Psychological distress among health professional students during the COVID-19 outbreak.

BACKGROUND: Due to the drastic surge of COVID-19 patients, many countries are considering or already graduating health professional students early to aid professional resources. We aimed to assess outbreak-related psychological distress and symptoms of acute stress reaction (ASR) in health professional students and to characterize individuals with potential need for interventions. METHODS: We conducted a prospective cohort study of 1442 health professional students at Sichuan University, China. At baseline (October 2019), participants were assessed for childhood adversity, stressful life events, internet addiction, and family functioning. Using multivariable logistic regression, we examined associations of the above exposures with subsequent psychological distress and ASR in response to the outbreak. RESULTS: Three hundred and eighty-four (26.63%) participants demonstrated clinically significant psychological distress, while 160 (11.10%) met the criterion for a probable ASR. Individuals who scored high on both childhood adversity and stressful life event experiences during the past year were at increased risks of both distress (ORs 2.00-2.66) and probable ASR (ORs 2.23-3.10), respectively. Moreover, internet addiction was associated with elevated risks of distress (OR 2.05, 95% CI 1.60-2.64) and probable ASR (OR 2.15, 95% CI 1.50-3.10). By contrast, good family functioning was associated with decreased risks of distress (OR 0.43, 95% CI 0.33-0.55) and probable ASR (OR 0.48, 95% CI 0.33-0.69). All associations were independent of baseline psychological distress. CONCLUSIONS: Our findings suggest that COVID-19 related psychological distress and high symptoms burden of ASR are common among health professional students. Extended family and professional support should be considered for vulnerable individuals during these unprecedented times.

What support do young people affected by adverse childhood experiences need?

The studyLester S, Khatwa M, Sutcliffe K. Service needs of young people affected by adverse childhood experiences (ACEs): A systematic review of UK qualitative evidence. Child Youth Serv Rev 2020;118:105429.To read the full NIHR Alert, go to https://evidence.nihr.ac.uk/alert/support-needs-of-young-people-affected-by-adverse-childhood-experiences/.

Outcomes of COVID-19 on Latinx youth: Considering the role of adverse childhood events and resilience.

Early research on the COVID-19 pandemic has demonstrated differential impact on the Latinx community. There has been limited research exploring the mental health outcomes of the pandemic on Latinx youth. This study explores the severity of pandemic-related stress on Latinx youth considering their resilience factors and previous adverse childhood events (ACEs). Adolescents (n = 142) ages 13-18 completed measures related to exposure to the pandemic, pandemic stress, number of ACEs, resilience factors, and general demographic information. Results of multiple regression analysis found that exposure to the pandemic, ACEs, gender, and resilience factors predicted the levels of stress that youth experienced. No differences in pandemic-related stress were found between Latinx youth and their non-Latinx counterparts. Implications are discussed related to how school psychologists can support all students with culturally sensitive practices as we continue through the pandemic and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Special Report from the CDC: Strengthening social connections to prevent suicide and adverse childhood experiences (ACEs): Actions and opportunities during the COVID-19 pandemic.

INTRODUCTION: During this time ofintensified hardship and disruption due to the SARS-CoV-2 (COVID-19) pandemic, communities, practitioners, and state and local governments have had to rapidly implement and adapt strategies that support mental health and wellbeing during a global pandemic. Prior to the COVID-19 pandemic, suicide was the 10th leading cause of death in the United States, and at least half of the top 10 leading causes of death have been associated with adverse childhood experiences (ACEs). A number of established risk factors for suicide and ACEs may have been exacerbated by the pandemic, including loneliness and the lack of connectedness. METHOD: This article briefly considers the effects of COVID-19 on social connection and outlines the importance of adapting and developing programming and resources that address suicide and ACEs prevention during a time of infrastructure disruption. Practical Applications: The COVID-19 pandemic has affected the ways that many individuals are able to safely interact and socially connect due to public health prevention strategies implemented to slow the spread of COVID-19. Local, city, and state government, community organizations, and public health and medical practitioners should consider the adaptation and development of existing and new programming, resources, and activities that support and strengthen social connection. In addition to implementing programs, policies may help address systemic and structural barriers to social connection, such as access to parks and open space, public transportation, or digital connectivity.

A Prospective Study of Mental Health During the COVID-19 Pandemic in Childhood Trauma-Exposed Individuals: Social Support Matters.

The novel coronavirus disease 2019 (COVID-19) pandemic and its unprecedented social restrictions may have serious mental health implications, especially in individuals who have experienced childhood traumatic experiences (CTEs). This prospective study aimed to investigate whether general psychopathology and posttraumatic stress disorder (PTSD) symptom severity increased during the pandemic as compared to prepandemic baseline data collected approximately 1 year earlier. Furthermore, we investigated whether an increase in symptomatology was linked to CTEs and mediated by a lack of perceived social support and fear of COVID-19. An online survey was administered to 85 individuals, including both participants with PTSD, major depression, or somatic symptom disorder (n = 63) and healthy volunteers (n = 22), during a period of the most severe social restrictions in Germany. The survey included the Childhood Trauma Questionnaire, Brief Symptom Inventory, PTSD Checklist for DSM-5, ENRICHD Social Support Inventory, and Fear of COVID-19 Scale. In the whole sample, we found significant increases in general psychopathology and PTSD symptom severity, ω2 = .07-.08, during as compared to before the COVID-19 pandemic, with CTEs predicting increased PTSD symptom severity, ß = .245, p = .042. This effect was mediated by a lack of perceived social support, indirect effect = .101, 95% CI [.013, .209], but not fear of COVID-19, indirect effect = .060, 95% CI [-.035, .167]. These findings emphasize the importance of interventions that promote social inclusion to mitigate the potentially detrimental effects of public health actions implemented against the COVID-19 pandemic in individuals with CTEs.

Cognitive flexibility and perceived threat from COVID-19 mediate the relationship between childhood maltreatment and state anxiety.

Converging empirical evidence indicates that exposure to adversity in childhood is associated with increased vulnerability to mental health problems in adulthood. As early life adversity has the potential to alter an individual's appraisal of threat, we hypothesized that individuals exposed to adversity in childhood may also exhibit increased threat from environmental stressors, which in turn may impact their state anxiety levels. We examined the relations between adverse childhood experiences, assessed using the Adverse Childhood Experiences Scale (ACEs), perceived threat from COVID-19, and state anxiety in a sample of adults. Additionally, flexibility is implicated in adaptive coping with life's stressors so we also assessed participants' cognitive flexibility. Parallel mediation regression analyses revealed that both perceived threat from COVID-19 and flexibility in the appraisal of challenges mediated the influence of maltreatment, but not household dysfunction, on state anxiety. Our data indicate that experience with early life adversity in the form of maltreatment is associated with increased perceived threat from COVID-19, which results in higher anxiety levels for the individual. In contrast, childhood maltreatment is associated with reduced flexibility in appraising challenges, which in turn mediates the relationship between maltreatment and anxiety. The findings of this study adds to the limited literature on the impact of early life adversity on cognitive flexibility and highlights the psychological toll of COVID-19 on individuals who have been exposed to adverse childhood experiences.

Is the psychological impact of exposure to COVID-19 stronger in adolescents with pre-pandemic maltreatment experiences? A survey of rural Chinese adolescents.

BACKGROUND: Since the COVID-19 outbreak at the end of 2019, it has evolved into a global pandemic with tremendous mental health impact besides the threats to people's physical health. OBJECTIVE: The aims were to examine whether exposure to COVID-19 predicts elevated levels of anxiety and post-traumatic stress symptoms and whether pre-pandemic maltreatment experiences exacerbate this impact on mental health in adolescents. PARTICIPANTS AND SETTING: The survey was conducted online from February 8 st to February 27th, 2020, and the questionnaires were distributed and retrieved through a web-based platform. This study includes a total of 6196 subjects, aged range from 11 to 18 years old. METHODS: Several multivariable linear regressions were used to analyse the data. RESULTS: The largest variance in PTSS and anxiety problems was explained by ACEs, with more pre-pandemic maltreatment experiences predicting more PTSS (effect size beta = 0.16∼0.27), and more anxiety (effect size beta = 0.32∼0.47). Experienced or subjective fear of exposure to COVID-19 predicted statistically significant variance in PTSS and anxiety, and standardized betas ranged from 0.04 to 0.09. Participants who had adverse childhood experiences and had experienced exposure to COVID-19 showed elevated PTSS. CONCLUSIONS: After pre-pandemic maltreatment experiences the impact of exposure to COVID-19 on mental health may be stronger. Scars from the past seem to be vulnerabilities during societal upheaval. We therefore suggest that when exposed to COVID-19 rural adolescents should get prioritized professional family support and mental health counseling in particular when they have experienced family abuse and neglect in childhood, even though such support is more difficult to organize in rural areas.