Prevalence of and Risk Factors Associated With Mental Health Symptoms Among the General Population in China During the Coronavirus Disease 2019 Pandemic.

Importance: People exposed to coronavirus disease 2019 (COVID-19) and a series of imperative containment measures could be psychologically stressed, yet the burden of and factors associated with mental health symptoms remain unclear. Objective: To investigate the prevalence of and risk factors associated with mental health symptoms in the general population in China during the COVID-19 pandemic. Design, Setting, and Participants: This large-sample, cross-sectional, population-based, online survey study was conducted from February 28, 2020, to March 11, 2020. It involved all 34 province-level regions in China and included participants aged 18 years and older. Data analysis was performed from March to May 2020. Main Outcomes and Measures: The prevalence of symptoms of depression, anxiety, insomnia, and acute stress among the general population in China during the COVID-19 pandemic was evaluated using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Insomnia Severity Index, and Acute Stress Disorder Scale. Logistic regression analyses were used to explore demographic and COVID-19-related risk factors. Results: Of 71 227 individuals who clicked on the survey link, 56 932 submitted the questionnaires, for a participation rate of 79.9%. After excluding the invalid questionnaires, 56 679 participants (mean [SD] age, 35.97 [8.22] years; 27 149 men [47.9%]) were included in the study; 39 468 respondents (69.6%) were aged 18 to 39 years. During the COVID-19 pandemic, the rates of mental health symptoms among the survey respondents were 27.9% (95% CI, 27.5%-28.2%) for depression, 31.6% (95% CI, 31.2%-32.0%) for anxiety, 29.2% (95% CI, 28.8%-29.6%) for insomnia, and 24.4% (95% CI, 24.0%-24.7%) for acute stress. Participants with confirmed or suspected COVID-19 and their family members or friends had a high risk for symptoms of depression (adjusted odds ratios [ORs], 3.27 [95% CI, 1.84-5.80] for patients; 1.53 [95% CI, 1.26-1.85] for family or friends), anxiety (adjusted ORs, 2.48 [95% CI, 1.43-4.31] for patients; 1.53 [95% CI, 1.27-1.84] for family or friends), insomnia (adjusted ORs, 3.06 [95% CI, 1.73-5.43] for patients; 1.62 [95% CI, 1.35-1.96] for family or friends), and acute stress (adjusted ORs, 3.50 [95% CI, 2.02-6.07] for patients; 1.77 [95% CI, 1.46-2.15] for family or friends). Moreover, people with occupational exposure risks and residents in Hubei province had increased odds of symptoms of depression (adjusted ORs, 1.96 [95% CI, 1.77-2.17] for occupational exposure; 1.42 [95% CI, 1.19-1.68] for Hubei residence), anxiety (adjusted ORs, 1.93 [95% CI, 1.75-2.13] for occupational exposure; 1.54 [95% CI, 1.30-1.82] for Hubei residence), insomnia (adjusted ORs, 1.60 [95% CI, 1.45-1.77] for occupational exposure; 1.20 [95% CI, 1.01-1.42] for Hubei residence), and acute stress (adjusted ORs, 1.98 [95% CI, 1.79-2.20] for occupational exposure; 1.49 [95% CI, 1.25-1.79] for Hubei residence). Both centralized quarantine (adjusted ORs, 1.33 [95% CI, 1.10-1.61] for depression; 1.46 [95% CI, 1.22-1.75] for anxiety; 1.63 [95% CI, 1.36-1.95] for insomnia; 1.46 [95% CI, 1.21-1.77] for acute stress) and home quarantine (adjusted ORs, 1.30 [95% CI, 1.25-1.36] for depression; 1.28 [95% CI, 1.23-1.34] for anxiety; 1.24 [95% CI, 1.19-1.30] for insomnia; 1.29 [95% CI, 1.24-1.35] for acute stress) were associated with the 4 negative mental health outcomes. Being at work was associated with lower risks of depression (adjusted OR, 0.85 [95% CI, 0.79-0.91]), anxiety (adjusted OR, 0.92 [95% CI, 0.86-0.99]), and insomnia (adjusted OR, 0.87 [95% CI, 0.81-0.94]). Conclusions and Relevance: The results of this survey indicate that mental health symptoms may have been common during the COVID-19 outbreak among the general population in China, especially among infected individuals, people with suspected infection, and people who might have contact with patients with COVID-19. Some measures, such as quarantine and delays in returning to work, were also associated with mental health among the public. These findings identify populations at risk for mental health problems during the COVID-19 pandemic and may help in implementing mental health intervention policies in other countries and regions.

Association between Lifestyle- and Circadian Rhythm-Related Changes, and Different Depression Symptom Clusters during COVID-19.

BACKGROUND: The COVID-19 pandemic brought along a new situation for the population worldwide. The most important safety measures and lockdown expected extreme adaptability and flexibility impacting mental well-being. The aim of our study was to identify associations between changes in lifestyle and circadian rhythm and depression during the pandemic. SUBJECTS AND METHODS: Our analysis has been carried out on the Hungarian data set of the COMET-G study including information on lifestyle and circadian rhythm-associated factors and severity of depression and its 3 symptom clusters. Associations were assessed using linear regression models adjusted for age and sex. RESULTS: All variables reflecting changes in quality and quantity of sleep showed significant associations with overall depression scores and the three distinct symptom cluster scores. All variables reflecting importance and changes in physical activity during the pandemic were similarly significantly associated with all depression measures. However, only changes in quality of diet, but not quantity was associated with depression scores. CONCLUSIONS: Our results may confirm the association of circadian rhythm and lifestyle-related environmental factors in deterioration of mental health during COVID and help devise prevention and intervention methods and targets for similar situations.

Inflammation at the crossroads of COVID-19, cognitive deficits and depression.

Acute neurological alterations have been associated with SARS-CoV-2 infection. Additionally, it is becoming clear that coronavirus disease 2019 (COVID-19) survivors may experience long-term neurological abnormalities, including cognitive deficits and mood alterations. The mechanisms underlying acute and long-term impacts of COVID-19 in the brain are being actively investigated. Due to the heterogeneous manifestations of neurological outcomes, it is possible that different mechanisms operate following SARS-CoV-2 infection, which may include direct brain infection by SARS-CoV-2, mechanisms resulting from hyperinflammatory systemic disease, or a combination of both. Inflammation is a core feature of COVID-19, and both central and systemic inflammation are known to lead to acute and persistent neurological alterations in other diseases. Here, we review evidence indicating that COVID-19 is associated with neuroinflammation, along with blood-brain barrier dysfunction. Similar neuroinflammatory signatures have been associated with Alzheimer's disease and major depressive disorder. Current evidence demonstrates that patients with pre-existing cognitive and neuropsychiatric deficits show worse outcomes upon infection by SARS-CoV-2 and, conversely, COVID-19 survivors may be at increased risk of developing dementia and mood disorders. Considering the high prevalence of COVID-19 patients that recovered from infection in the world and the alarming projections for the prevalence of dementia and depression, investigation of possible molecular similarities between those diseases may shed light on mechanisms leading to long-term neurological abnormalities in COVID-19 survivors.

Impact of COVID-19 on mental health: Effects on screening, care delivery, and people with cystic fibrosis.

BACKGROUND: Depression and anxiety are two to four times more prevalent in people with CF (pwCF) than the general population. COVID-19 may exacerbate mental health challenges, increasing demand for psychological services, while decreasing their availability. We assessed the impact of the pandemic on depression and anxiety in pwCF, including how COVID-19 affected the frequency of mental health screening and the types of services provided. METHODS: A 38-item internet survey, completed in June 2020, assessed how COVID-19 affected: 1) the mental health clinician's role and screening processes; 2) barriers to screening and resource needs; 3) impact of COVID-19 on depression and anxiety, and 4) positive outcomes and confidence in sustaining mental health screening and treatment, including telehealth services, after the pandemic. RESULTS: Responses were obtained from 131 of the 289 US CF programs. Overall, 60% of programs (n=79) continued mental health screening and treatment, although less frequently; 50% provided individual tele-mental health interventions, and 9% provided telehealth group therapy. Clinically elevated depression symptoms (PHQ-9≥10; moderate to severe), were found in 12% of 785 pwCF, with 3.1% endorsing suicidal ideation. Similarly, elevated anxiety (moderate to severe; GAD-7≥10) was found in 13% of pwCF (n=779). CONCLUSIONS: The COVID-19 pandemic created an opportunity to implement innovative solutions to disruptions in mental health screening and treatment in CF programs. We found that pwCF had increased access to psychological interventions during the pandemic via telehealth, supporting the continued integration of tele-mental health screening and treatment into CF care.

Investigations on the Respiratory Function in COVID-19 Patients: A Prospective Cohort Study.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a global public health crisis. However, whether it can cause respiratory dysfunction or physical and psychological disorders in patients remains unknown. Thus, this study was conducted to investigate the respiratory function, activities of daily living, quality of life, and mental status of patients with COVID-19. Participants and outcomes. Data was collected from the follow-up of eligible patients who attended the fever clinic of three hospitals in Jiangxi Province, from March to May 2020. The outcomes included respiratory muscle function, degree of dyspnea, aerobic capacity, activities of daily living, quality of life, and mental status. RESULTS: A total of 139 patients (72 men and 67 women) were included in this study. The proportions of mild, moderate, severe, and critical cases of COVID-19 were 7.1% (10 cases), 68.3% (95 cases), 20.1% (28 cases), and 4.2% (6 cases), respectively. The rates of abnormal maximal inspiratory pressure were 10.0%, 25.2%, 25.0%, and 16.7%, respectively. There were 50%, 65.3%, 50%, and 66.7% of the patients with abnormal dyspnea in the four clinical classifications, respectively. Patients generally show a decline in quality of life, anxiety, and depression symptoms. CONCLUSIONS: Respiratory dysfunction, decreased quality of life, and psychological disorders were present in each clinical classification of COVID-19. Therefore, it is necessary to carry out respiratory rehabilitation and psychological intervention for COVID-19 patients.

Is there a common pathophysiological mechanism between COVID-19 and depression?

COVID-19 is a disease caused by SARS-CoV-2 and was initially considered to cause serious damage to the respiratory system. Over time, it has been found to affect other organs due to its ability to bind to the ACE2 receptor (type 2 angiotensin-converting enzyme), which can be found in various tissues, including the central nervous system. In addition, a large formation of pro-inflammatory cytokines responsible for various lesions was observed during the evolution of this disease. Our objective was to demonstrate the molecular mechanisms involved in the infection that may demonstrate the relationship between COVID-19 and the development of depressive conditions. Based on the main medical databases (LiLacs, SciELO, Bireme, Scopus, EBSCO, and PubMed) and using the terms 'coronavirus infections' AND 'Inflammation' AND 'depression' AND 'cytokines', we conducted an integrative review of articles published in 2020. Considering this stage of Covid-19 and the inflammatory component of depression, this review showed a relationship between these two conditions based on common pathophysiological mechanisms indicating possible depressive disorders in surviving patients, especially in the most severe cases. The role of inflammatory cytokines and the presence of ACE-2 receptors on the cell surface appear to be the common pathophysiological mechanism between COVID-19 and depression.

Effect of COVID-19 pandemic on mental health among Bangladeshi healthcare professionals: A cross-sectional study.

The COVID-19 has been spreading across the world since December 2019. The pandemic has created tremendous fear of death from infection and awful psychological pressure on healthcare professionals (HCPs). The measures of psychological effects of the COVID-19 outbreak on the Bangladeshi HCPs are unknown. The present study aimed to assess the mental health outcomes of Bangladeshi HCPs and associated risk factors. We conducted this cross-sectional study from July 15 to September 20, 2020. A total of 355 HCPs aged between 20 and 60 years residing in Bangladesh participated in this study. All the participants completed a self-administered questionnaire through Google Forms consisting of socio-demographic characteristics and mental health outcomes. We measure loneliness, depression, anxiety, and sleep disturbance using the UCLA loneliness scale-8, patient health questionnaire-9, 7-item generalized anxiety disorder scale, Pittsburgh sleep quality index. The present study observed the prevalence of loneliness, depression, anxiety, and sleep disturbance among HCPs were 89%, 44%, 78%, and 87%, respectively. The factors significantly associated with the development of mental health problems among HCPs were working environment, economic condition, education level, area of residence, marital status, gender differences, professional category, body mass index, and smoking habit. Moreover, we have seen significant correlations among the different mental health outcomes. In Bangladesh, a large portion of HCPs reported mental health issues during the COVID-19 pandemic. COVID-19 pandemic incredibly impacted the psychological health of Bangladeshi healthcare professionals. Appropriate supportive programs and interventional initiatives might help the HCPs with mental health problems during and after this pandemic.

Changes in mental health during the COVID-19 crisis in Romania: A repeated cross-section study based on the measurement of subjective perceptions and experiences.

The coronavirus 2019 (COVID-19) pandemic has caused dramatic changes in the daily lives of Romanians, affecting their mental health. The COVID-19 pandemic has evolved at three significant peaks, which sequentially occurred on: April 29, 2020; September 18, 2020; and the third wave registered the highest severity on November 27, 2020. Little is known about the mental health changes during this phase of this pandemic. This study evaluated mental health levels in Romania at the end of the first wave of the pandemic and amidst the third and most severe wave. We administered a two-phase internet-based survey among 543 and 583 participants, respectively, recruited through snowball sampling at a 6-month interval. The IPAT Anxiety Scale measured anxiety, the Beck's Depression Inventory measured depression, and the Dissociative Experiences Scale measured dissociation. We observed no statistically significant differences in the number of participants with clinically relevant scores at either time point. In the first survey, 23.8%, 19.2%, and 32.6% reported being clinically anxious, clinically depressed, and showed clinical dissociation, respectively. Binary logistic regressions indicated that age, education level, and previous traumatic events were significantly associated with clinical levels of anxiety and depression. Moreover, multiple linear regression analysis reported a collective significant effect of gender, age, psychological impact, traumatic events, and dissociation on predicting high levels of anxiety and depression. Romanian adults' mental health status was affected during the COVID-19 pandemic, and it did not change 6 months after the first lockdown.

Depression and cardiovascular disease.

PURPOSE OF REVIEW: The purpose of this review is to outline the relationship between cardiovascular disease (CVD) and depression, both as a cause of and a result of CVD. RECENT FINDINGS: The prevalence of depression seems to be increasing in the general population.It is likely that depression will be even more of a problem for CVD patients in the post-COVID-19 pandemic era.New studies confirm the independent association of depression with later incident CVD, although perhaps not as strong as suggested by some previous studies.Depression seems to be becoming even more prevalent in CVD patients, with new data for stroke and peripheral arterial disease patients.Cardiologists rarely screen for depression and most do not believe that they have a responsibility for detecting or treating depression.There are new data suggesting that patients who are more in control of their lives have better outcomes and that change is possible. SUMMARY: Depression is preventable and treatable. It is imperative to detect and manage depression in CVD patients. Additional research is required to see whether or not comprehensive patient screening for depression translates into both better quality of life and improved clinical outcomes.

The Association between Emotional Stress, Sleep Disturbance, Depression, and Burning Mouth Syndrome.

INTRODUCTION: Burning mouth syndrome (BMS) is one of the challenging clinical problems not only in its diagnosis and treatment but also its concurring mental impact. This study is aimed at determining the association between psychological factors, including emotional stress, depression, anxiety, and sleep pattern among BMS patients. METHODS: In this cross-sectional study, 19 patients with idiopathic BMS were enrolled along with a control group equivalent in age and sex, but without BMS. Questionnaires used were the Visual Analog Scale (VAS), the Pittsburgh Sleep Quality Index (PSQI), and the Depression, Anxiety, and Stress Scale (DASS-21). Demographic information was also recorded and analyzed. RESULTS: There was a significant correlation among the two groups of BMS and non-BMS patients regarding stress, depression, and sleep disorder. The average severity of the burning score was 8.31 among the patients. Furthermore, a significant correlation was observed among mental disorders and educational level and sex, but not with age. There was also no significant correlation among the severity of the burning score with sex, education, and mental disorder. CONCLUSION: BMS is significantly associated with psychological symptoms. This condition requires proper treatment and support because it can represent psychological or mental issues and/or have a significant effect on daily life.

Nurses' Mental Health During the Covid-19 Outbreak: A Cross-Sectional Study.

OBJECTIVE: To describe nurses' mental health status during the Covid-19 outbreak and to explore the factors that might accentuate the negative consequences on their mental health. METHODS: We conducted an online survey to evaluate demographic variables, working conditions, family dynamics, and mental health variables in nurses working in healthcare settings, in Portugal, during the Covid-19 outbreak. RESULTS: Portuguese nurses presented higher depression, anxiety and stress levels, when compared to the Portuguese general population, during the outbreak. Overall, nurses who did not consider the quantity and quality of personal protective equipment as adequate presented significantly higher levels of depression, anxiety, and stress. CONCLUSIONS: Our results suggest that nurses' mental health status seems to be particularly affected by the Covid-19 outbreak and that some modifiable elements might accentuate the impacts on their mental health.

Healthcare workers' sleep and mood disturbances during COVID-19 outbreak in an Iranian referral center.

PURPOSE: This study aimed to assess the frequency of sleep and mood disturbances, and their association with COVID-like symptoms in healthcare workers (HCWs) with and without positive Coronavirus RT-PCR in a corona referral center. METHODS: This study was a cross-sectional, anonymous survey of adult HCWs. Data collection was performed in May and June 2020, while governmental restrictions were in place. The participants completed the forms including six separate parts: personal and occupational information, Insomnia Severity Index (ISI), Generalized Anxiety Disorder-7 (GAD-7), Patient's Health Questionnaire (PHQ-9), Pittsburgh Sleep Quality Index (PSQI), and COVID-like symptoms and Coronavirus RT-PCR status. RESULTS: Among the 372 HCW participants, 245 (66%) were women and  mean age was 34.5 ± 7.1 years (age range 23 to 58). The mean scores of all questionnaires except ISI were significantly higher in the HCWs with positive Coronavirus RT-PCR than another group (PSQI, 9 ± 3.4 vs. 6.9 ± 3.1; GAD-7, 9.8 ± 3.6 vs. 7.9 ± 5.3; PHQ-9, 12.8 ± 6.1 vs. 9.5 ± 6.4, P < 0.05; and ISI, 13.8 ± 5.3 vs. 12.3 ± 6 P = 0.163). Positive association between COVID-like symptoms and sleep and mood disturbances was found in the group without a positive test result. Analysis of questionnaires showed higher scores in the group directly involved except for ISI (P < 0.001 and P = 0.053 respectively). CONCLUSIONS: During the COVID-19 pandemic, the HCWs in this sample experienced a high rate of sleep and mood disturbances. There was also a strong association between sleep and mood disturbances and COVID-like symptoms in the group without a positive RT-PCR result. With all this considered, effective psychological support for HCWs during crisis seems to be necessary.

Social isolation stress facilitates chemically induced oral carcinogenesis.

Social isolation has affected a large number of people and may lead to impairment of physical and mental health. Although stress resulting from social isolation may increase cancer progression, its interference on tumorigenesis is poorly known. In this study, we used a preclinical model to evaluate the effects of social isolation stress on chemically induced oral carcinogenesis. Sixty-two 21-day-old male Wistar rats were divided into isolated and grouped groups. After 90 days of age, the rats from both groups underwent oral carcinogenesis with 4-nitroquinoline 1-oxide (4NQO) for 20 weeks. All rats were assessed for depressive-like behavior and euthanized for oral squamous cell carcinoma (OSCC) diagnosis and measurement of inflammatory mediators in the tumor microenvironment. Social isolation stress increased the OSCC occurrence by 20.4% when compared to control. Isolated rats also showed higher tumor volume and cachexia than the grouped rats. Social isolation did not induce changes in the depressive-like behavior after carcinogenic induction. Tumors from stressed rats had increased levels of the inflammatory mediators, TNF-alpha, IL1-beta and MCP-1. The concentrations of TNF-alpha and MCP-1 were significantly increased in the large tumors from isolated animals. Higher tumor levels of TNF-alpha, IL-6, IL1-beta and MCP-1 were positively correlated with OSCC growth. This study provides the first evidence that social isolation stress may facilitate OSCC occurrence and tumor progression, an event accompanied by increased local levels of inflammatory mediators.

Impacts of the COVID-19 pandemic on functional dyspepsia and irritable bowel syndrome: A population-based survey.

BACKGROUND AND AIM: Functional gastrointestinal disorders are a group of stress-sensitive gut-brain disorders. The COVID-19 outbreak has caused immense stress and anxiety among the general public. Strict measures to counter COVID-19 emergency, including physical distancing, have also taken a toll on physical and mental health. We investigated the impact of the COVID-19 pandemic on the gastrointestinal and psychological symptoms of functional dyspepsia (FD) and irritable bowel syndrome (IBS). METHODS: An online survey was conducted in Japan for a group of randomly assigned panelists from May 26 to 27, 2020. Each respondent answered a questionnaire on stress, physical distancing, and worries about COVID-19. Gastrointestinal symptoms were assessed to diagnose FD and IBS (Rome III), and psychological symptoms were assessed using the Hospital Anxiety and Depression Scale. RESULTS: A total of 5157 subjects were finally enrolled, with FD in 8.5%, IBS in 16.6%, and FD-IBS overlap in 4.0%. For both gastrointestinal and psychological symptoms, respondents with FD-IBS overlap showed the worst scores, followed by IBS-alone, then FD-alone respondents. During the COVID-19 pandemic, 11.9% of respondents reported deterioration and 2.8% reported improvement of gastrointestinal symptoms. FD-IBS overlap, psychological disease comorbidity, and stress at work/school were significantly associated with symptom deterioration. Younger age, commuting by public transport, and work/study from home were associated with symptom improvement. CONCLUSIONS: The COVID-19 pandemic negatively affected FD/IBS subjects, with respondents showing FD-IBS overlap syndrome as the most important independent factor associated with deterioration in gastrointestinal symptoms. Physicians need to take extra care of FD/IBS patients in the post-COVID period.

Post-COVID-19 Epidemic: Allostatic Load among Medical and Nonmedical Workers in China.

BACKGROUND: As the fight against the COVID-19 epidemic continues, medical workers may have allostatic load. OBJECTIVE: During the reopening of society, medical and nonmedical workers were compared in terms of allostatic load. METHODS: An online study was performed; 3,590 Chinese subjects were analyzed. Socio-demographic variables, allostatic load, stress, abnormal illness behavior, global well-being, mental status, and social support were assessed. RESULTS: There was no difference in allostatic load in medical workers compared to nonmedical workers (15.8 vs. 17.8%; p = 0.22). Multivariate conditional logistic regression revealed that anxiety (OR = 1.24; 95% CI 1.18-1.31; p < 0.01), depression (OR = 1.23; 95% CI 1.17-1.29; p < 0.01), somatization (OR = 1.20; 95% CI 1.14-1.25; p < 0.01), hostility (OR = 1.24; 95% CI 1.18-1.30; p < 0.01), and abnormal illness behavior (OR = 1.49; 95% CI 1.34-1.66; p < 0.01) were positively associated with allostatic load, while objective support (OR = 0.84; 95% CI 0.78-0.89; p < 0.01), subjective support (OR = 0.84; 95% CI 0.80-0.88; p < 0.01), utilization of support (OR = 0.80; 95% CI 0.72-0.88; p < 0.01), social support (OR = 0.90; 95% CI 0.87-0.93; p < 0.01), and global well-being (OR = 0.30; 95% CI 0.22-0.41; p < 0.01) were negatively associated. CONCLUSIONS: In the post-COVID-19 epidemic time, medical and nonmedical workers had similar allostatic load. Psychological distress and abnormal illness behavior were risk factors for it, while social support could relieve it.

The impact of SARS-CoV-2 on the mental health of healthcare workers in a hospital setting-A Systematic Review.

OBJECTIVES: The SARS-CoV-2 global pandemic has subjected healthcare workers (HCWs) to high risk of infection through direct workplace exposure, coupled with increased workload and psychological stress. This review aims to determine the impact of SARS-CoV-2 on mental health outcomes of hospital-based HCWs and formulate recommendations for future action. METHODS: A systematic review was performed between 31st December 2019 and 17th June 2020 through Ovid Medline and Embase databases (PROSPERO ID CRD42020181204). Studies were included for review if they investigated the impact of SARS-CoV-2 on mental health outcomes of hospital-based HCWs and used validated psychiatric scoring tools. Prevalence of ICD-10 classified psychiatric disorders was the primary outcome measure. RESULTS: The initial search returned 436 articles. Forty-four studies were included in final analysis, with a total of 69,499 subjects. Prevalence ranges of six mental health outcomes were identified: depression 13.5%-44.7%; anxiety 12.3%-35.6%; acute stress reaction 5.2%-32.9%; post-traumatic stress disorder 7.4%-37.4%; insomnia 33.8%-36.1%; and occupational burnout 3.1%-43.0%. Direct exposure to SARS-CoV-2 patients was the most common risk factor identified for all mental health outcomes except occupational burnout. Nurses, frontline HCWs, and HCWs with low social support and fewer years of working experience reported the worst outcomes. CONCLUSION: The SARS-CoV-2 pandemic has significantly impacted the mental health of HCWs. Frontline staff demonstrate worse mental health outcomes. Hospitals should be staffed to meet service provision requirements and to mitigate the impact onmental health. This can be improved with access to rapid-response psychiatric teams and should be continually monitored throughout the pandemic and beyond its conclusion.

Influence of the COVID-19 outbreak in people with epilepsy: Analysis of a Spanish population (EPICOVID registry).

BACKGROUND: The aim of this study was to have a better understanding of the influence of the coronavirus disease 2019 (COVID-19) pandemic in people with epilepsy (PWE) and to assess whether there have been changes in seizure control during the current COVID-19 outbreak, exploring the possible causes thereof. METHODS: This is an observational, retrospective study based on prospective data collection of 100 successive patients who attended an epilepsy outpatient clinic either face-to-face or telephonically during the months of the COVID-19 outbreak and national state of emergency. RESULTS: One hundred patients were included, 52% women, mean age 42.4 years. During the COVID-19 period, 27% of the patients presented an increase of >50% of seizure frequency. An increase of stress/anxiety (odds ratios (OR): 5.78; p = 0.008) and a prior higher seizure frequency (OR: 12.4; p = 0.001) were associated with worsening of seizures. Other risk factors were exacerbation of depression, sleep deprivation, less physical activity, and history of epilepsy surgery. Three patients had status epilepticus (SE) and one a cluster of seizures. Likewise, 9% of patients improved their seizure control. Reduction in stress/anxiety (OR: 0.05; p = 0.03) and recent adjustment of antiepileptics (OR: 0.07; p = 0.01) acted as protecting factors. CONCLUSIONS: A high proportion of PWE suffered a significant worsening of their seizure control during the months of the COVID-19 pandemic. Emotional distress due to home confinement was the main factor for the change in seizure control. Promoting physical activity and adequate sleep may minimize the potential impact of the pandemic in PWE. Ensuring correct follow-up can prevent decompensation in those PWE at high risk.