Can anxiety and depression serve as primary factors associated with erectile dysfunction after coronavirus disease?

OBJECTIVE: We investigated the association between anxiety and depression and erectile dysfunction (ED) in patients who developed ED after coronavirus disease 2019 (COVID-19). PATIENTS AND METHODS: This study included 228 men who were hospitalized in pandemic wards between July 2021 and January 2022 with positive reverse transcription-polymerase chain reaction test results for the severe acute respiratory syndrome coronavirus 2 RNA. All patients responded to a Turkish version of the International Index of Erectile Function (IIEF) questionnaire to determine erectile status. Patients were administered the Turkish version of the Beck Depression Inventory (BDI) and Generalized Anxiety Disorder 7-item scale (GAD-7) questionnaires the day after hospitalization and also during the 1st month after diagnosis of COVID-19 to compare the COVID-19 situation with the previous situation. RESULTS: Patients' mean age was 49.66 ± 13.3 years. The mean pre-COVID-19 erectile function score of 28.65 ± 1.33 decreased to a mean post-COVID-19 score of 26.58 ± 4.23, which indicates a statistically significant difference (p=0.03). Post-COVID-19 ED occurred in 46 (20.1%) patients; 10 (4.3%) patients had mild, 23 (10.0%) had mild-to-moderate, 5 (2.1%) had moderate, and 8 (3.5%) patients had severe ED. The mean pre-COVID-19 BDI score (which indicates depression) of 1.79 ± 2.45 increased to a mean post-COVID-19 score of 2.42 ± 2.89 (p<0.01). Additionally, the mean pre-COVID-19 GAD-7 score of 4.79 ± 1.83 increased to a mean post-COVID-19 score of 6.79 ± 2.52, which indicates a statistically significant difference (p<0.01). We observed a negative correlation between the increase in BDI and GAD-7 scores and the decrease in IIEF scores (r=0.426, p<.001, r=0.568, p<.001, respectively). CONCLUSIONS: Our study highlights that COVID-19 can cause ED and that disease-induced anxiety and depression serve as primary contributors to ED.

Impact of COVID-19 pandemic related stressors on patients with anxiety disorders: A cross-sectional study.

The COVID-19 pandemic and related containment measures are affecting mental health, especially among patients with pre-existing mental disorders. The aim of this study was to investigate the effect of the first wave and its aftermath of the pandemic in Germany (March-July) on psychopathology of patients diagnosed with panic disorder, social anxiety disorder and specific phobia who were on the waiting list or in current treatment at a German university-based outpatient clinic. From 108 patients contacted, forty-nine patients (45.37%) completed a retrospective survey on COVID-19 related stressors, depression, and changes in anxiety symptoms. Patients in the final sample (n = 47) reported a mild depression and significant increase in unspecific anxiety (d = .41), panic symptoms (d = .85) and specific phobia (d = .38), while social anxiety remained unaltered. Pandemic related stressors like job insecurities, familial stress and working in the health sector were significantly associated with more severe depression and increases in anxiety symptoms. High pre-pandemic symptom severity (anxiety/depression) was a risk factor, whereas meaningful work and being divorced/separated were protective factors (explained variance: 46.5% of changes in anxiety and 75.8% in depressive symptoms). In line with diathesis-stress models, patients show a positive association between stressors and symptom load. Health care systems are requested to address the needs of this vulnerable risk group by implementing timely and low-threshold interventions to prevent patients from further deterioration.

Posttraumatic Stress, Anxiety, and Depression in COVID-19 Survivors.

OBJECTIVES: This study aims to examine the rates of anxiety, depression, and posttraumatic stress disorder (PTSD) after hospital discharge among COVID-19 survivors and to determine the associated risk factors. METHODS: Adult COVID-19 survivors discharged from hospitals between March 2020 and March 2021 were asked to complete a questionnaire at 4 weeks after discharge. The Chinese version of the 22-item Impact of Event Scale - Revised (IES-R) was used to measure symptoms of PTSD. The 9-item Patient Health Questionnaire (PHQ-9) was used to assess symptoms of major depressive disorder. The 7-item Generalised Anxiety Disorder Scale (GAD-7) was used to measure symptoms of generalised anxiety disorder. The rates of anxiety, depression, and PTSD among discharged patients were determined, as were associations between psychosocial factors and outcome measures and predictors for moderate-tosevere symptoms of anxiety, depression, and PTSD. RESULTS: 96 men and 103 women aged 18 to 81 years returned the completed questionnaire. 12.1% to 20.1% of them reported symptoms of PTSD, anxiety, or depression. Higher symptom severity was associated with higher perceived life threat, lower emotional support, lower disease severity upon admission, and longer hospital stay. Women had more PTSD symptoms than men, particularly when knowing someone under quarantine. CONCLUSION: COVID-19 survivors with higher perceived life threat, lower emotional support, lower disease severity upon admission, and longer hospital stay were associated with higher severity of symptoms of PTSD, anxiety, and depression. Timely intervention should provide to at-risk survivors.

[Impact of the COVID pandemic on the anxiety of patients with functional gastrointestinal symptoms]. / Auswirkungen der COVID-Pandemie auf die Besorgtheit von Patient:innen mit funktionellen gastrointestinalen Symptomen.

Functional gastrointestinal disorders such as functional dyspepsia (FD) and irritable bowel syndrome (IBS) are stress-associated. The COVID-19 pandemic, which has been rampant since 2020, has caused anxiety and stress in the population. Distancing measures to combat the pandemic have affected mental health. Our objective was to examine the impact of the 3rd lockdown in Germany in December 2020 and January 2021 on the apprehension of patients with FD and IBS.Patients diagnosed with FD or IBS treated in a tertiary or primary care hospital in the South of Baden-Württemberg in 2020 voluntarily participated in an anonymous online survey. Questions about concomitant diseases, concern about COVID-19 and stress perception were answered.A total of 106 patients (♀=67, ♂=38, 1 diverse) participated in the survey. Of these, 16 had FD (♀=9, ♂=6, diverse=1), 80 had IBS (♀=52, ♂=28), and 10 had both (♀=6, ♂=4). The average age was 43.6 years. Depressive and anxiety disorders were most frequently reported comorbidities in both the FD (25% each) and IBS group (20% each), followed by joint wear and tear (FD: 13%, RDS: 14%). In a direct comparison of participants with FD and IBS, those with IBS showed significantly higher scores for an increase in gastrointestinal (GI) symptoms during the pandemic (p=0.007), more frequent presentation to a physician during the pandemic, and greater social withdrawal due to GI symptoms (p=0.05). In direct comparison, those with IBS showed higher scores for fear that vaccination against COVID-19 would adversely affect GI symptoms compared to FD (p=0.05).In times of the pandemic, interdisciplinary collaboration in the care of patients with FD or IBS seems more necessary than ever to address concerns and provide good patient care.

Short Research Article: Impact of a prolonged lockdown on the symptoms of paediatric ADHD and common associated disorders.

OBJECTIVE: Our objective is to explore the change in the severity of ADHD, ODD and anxiety during a two-month lockdown among children in France and the moderating role of behavioural regulation. METHOD: In 235 children with ADHD, the symptom severity of ADHD, ODD and anxiety was investigated one and two months after the beginning of lockdown, and one month after its end. Behavioural regulation skills were estimated with the Behaviour Regulation Index. RESULTS: ADHD, ODD and anxiety scores were increasing or decreasing depending on BRI. CONCLUSION: Baseline behavioural regulation skills may act as a moderating factor for the persistence of ADHD, ODD and anxiety symptoms related to the lockdown.

Comparison of Food-Based and Music-Based Regulatory Strategies for (Un)Healthy Eating, Depression, Anxiety and Stress.

There are many ways to regulate emotions. People use both adaptive (e.g., regulation by music) and maladaptive (e.g., regulation by food) strategies to do this. We hypothesized that participants with a high level of food-based regulatory strategies and a low level of music-based regulatory strategies (a group with the least adaptive form of emotion regulation) would have significantly greater levels of unhealthy eating behaviours, depression, anxiety and stress, as well as a significantly lower level of healthy eating behaviours than those with a low level of food-based regulatory strategies and a high level of music-based regulatory strategies (a group with the greatest adaptive form of emotion regulation). Participants (N = 410; Mage = 31.77, SD = 13.53) completed: the Brief Music in Mood Regulation Scale, the Emotional Overeating Questionnaire, the Healthy and Unhealthy Eating Behavior Scale, the Depression, Anxiety and Stress Scale and a socio-demographic survey. The four clusters were identified: (a) Cluster 1 (N = 148): low food-based regulatory strategies and high music-based regulatory strategies; (b) Cluster 2 (N = 42): high food-based regulatory strategies and high music-based regulatory strategies; (c) Cluster 3 (N = 70): high food-based regulatory strategies and low music-based regulatory strategies; (d) Cluster 4 (N = 150): low food-based regulatory strategies and low music-based regulatory strategies. Overall, our outcomes partially support our hypothesis, as higher levels of unhealthy eating behaviours, depression, anxiety and stress were observed in participants with high food-based and low music-based regulatory strategies as compared with adults with low food-based and high music-based regulatory strategies. To sum up, the results obtained indicate that during the COVID-19 pandemic the group of people regulating their emotional state and unhealthy eating predominantly with food is potentially characterized by worse functioning than the group of people regulating with music. Therefore, it can be concluded that people who regulate their functioning using food should be included in preventive measures by specialists. During the visit, psychologists and primary care physicians can ask patients about their daily strategies and based on this information specialists can estimate the potential risk of developing high levels of stress and anxiety, depressive disorders and unhealthy eating habits and provide specific (match) intervention.

Characterizing worry content and impact in pregnant and postpartum women with anxiety disorders during COVID-19.

The novel COVID pandemic has had a substantial impact on global mental health, including those populations that are inherently vulnerable such as pregnant and postpartum (perinatal) women. Anxiety disorders (ADs) are the most common mental health disorders during the perinatal period, affecting up to one in five women. However, since the onset of the pandemic, up to 60% of perinatal women are experiencing moderate to severe levels of anxiety. Given the substantial increase in perinatal anxiety during COVID, we sought to better understand its phenomenology by characterizing the collective worry content and impact of COVID using a content analysis. Eighty-four treatment-seeking pregnant (n = 35) and postpartum (n = 49) women with a principal AD, participated in this study between April and October 2020. In addition to completing questionnaire measures and a semistructured diagnostic interview, participants were asked to (1) describe their top excessive and uncontrollable worries, (2) describe additional COVID and non-COVID worries, and (3) describe how the pandemic had affected their lives. All responses were given verbally and transcribed verbatim by assessors. A content analysis led to the emergence of various COVID and non-COVID worry and impact themes. One third of participant's principal worries were specific to COVID, and 40% of COVID worries were specific to the perinatal context. Understanding the worry content and impact of COVID may improve symptom detection and inform the development of targeted treatment strategies to support the mental health needs of perinatal women with ADs throughout the pandemic and thereafter. Understanding pandemic-specific worries is important for perinatal symptom screening and may allow for the development of targeted treatment strategies to address COVID-specific worries and impact.

Assessing anxiety, depression and insomnia symptoms among Ebola survivors in Africa: A meta-analysis.

BACKGROUND: During health disaster events such as the current devastating havoc being inflicted on countries globally by the SARS-CoV-19 pandemic, mental health problems among survivors and frontline workers are likely concerns. However, during such health disaster events, stakeholders tend to give more precedence to the socio-economic and biomedical health consequences at the expense of mental health. Meanwhile, studies show that regardless of the kind of disaster/antecedent, all traumatic events trigger similar post-traumatic stress symptoms among survivors, families, and frontline workers. Thus, our study investigated the prevalence of anxiety, depression and insomnia symptoms among survivors of the 2014-2016 Ebola virus disease that plagued the West African sub-region. METHODS: We systematically retrieved peer-reviewed articles published between 1970 and 2019 from seven electronic databases, including Google Scholar, MEDLINE, PsychInfo, PubMed, Scopus, Springer Link, Web of Science on Ebola and post-traumatic stress disorder symptoms. A comprehensive hand search complemented this literature search. Of the 87 articles retrieved, only 13 met the inclusion criteria for this meta-analysis. RESULTS: After heterogeneity, influence, and publication bias analysis, our meta-analysis pooled proportion effects estimates showed a moderate to a high prevalence of anxiety (14%; 99% CI: 0.05-0.30), depression (15%; 99% CI: 0.11-0.21), and insomnia (22%; 99% CI: 0.13-0.36). Effect estimates ranging from (0.13; 99% CI: 0.05, 0.28) through to (0.11; 99% CI: 0.05-0.22), (0.15; 99% CI: 0.09-0.25) through to (0.13; 99% CI: 0.08-0.21) and (0.23; 99% CI: 0.11-0.41) to (0.23; 99% CI: 0.11-0.41) were respectively reported for anxiety, depression and insomnia symptoms. These findings suggest a significant amount of EVD survivors are struggling with anxiety, depression and insomnia symptoms. CONCLUSION: Our study provided the first-ever meta-analysis evidence of anxiety, depression, and insomnia symptoms among EVD survivors, and suggest that the predominant biomedical health response to regional and global health disasters should be complemented with trauma-related mental health services.

Effects of the COVID-19 pandemic on psychology and disease activity in patients with ankylosing spondylitis and rheumatoid arthritis

Background/aim: The COVID-19 outbreak is known to increase stress levels of most patients with chronic diseases. Patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA) are highly susceptible to environmental stress. In the current study, we aimed to determine how the COVID-19 pandemic psychologically affected patients with chronic progressive diseases such as AS and RA and the effects of these psychological factors on disease activity. Materials and methods: Age and sex-matched patients with AS (n = 80), RA (n = 80), and healthy controls (n = 80) were included in the study. All participants were evaluated with the "Perceived COVID-19 Threat Form (PCTF)", "Suicide-Ideation Scale (SIS)", "Hospital Anxiety and Depression Scale (HADS)", "The Ability to Cope with Trauma (PACT)", and "Psychological General Well-Being Index (PGWB)" scales. BASDAI was used in patients with AS, and DAS28 was used in patients with RA to assess disease severity. Results: Compared to healthy individuals, patients with RA and AS had lower PGWB scores and higher HADS depression and anxiety subscale scores. Almost all psychometric assessment test scores were worse in AS patients with high-disease activity compared to those in low-disease activity. PACT scores were higher in patients with moderate RA compared to patients with mild RA (p = 0.006). While a positive correlation was identified between BASDAI and most of the psychometric assessment test scores (r = 0 .36 for PCTF, r = 0.53 for depressive scores, r = 0.54 for anxiety scores, r = 0.57 for suicidal ideation), DAS28 scores were found to be associated only with PACT total and PACT perceived forward-focused subscale scores (r = ­.26 and r = .33, respectively). Conclusion: Psychologically, AS and RA patients were found to be worse off compared to healthy controls. The perceived COVID threat and psychological status were associated with disease activity in AS, but not RA patients. Patients with chronic illnesses may be more vulnerable to the psychological effects of the pandemic, which can worsen disease activity.

Depression and anxiety symptoms associated with internet gaming disorder before and during the COVID-19 pandemic: A longitudinal study.

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic has profoundly impacted aspects of human life globally. Playing videogames has been encouraged by several organizations to help individuals cope with the COVID-19 pandemic and associated restrictive measures. This longitudinal study was the first to examine gaming in the context of the pandemic and its association with depressive and anxiety symptoms. METHODS: The sample comprised 1,778 children and adolescents (50.7% male) who were part of the Project of School Mental Health in Southwest China. Data were collected at two-time intervals: before the COVID-19 pandemic (October to November 2019 - [T1]) and during the COVID-19 pandemic (April to May 2020 - [T2]). Data were collected on perceived COVID-19 impacts, videogame use, Internet Gaming Disorder (IGD), and depressive and anxiety symptoms. Cross-lagged panel models were computed to examine longitudinal relationships. RESULTS: The results indicated that both videogame use and IGD increased significantly for adolescents at T2. The cross-lagged panel model results suggested that depressive and anxiety symptoms at T1 positively predicted IGD and videogame use at T2 (especially for boys), but not inversely. Perceived COVID-19 impacts mediated the relationship between depressive and anxiety symptoms at T1 and IGD at T2. CONCLUSION: Children and adolescents both increased videogame use at T2, but only adolescents significantly increased IGD severity at T2. The findings supported the compensatory hypothesis, and are consistent with the Interaction of Person-Affect-Cognition-Execution model as individual responses to COVID-19 may function as a mediator between personal predisposing variables and IGD.

Anxiety responses to the unfolding COVID-19 crisis: Patterns of change in the experience of prolonged exposure to stressors.

An immense amount of work has investigated how adverse situations affect anxiety using chronic (i.e., average) or episodic conceptualizations. However, less attention has been paid to circumstances that unfold continuously over time, inhibiting theoretical testing and leading to possible erroneous conclusions about how stressors are dynamically appraised across time. Because stressor novelty, predictability, and patterns are central components of appraisal theories, we use the COVID-19 crisis as a context to illustrate how variation in the phenomenon's patterns of change (specifically, total cases [average level] but also the rate of linear [velocity] and nonlinear growth [acceleration] in cases) influence anxiety. We also show the implications of anxiety for next-day functioning at work. These effects are tested in data drawn from a sample of employed adults in a daily diary study conducted in four overlapping waves. The data span the emergence, exponential rise, and initial tapering of the virus in the United States (February 10, 2020 to April 28, 2020). Our results show that although the impact of level of COVID-19 cases on anxiety decreases over time, the effect of change in cases (velocity and acceleration) increases over time. Anxiety is then associated with next-day work functioning (engagement, performance, and emotional exhaustion). (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Changes of perceptions and behaviours during the phases of COVID-19 pandemic in German elderly people with neurological disorders: an observational study using telephone interviews.

OBJECTIVES: Describing perceived limitations in everyday life, psychological burden and approval to easing of measures during the COVID-19 phases in elderly people with neurological disorders. DESIGN: Observational, prospective study SETTING: This is a monocentric study conducted at a university hospital in Germany. PARTICIPANTS: Overall, 452 elderly people participated in the NeuroGerAdh study (DRKS00016774) and were interviewed by telephone between 18 March and 30 August 2020. RESULTS: Overall, 307 (67.9%) patients had relevant limitations in daily life due to the measures. These limitations significantly decreased during the pandemic phases. At the beginning of the pandemic, people complained about restricted social contacts and mobility, which were the most common reasons for perceived limitations in daily life. Later, since June 2020, wearing a mouth-nose mask had become the main reason for perceived limitations. In the elastic net regularisation, model higher perceived limitations in daily life were among others associated with younger age and earlier pandemic phases. Higher psychological burden was mainly associated with early pandemic phase, younger age and depression.The perceived psychological burden decreased as the pandemic phases passed, even though the reasons for psychological burden (anxiety or fear of infection, insecurity and concerns) did not remarkably change during the phases. From 16 June 2020, the patients were asked whether they approve the easing of measures. Sixty-seven of 136 patients (49.3%) approved and 55 (40.4%) did not. The common reasons for disapproval were fear of increased risk of infection and irresponsible behaviour of other people. CONCLUSION: While limitations in daily life decreased during the study period, anxiety remains a common psychological burden in elderly sick people, and this needs special attention. Accordingly, most people do not approve easing of measures. Special strategies are needed to cope with changing measures during the COVID-19 pandemic.

Videoconference Intervention for Distance Caregivers of Patients With Cancer: A Randomized Controlled Trial.

PURPOSE: Approximately 20% of caregivers (CGs) live > 1 hour away from the patient and are considered distance caregivers (DCGs) who often report higher distress and anxiety than local CGs. The purpose of this study was to test the effectiveness of an intervention aimed at reducing anxiety and distress in DCGs of patients with cancer. METHODS: This randomized controlled trial enrolled DCGs of patients with all cancer types who were being seen monthly by oncologists in outpatient clinics. There were three arms of the intervention delivered over a 4-month period: arm 1 (a) received 4 monthly videoconference-tailored coaching sessions with an advanced practice nurse or social worker focused on information and support, (b) participated in patient's appointments with the oncologist via videoconference over the 4-month study period, and (c) had access to a website designed for DCGs. Arm 2 did not receive the coaching sessions but received the other two components, and arm 3 received access to the DCG website only. RESULTS: There were 302 DCGs who provided pre- and postintervention data. There were significant anxiety by group (P = .028 and r = 0.16) and distress by group interactions (P = .014 and r = 0.17). Arm 1 had the greatest percentage of DCGs who demonstrated improvement in anxiety (18.6%) and distress (25.2%). CONCLUSION: Coaching and use of videoconference technology (to join the DCG into the patient-oncologist office visit) were effective in reducing both anxiety and distress for DCGs. These components could be considered for local CGs who-with COVID-19-are unable to accompany the patient to oncologist visits.

Prenatal exposure to gestational diabetes is associated with anxiety and physical inactivity in children during COVID-19.

BACKGROUND: The coronavirus disease 2019 (COVID-19) is associated with adverse child mental health outcomes and reduced physical activity. Moreover, prenatal exposure to gestational diabetes (GDM) is associated with increased risk for adverse psychological outcomes in children. OBJECTIVES: Assess prenatal exposure to GDM on anxiety levels and physical activity in children during the COVID-19 pandemic. METHODS: Sixty-five children age 9 to 15 reported their physical activity and anxiety levels using the 24-hours physical activity recall and the State-Trait Anxiety Inventory for Children via phone or video meetings. Prenatal exposure to GDM was obtained from maternal electronic medical records. RESULTS: The 38 GDM-exposed children reported significantly higher anxiety levels and were less likely to engage in any vigorous physical activity (VPA) (5% vs 30%) compared to the 27 GDM-unexposed children. Lower levels of physical activity were significantly associated with higher levels of anxiety. Less engagement in VPA explained 75% of the association between GDM exposure and anxiety levels. CONCLUSIONS: Engaging in physical activity during the COVID-19 pandemic may be beneficial for reducing anxiety, particularly amongst GDM-exposed children.

Mental health status of relapsing-remitting multiple sclerosis Italian patients returning to work soon after the easing of lockdown during COVID-19 pandemic: A monocentric experience.

BACKGROUND: The prolonged lockdown related to COVID-19 pandemic determined disruption of lifestyle and social isolation. METHODS: To assess the mental health status of Relapsing-Remitting Multiple Sclerosis (RRMS) patients regularly followed at the MS center of Catania (Italy) and returning to work after the easing of lockdown during COVID-19 pandemic. Then, to identify any variables associated to psychological distress. RRMS patients returning to work during the COVID-19 pandemic were invited to answer a telephonic interview consisting of the administration of the Short-Screening-Scale for DSM IV (SSS-DSM-IV), the Depression, Anxiety, Stress Scale- 21 (DASS-21) and the Insomnia Severity Index (ISI). Other information was extracted from electronic medical records. RESULTS: Valid and complete interviews were obtained from 432 patients (response rate 64.3%). Out of them, 277 (64.1%) were female, mean age 40.4 (SD 12.4) years. One-hundred thirty-seven (31.7%) RRMS patients received a score ≥4 at the SSS-DSM-IV, indicating clinically significant PTSD-like symptoms. About DASS-21, moderate-to-severe anxiety was reported by 210 RRMS patients (48.6%), moderate-to-severe depression, and moderate-to-severe stress were respectively reported by 95 (22%) and 220 (50.9%) RRMS patients. Insomnia was reported by 128 patients (29.6%). Factors associated with major severity of symptoms were: marital status, previous diagnosis of mood disorders, switching/starting Disease-Modifying Therapies in the last 12 months, and a higher level of disability measured with Expanded Disability Status Scale (for all, p<.05). CONCLUSIONS: Our findings highlight the need to provide psychological support to MS patients facing the delicate phase of returning to work and to normal activities.

Anxiety and public responses to covid-19: Early data from Thailand.

Any new pandemic has the potential to arouse considerable anxiety, with this anxiety associated in previous work with economic disruption and societal disruption. We examined anxiety, symptom awareness, trust and associated behavioural responses in the first three weeks of the SARS-CoV-2 (covid-19) outbreak in Thailand. We collected data on-street at randomly selected locations in Bangkok. Of 274 potential respondents, 203 (74.7%) responded. A four-item measure assessed anxiety, with open-ended questions assessing knowledge of symptoms, trusted information sources and measures taken to avoid infection. Respondents reported good awareness of the prime symptoms of the Coronovirus. Binary logistic regressions controlling for sex and age found the more anxious avoided the Chinese, people who were coughing, crowded places and public transport or flying. Younger respondents reported greater trust in foreign media and older populations information from national government. Trust in doctors online was positively associated with avoidance of coughing people and keeping fit; trust in national government with avoiding coughing people, keeping fit, and avoiding public transport . We conclude that anxiety can motivate both desirable and undesirable behaviours during pandemic outbreaks. Effective and targeted communication by trusted sources is needed to motivate preventive actions but also to limit unnecessary or disruptive behaviours.