Quantitative and qualitative analysis of medical students’ symptoms and feelings during COVID-19 pandemic (preprint)

Background Due to the COVID-19 pandemic, traditional face-to-face teaching was disrupted, leading to a transition to online activities. Social restrictions and isolation during this period may have contributed to various physical and emotional disorders, such as anxiety, depression, reduced perception of happiness, and a decline in overall quality of life. The objective of our study was to assess the perceptions of medical students regarding their emotions, anxiety and depression symptoms, and daily experiences during the pandemic.Methods We conducted a prospective study with both quantitative and qualitative components involving students in their 1st to 4th year of medicine at a private university in São Paulo, Brazil in 2020 and 2021. Participants completed online questionnaires, including the State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), Oxford Happiness Questionnaire (OHQ), and Medical Student Quality-of-Life Questionnaire (VERAS-Q). Additionally, they engaged in online focus group discussions.Results A total of 313 students completed the questionnaires, and 200 participated in the focus group. Women exhibited higher scores for anxiety (p = 0.002) and depression (p = 0.007), while men demonstrated better quality of life (p = 0.042). The students aged 18 to 24 years (p = 0.048) presented better quality of life and lower trait anxiety (p = 0.001). Both trait and state anxiety were strongly associated with depression (p < 0.01) and inversely related to quality of life, showing a moderate association with happiness (p < 0.01). Depression was strongly linked to both trait and state anxiety (p < 0.01) and moderately negatively correlated with happiness and quality of life (p < 0.01). The focus groups revealed recurring negative feelings among students, such as anxiety, depression, tiredness, discouragement, loneliness, difficulty managing time, poor sleep quality, exacerbation of harmful habits, and challenges in relationships, resulting in reduced mental and physical health during the pandemic. Coping strategies were discussed, including the adoption of new healthy habits, religious practices, and reconnection with family.Conclusion Depression and anxiety symptoms were more prevalent among females, while quality of life improved for younger and male students. The qualitative analysis enhanced our understanding of the determinants and consequences of students' recurring negative feelings, and also showed positive aspects like greater proximity to family and religiosity.

The impact of Covid-19 on menstrual cycle’s alterations, in relation to depression and sleep disturbances: a prospective observational study in a population of medical students (preprint)

Background: The sars-Cov-2 pandemic has determined adverse circumstances beyond everyday experience, leading to psychological stress, with particular relevance to the young population of female medical students. This work aims at studying the impact of the pandemic on menstrual cycle alteration in relation to psychological stress, monitoring the presence of depression, sleep disturbances and post-traumatic stress, on a population of medical students. Methods: 293 female students (23,08 years old ±3,8) were enrolled. One year after quarantine, a personal data sheet on menstrual cycle, the Beck Depression Inventory (BDI) and the Impact of Event Scale (IES-R) have been administered. Results: A statistically significant association between menstrual alterations and stress during pandemic has been found. The onset of depressive symptoms and sleep disturbances has been observed in 57,1% and in 58,1% of young women with cycle’s alterations, respectively. Amenorrhea was three times more common in female students with depressive symptoms, PMS had a significant correlation with both depression and sleep disturbances. Pandemic has been related to menstrual alterations, with depressive symptoms and sleep disorders. Amenorrhea is connected to depression, as observed on the functional hypothalamic amenorrhea (FHA). Conclusions:  Post-traumatic stress disorder has not been found, it may be more likely associated with high physical and psychological stress in frontline female health workers during the pandemic. New strategies of psychological intervention should be considered after pandemic experience, in order to help students, and particularly medical trainees, with specific attention to women’s needs.

Increased insulin resistance due to Long COVID is associated with depressive symptoms and partly predicted by the inflammatory response during acute infection (preprint)

Background: Some months after the remission of acute COVID-19 infection, some people show depressive symptoms, which are predicted by increased peak body temperature (PBT) and lowered blood oxygen saturation (SpO2). Nevertheless, no data indicate whether Long COVID is associated with increased insulin resistance (IR) in association with depressive symptoms and immune, oxidative, and nitrosative (IO&NS) processes. Methods. We used the homeostasis Model Assessment 2 (HOMA2) calculator to compute beta-cell function, insulin sensitivity and resistance (HOMA2-IR) and measured the Beck Depression Inventory (BDI) and the Hamilton Depression Rating Scale (HAMD) in 86 Long COVID patients and 39 controls. We examined the associations between the HOMA2 indices and PBT and SpO2 during acute infection, and depression, IO&NS biomarkers (C-reactive protein, NLRP3 activation, myeloperoxidase, and advanced oxidation protein products) 3-4 months after the acute infection. Results. Long COVID is accompanied by increased HOMA2-IR, fasting blood glucose, and insulin levels. We found that 33.7% of the patients versus 0% of the controls had HOMA2-IR values >1.8, suggesting IR. PBT, but not SpO2, during acute infection significantly predicted IR, albeit with a small effect size. Increased IR was significantly associated with depressive symptoms as assessed with the BDI and HAMD above and beyond the effects of IO&NS pathways. There were no significant associations between increased IR and the activated IO&NS pathways during Long COVID. Conclusion. Long COVID is associated with new-onset IR in a subset of patients. Increased IR may contribute to the onset of depressive symptoms due to Long COVID by enhancing overall neurotoxicity.

What is the impact of post-COVID-19 syndrome on health-related quality of life and associated factors: a cross-sectional analysis (preprint)

Background. After the acute phase, symptoms or sequelae related to post-COVID-19 syndrome may persist for months. We aim to measure their impact on health-related quality of life (HRQoL) and to investigate influencing factors, among patients, previously hospitalized and not, followed up to 12 months.Methods. We present the cross-sectional analysis of a prospective study, including patients referred to the post-COVID-19 service. Questionnaires and scales administered at 3, 6, 12 months were: Short-Form 36-item questionnaire (SF-36); Visual Analogue Scale of the EQ5D (EQ-VAS); in a subgroup, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II) and Pittsburgh Sleep Quality Index (PSQI). Linear regression was used to assess for the presence of a trend over time by month of evaluation after the acute infection (continuous measure in month); two different linear regression models were fitted to identify factors associated with HRQoL.Results. We considered the first assessment of each participant (n = 572): 235 (41%), 175 (31%) and 118 (21%) patients were evaluated 3 months [median 3.5 (IQR 2.9-3-9)], 6 months [5.6 (5.0-6.5)], and more than 6 months [9.6 (8.3–14.7)], after the acute infection, respectively. The mean scores in SF-36 and in EQ-VAS were significantly lower than the Italian normative values and remained stable over time, except the mental components score (MCS) of the SF-36 and EQ-VAS which resulted in lower ratings at the last observations. Female gender, presence of comorbidities, and corticosteroids treatment during acute COVID-19, were associated with lower scores in SF-36 and EQ-VAS; patients previously hospitalized (54%) reported higher MCS. Alterations in BAI, BDI-II, and PSQI, evaluated in a subgroup of 265 participants, were associated with lower ratings in SF-36 and EQ-VAS.Conclusions. This study provides evidence of a significantly bad perception of health status among persons with post-COVID-19 syndrome, associated with female gender and, indirectly, with disease severity. In case of anxious-depressive symptoms and sleep disorders, a worse HRQoL was also reported. A systematic monitoring of these aspects is recommended to properly manage the post-COVID-19 period.

Effectiveness of the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders in Online and Group format in Argentina: study protocol for a randomized controlled trial (preprint)

Background The Unified Protocol (UP) is a transdiagnostic intervention based on emotional regulation for the treatment of emotional disorders. Its application in individual and group formats has been studied worldwide, obtaining similar results to specific protocols but with a lower drop-out rate and improving the cost-benefit ratio, since a larger number of patients can benefit from it. Moreover, the inclusion of digital technologies in psychotherapy aims to improve the accessibility of treatments, especially since the pandemic of Covid-19 that forced the implementation of treatments through teletherapy increasing its use. To date, no studies have been carried out in Argentina on the application of the UP in a group format and through teletherapy. The aim of the present study is to evaluate the efficacy of the UP in a group format and through teletherapy in the argentine population. Methods A parallel-group, controlled, randomized trial, with a pre-post and repeated follow-up measures intergroup design will be conducted. 180 patients will be randomized to one of the following conditions: an online, group-based UP intervention or a waiting list. The Beck Depression Inventory II and the Beck Anxiety Inventory will be used to compare primary outcomes and the Beck Hopelessness Scale, Difficulties in Emotion Regulation Scale, Positive Affect and Negative Affect Scale, and Multicultural Quality of life Index will be administered for secondary outcomes at baseline, post-intervention, and 3 months follow-up. Ad-doc questionnaires will be used to assess patients' experiences and treatment satisfaction. Discussion The purpose of this trial is to evaluate the efficacy of the online and group application of the UP in the Argentine population, as well as to evaluate the patient's experience and satisfaction with the treatment. It is expected that the findings of this study will be useful in reducing anxious and depressive symptomatology, will allow us to adapt the UP to our culture, and will improve accessibility to treatment. Trial registration: ClinicalTrials.gov ID: NCT05275322 Registered on 11 March 2022,

sexual function and its associated factors in Iranians with and without a recent history of COVID-19 infection (preprint)

This study was designed to investigate the sexual function and its associated factors in Iranian women and men with and without a recent history of contracting COVID-19. This cross-sectional study was conducted with 384 individuals from August 1 to December 25, 2021, in Iran. The respondents were asked to fill out the International Index of Erectile Function (IIEF) questionnaire, the Female Sexual Function Index (FSFI) questionnaire, the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI-II), and Haj-Yahia’s questionnaire of violence against women. The results showed that mean FSFI score of female respondents was 20.39 ± 4.15. Women with a recent history of COVID-19 infection had significantly lower scores in the orgasm (P = 0.012) and satisfaction (P = 0.030) dimensions of FSFI. The mean IIEF score of male respondents was 17.79 ± 4.31. There was a significant difference between groups with and without a recent history of COVID-19 in terms of mean IIEF score and also mean scores of each dimension of IIEF (p = 0.004). Multivariate regression showed that women’s sexual function was associated with age and BDI-II score, whereas men’s sexual function was associated with the history of recent COVID-19 infection and the education level. In addition, the results suggest an increase in the prevalence of sexual dysfunction during the COVID-19 pandemic in both women and men. These results can help the country’s health policymakers to devise appropriate measures for mitigating the adverse impacts of the COVID-19 pandemic on the well-being of communities, families, and individuals.

The reliability and success of peritoneal dialysis during the COVID-19 pandemic (preprint)

Aim: This study aimed to evaluate the symptoms, changes in laboratory findings during the COVID-19 pandemic, and the effect of depression on symptoms associated with end-stage kidney disease in patients with peritoneal dialysis (PD).Methods: This was an observational and cross-sectional study. The patients underwent three different PD modalities, including continuous ambulatory PD, automated peritoneal dialysis, and remote monitoring automated peritoneal dialysis (RM-APD). All patients were asked to complete the clinical assessment form and Beck depression and anxiety inventory. Additionally, the last two laboratory evaluations during this period were examined.Results: A total of 123 patients undergoing PD were included. None of the patients were diagnosed with COVID-19 infection. Serum ferritin, creatinine, phosphorus, albumin and parathyroid hormone levels were significantly elevated in the total study population (p=0.03, p=0.01, p=0.02, p=0.02 and p=0.05, respectively). While calcium, phosphorus, and parathyroid hormone tended to increase in patients with APD or CAPD, they remained stable in patients performing RM-APD. Most of the patients did not experience dyspnea, pitting edema, difficulty in blood pressure control, palpitation, bone muscle pain, or peritonitis. Moderate to severe depression was associated with dyspnea, weight gain, fatigue, palpitation, and increased anxiety.Conclusion: PD is a reliable and successful form of dialysis and can be safely administered even if hospital access is restricted. PD is a safe method of renal replacement therapy to protect patients from COVID-19 infection. Additionally, RM-APD may be a better choice because it provides more stable bone mineral metabolism. Moreover, evaluating depression and anxiety at phone visits may be necessary for accurate clinical assessment.

COVID-19-related mental health burden and reduced awareness of mental healthcare services in low income earners of Western Uganda (preprint)

Background: The imposed COVID-19 lockdown is taking a toll on mental health individuals, with low-income earners considered most affected, as the imposed lockdown was accompanied with partial or complete loss of livelihood among low income earners. The study aimed to investigate level of education and relationship status on awareness of mental healthcare and explore how these factors influence mental health among low income earners in Western Uganda.Methods: A cross sectional descriptive study was undertaken among low-income earners in South Western Uganda. Data were collected from two hundred and fifty-three (253) participants using a structured closed ended questionnaire. Anxiety, anger and depression were assessed using a modified generalized anxiety disorder (GAD-7), Spielberger’s State-Trait Anger Expression Inventory-2 (STAXI-2) and Beck Depression Inventory (BDI) item tools respectively.Result: Most respondents were single male individuals with secondary level of education. Respondents with tertiary level of education and those with partners had higher score (71.7% and 70.28% respectively) for awareness on mental healthcare. Respondents with primary education level and individuals that were single had higher score (46.98% and 43.72% respectively) for anxiety. Respondents with primary education level and those living with partners had higher mean score (56.44% and 56.21% respectively) for anger. Respondents with no formal education and those who had lost partners had higher mean score (32.11% and 30.50% respectively) for depression. Individuals without formal educational and primary education were observed to have a negative correlation (r2 = 47.4 and 6.4% respectively) with awareness on mental healthcare, and the no formal group had positive correlation with anger and depression (r2 =1.9 and 0.3% respectively), while other groups were negatively correlated (r2 =10.1%). The group of single individuals had a negative correlation with awareness on mental healthcare, anger and depression (r2 =1.9, 0.8 and 0.3% respectively), and a positive correlation with anxiety (r2 =3.9%).Conclusion: It is evident that education and relationship status influence awareness on mental healthcare and mental health state among low income earners in Western Uganda. Therefore, we suggest policy maker pay more attention to social transformation, through proper engagement of low income earners.

COVID-19 related mental health burdens: Impact of educational level and relationship status among low income earners of Western Uganda (preprint)

Introduction: The imposed COVID-19 lockdown is taking a toll mental health, with low-income earners considered particularly affected. The study aimed to investigate level of education and relationship status on awareness of mental healthcare and explore how these factors influence mental health among low income earners in Western Uganda. Methods: A cross sectional descriptive study was undertaken among low-income earners in South Western Uganda. Data were collected from two hundred and fifty-three (253) participants using a structured closed ended questionnaire. Anxiety, anger and depression were assessed using a modified generalized anxiety disorder (GAD-7), Spielberger’s State-Trait Anger Expression Inventory-2 (STAXI-2) and Beck Depression Inventory (BDI) item tools respectively. Result: Most respondents were single male individuals with secondary level. Respondents with tertiary level of education and those with partners had higher score (71.7% and 70.28% respectively) for awareness on mental healthcare. Respondents with primary education level and individuals that were single had higher score (46.98% and 43.72% respectively) for anxiety. Respondents with primary education level and those living with partners had higher mean score (56.44% and 56.21% respectively) for anger. Respondents with no formal education and those who had lost partners had higher mean score (32.11% and 30.50% respectively) for depression. Individuals without formal educational and primary education were observed to have a negative correlation (r 2 = 47.4 and 6.4% respectively) with awareness on mental healthcare, and the no formal group had positive correlation with anger and depression (r 2 =1.9 and 0.3% respectively), while other groups were negatively correlated (r 2 =10.1%). The group of single individuals had a negative correlation with awareness on mental healthcare, anger and depression (r 2 =1.9, 0.8 and 0.3% respectively), and a positive correlation with anxiety (r 2 =3.9%). Conclusion: It is evident that education and relationship status influence awareness on mental healthcare and mental health state among low income earners in Western Uganda. Therefore, we advocate for new approaches in mental healthcare awareness programs equipped with robust strategy, which will focus on improving optimal mental health among these set of people.

Psychological consequences of COVID-19 pandemic in Italian MS patients: signs of resilience? (preprint)

Background: Anxiety, depression and reduction of quality of life (QoL) are common in people with multiple sclerosis (pwMS). Fear of getting sick from COVID-19, government’s lockdown and the imposed social distancing might have an impact on psychological distress and QoL. Objectives: The aim of our study was to investigate anxiety, depression and QoL changes in pwMS during SARS-CoV-2 outbreak and lockdown in Italy.Methods: 67 pwMS with a previous (less than 6 months) neuropsychological evaluation before SARS-CoV-2 outbreak (T0) were re-evaluated at the time of the outbreak and lockdown in Italy (T1). They underwent a clinical and neurological evaluation (at T0) and completed the State-Trait Anxiety Inventory (STAI-Y1), the Beck Depression Inventory second edition (BDI-II), and Multiple Sclerosis Quality of Life-54 (MsQoL-54) at T0 and T1. Bonferroni correction for multiple comparisons was applied.Results: BDI-II and STAI-Y1 scores did not change between T0 and T1, whereas the satisfaction on sexual function subscale of MsQoL-54 was significantly higher at T1 (p<0.001).Conclusions: This is the first study that evaluated mood and QoL levels before and during the lockdown due to COVID-19 pandemic in pwMS. No worsening of anxiety and depression levels was found. Contrariwise, some improvements were noted on QoL, the most reliable regarding the sexual satisfaction.

The Influence of Illness Perception, Anxiety and Depression Disorders on Students Mental Health during COVID-19 Outbreak in Pakistan: A Web-Based Cross-Sectional Survey (preprint)

Background: Since the emergence of a coronavirus disease (2019-nCoV) in December 2019, the whole world is in a state of chaos. Isolation strategy with quarantine is a useful model in controlling transmission and rapid spread. As a result, people remained at homes and disrupted their outside daily activities. It led to the closure of educational institutes, which is a source of many students to cope with numerous personal and familial issues. This study focuses on exploring the relationships and potential mediational pathways between mental health problems, illness perception, anxiety, and depression disorders.Method: The study incorporated snowball sampling techniques through a cross-sectional, web-based survey and recruited 500 students from different public and private universities from twin cities, Rawalpindi, and Islamabad from March 23 to April 15, 2020, during the coronavirus outbreak lockdown. The study used four instruments, Beck Depression Scale, Beck Anxiety Inventory, Revised Illness Perception Questionnaire, and The Warwick-Edinburgh Mental Well-being Scale for assessing depression, anxiety, illness perception, and mental health disorders.Results: The findings indicated normal (43.2%) mild (20.5%), moderate (13.6%), and severe (22.7%) level of anxiety prevalence in students. Results specified a normal (65.9%), mild (9.10%), moderate (9.12%), and severe (15.90%) depression prevalence, and findings stipulated that anxiety disorder prevalence was higher than the depression disorder. The correlational results specified a negative and significant relationship between mental health, illness perception, anxiety, and depression symptoms. The multiple regression analysis stated that anxiety and depression disorders mediated the relationship between mental health and present illness perception. The perception of illness exhibited a relation to depression and anxiety disorders.Conclusion: The study proposed a model to address mental health problems during the lockdown. The (2019-nCoV) illness perception developed mental disorders, including anxiety and depression, which has declined individuals' mental health. There is an urgent need for ongoing clinical examination and management to address psychological disorders, and findings suggest assessing mental health to combatting the pandemic worldwide. Findings recommend developing strategies to promote mental healthcare facilities during COVID-19 wide-ranging disasters. These results highlight the impending importance of devising strategies to treat mental health problems.