased drinking with family. Participants confirmed that their drinking decreased due to reduced social opportunities and/or settings, limited access to alcohol, and reasons related to health and self-discipline. Increases were attributed to greater opportunity (more time) and boredom and to a lesser extent, lower perceived risk of harm and to cope with distress. CONCLUSION: This study documents COVID-19-related changes in drinking among college student drinkers that were attributable to changes in context, particularly a shift away from heavy drinking with peers to lighter drinking with family. Given the continued threat of COVID-19, it is imperative for researchers, administrators, and parents to understand these trends as they may have lasting effects on college student drinking behaviors.

Alcohol consumption changes during the first COVID-19 lockdown: an online population survey in a convenience sample of French-speaking Belgian residents.

An online survey among French-speaking Belgians (N=7711) investigated self-reported changes in alcohol consumption during the first COVID-19-related lockdown (March 17th - May 4th 2020). Population-weighted estimates indicated that 31.37% of the population increased consumption during lockdown, 30.32% decreased consumption and 38.31% reported unchanged consumption. The magnitude of change was higher for "decreasers" than "increasers", resulting in a slight reduction in overall consumption. A multiple regression analysis revealed that age, occupational status, number of cohabitants, perceived alcohol accessibility, drinking motivations and previous consumption predicted consumption changes. The lockdown was thus associated with consumption modifications among French-speaking Belgians, without a prevailing direction of change.

Longitudinal changes in psychological distress in the UK from 2019 to September 2020 during the COVID-19 pandemic: Evidence from a large nationally representative study.

In a large (n=10918), national, longitudinal probability-based sample of UK adults the prevalence of clinically significant psychological distress rose from prepandemic levels of 20.8% in 2019 to 29.5% in April 2020 and then declined significantly to prepandemic levels by September (20.8%). Longitudinal analyses showed that all demographic groups examined (age, sex, race/ethnicity, income) experienced increases in distress after the onset of the pandemic followed by significant decreases. By September 2020 distress levels were indistinguishable from prepandemic levels for all groups. This recovery may reflect the influence of the easing of restrictions and psychological adaptation to the demands of the pandemic.

Impact and consequences of COVID-19 pandemic on complicated grief and persistent complex bereavement disorder.

Mourning is a coping-with-loss stage that prevents grief from becoming pathologic, i.e., complicated grief (CG) syndrome and persistent complex bereavement disorder (PCBD), recently included in international classification systems. During the COVID-19 pandemic, to contain virus spread, several countries adopted/adopt the prohibition of mourning rituals (funeral ceremonies/visiting to cemeteries), so that people were/are unable to give their hospitalized relatives the latest goodbye. Such measures can lead vulnerable individuals to develop CG and PCBD. We critically discuss literature-based risk factors for and protective resources against the onset of these conditions since the start of the pandemic and analyze prevention strategies to inform public health programs.

OCD during COVID-19: Understanding clinical and non-clinical anxiety in the community.

The COVID-19 pandemic has created a great deal of anxiety for many individuals. Several papers have noted that individuals with OCD may be particularly negatively impacted by COVID-19, and that the threat of COVID-19 may impact treatment (Banerjee, 2020; Jassi et al., 2020; Sheu et al., 2020). The study presented herein examined OCD-related and COVID-related intrusions in a non-patient sample. Individuals with elevated OCD symptoms reported having both OCD and COVID intrusions at a similar frequency. Further, OCD symptom severity was significantly correlated with the frequency of COVID related intrusions and the amount of distress they caused. However, distress from COVID related intrusions was not significantly correlated with OCD symptom severity. These results shed light on the similarities between reactions to objectively elevated threat and the perceptions of elevated threat experienced in OCD.

Left-behind children's social adjustment and relationship with parental coping with children's negative emotions during the COVID-19 pandemic in China.

Using data collected from two provinces in China through an online survey, the current study aimed to investigate left-behind children's emotional and academic adjustment during the COVID-19 pandemic in China. The participants included 1780 left-behind (960 boys) and 1500 non-left-behind (811 boys) children in elementary and junior high school with a mean age of 11.23. Self-reported questionnaires concerning children's depression, loneliness, anxiety, and academic adjustment, and parents' coping with children's negative emotions were completed. The results suggested that compared with non-left-behind children, left-behind children's depression and anxiety symptoms were more severe and their academic adjustment was poorer. However, left-behind children had lower levels of loneliness than non-left-behind children. Additionally, supportive coping types, especially emotion-focused and problem-focused reactions, were significantly negatively correlated with children's depression and anxiety. Unsupportive coping types, especially distress and punitive reactions, were significantly positively correlated with children's depression and anxiety symptoms. Moreover, the relationships between punitive reactions and depression, ignoring and loneliness and problem-focused reactions and academic adjustment were significantly stronger in left-behind children. Hence, during the pandemic, left-behind children were still at a disadvantage even with their parents' company. However, parents' coping style towards left-behind children's negative emotions played a significant role in their adjustment.

Physical Exercise as a Resilience Factor to Mitigate COVID-Related Allostatic Overload.

INTRODUCTION: The long-lasting threat of COVID-19 makes it necessary to explore strategies to improve coping skills which enable us to master a balanced life in the face of adversity. OBJECTIVE: To unravel the most challenging aspects of COVID-19 in a nonclinical adult population and identify predictors of lost balance and consequent allostatic overload (AO). We examined the role of regular, moderate-intensity formula aerobic exercise (312 meridian exercise) in preventing allostatic overload through increasing well-being. METHODS: An online survey was conducted to measure CO-VID-related allostatic overload according to clinimetric criteria. The Psychosocial Index (PSI), Kellner's Symptom Questionnaire (KSQ), short Depression Anxiety Stress Scales (DASS-21), Public Health Surveillance Well-Being Scale -(PHS-WB), and Whiteley-7 were used to explore mental health characteristics. Univariate statistics logistic regression analysis and a general linear model were used. RESULTS: According to 442 valid answers, 217 adults practiced physical exercise (PE) frequently (fPE, 3-5 times/every day) while 120 did it less regularly (1-2 times/week), and 105 did not exercise/practiced irregularly (controls). Restriction-related stressors were most challenging, resulting in AO in 29% (n = 128) of the sample. The main predictors were additional stressors (p = 0.005) and anxiety symptoms (p < 0.001). The prevalence of AO was lower (p = 0.018) in the fPE group when compared to controls. KSQ distress symptoms were also lower in fPE (p < 0.0001), while total well-being was increased (p < 0.001) after adjusting for sex, age, and number of chronic diseases. According to the PHS-WB, both physical and mental well-being were higher (p = 0.003 and p = 0.004, respectively) in fPE. CONCLUSIONS: Frequent moderate exercise is associated with better mental and physical well-being and a lower prevalence of AO.

Are We Coping Well with COVID-19?: A Study on Its Psycho-Social Impact on Front-line Healthcare Workers.

BACKGROUND: Global pandemics have a profound psycho-social impact on health systems and their impact on healthcare workers is under-reported. METHODS: We performed a cross-sectional survey with 13 Likert-scale responses and some additional polar questions pertaining to dressing habits and learning in a university hospital in the midwest United States. Descriptive and analytical statistics were performed. RESULTS: The 370 respondents (66.1% response rate, age 38.5±11.6 years; 64.9% female), included 102 supervising providers [96 (25.9%) physicians, 6 (1.6%) mid-level], 64 (17.3%) residents/fellows, 73 (19.7% nurses, 45 (12.2%) respiratory therapists, 31 (8.4%) therapy services and others: 12 (3.2%) case-managers, 4 (1.1%) dietitians, 39 (10.5%) unclassified]. Overall, 200 (54.1%) had increased anxiety, 115 (31.1%) felt overwhelmed, 159 (42.9%) had fear of death, and 281 (75.9%) changed dressing habits. Females were more anxious (70.7% vs. 56%, X2 (1, N=292)=5.953, p=0.015), overwhelmed (45.6% vs. 27.3%, X2 (1, N=273)=8.67, p=0.003) and suffered sleep disturbances (52% vs. 39%, X2 (1, N=312)=4.91, p=0.027). Administration was supportive; 243 (84.1%, N=289), 276 (74.5%) knew another co-worker with COVID-19, and only 93 (25.1%) felt healthcare employment was less favorable. Residents and fellows reported a negative impact on their training despite feeling supported by their program. CONCLUSION: Despite belief of a supportive administration, over half of healthcare workers and learners reported increased anxiety, and nearly a third felt overwhelmed during this current pandemic.