Seclusion Reduction on an Adult Inpatient Psychiatric Unit: A Quality Improvement Project.

Seclusion practices have traditionally been used in psychiatry to maintain patient and staff safety. Despite negative emotional consequences for all involved parties and the movement toward patient-centered care, these practices continue in in-patient psychiatric units across the United States. The purpose of the current quality improvement project was to decrease the rate of seclusion events on an adult inpatient psychiatric unit through the implementation of a standard debriefing process based on the National Association of State Mental Health Program Directors' Six Core Strategies for Reducing Seclusion and Restraint Use. In 2020, the seclusion rates at the project site were above state and national benchmarks. Post-intervention, the seclusion hours per 1,000 patient care hours increased by 16% (0.38 to 0.44); however, the mean duration of each seclusion episode decreased by 10% (158 minutes to 142 minutes). Intervention compliance was low, including interprofessional participation. These findings demonstrate the need to address seclusion practices with an evidence-based solution, such as debriefing, coupled with adequate support from interprofessional leadership. [Journal of Psychosocial Nursing and Mental Health Services, 60(6), 27-32.].

Impact of the COVID-19 pandemic and lockdown restrictions on psychosocial and behavioural outcomes among Australian adults with type 2 diabetes: Findings from the PREDICT cohort study.

AIM: To examine psychosocial and behavioural impacts of the novel coronavirus disease 2019 (COVID-19) pandemic and lockdown restrictions among adults with type 2 diabetes. METHODS: Participants enrolled in the PRogrEssion of DIabetic ComplicaTions (PREDICT) cohort study in Melbourne, Australia (n = 489 with a baseline assessment pre-2020) were invited to complete a phone/online follow-up assessment in mid-2020 (i.e., amidst COVID-19 lockdown restrictions). Repeated assessments that were compared with pre-COVID-19 baseline levels included anxiety symptoms (7-item Generalised Anxiety Disorder scale [GAD-7]), depressive symptoms (8-item Patient Health Questionnaire [PHQ-8]), diabetes distress (Problem Areas in Diabetes scale [PAID]), physical activity/sedentary behaviour, alcohol consumption and diabetes self-management behaviours. Additional once-off measures at follow-up included COVID-19-specific worry, quality of life (QoL), and healthcare appointment changes (telehealth engagement and appointment cancellations/avoidance). RESULTS: Among 470 respondents (96%; aged 66 ± 9 years, 69% men), at least 'moderate' worry about COVID-19 infection was reported by 31%, and 29%-73% reported negative impacts on QoL dimensions (greatest for: leisure activities, feelings about the future, emotional well-being). Younger participants reported more negative impacts (p < 0.05). Overall, anxiety/depressive symptoms were similar at follow-up compared with pre-COVID-19, but diabetes distress reduced (p < 0.001). Worse trajectories of anxiety/depressive symptoms were observed among those who reported COVID-19-specific worry or negative QoL impacts (p < 0.05). Physical activity trended lower (~10%), but sitting time, alcohol consumption and glucose-monitoring frequency remained unchanged. 73% of participants used telehealth, but 43% cancelled a healthcare appointment and 39% avoided new appointments despite perceived need. CONCLUSIONS: COVID-19 lockdown restrictions negatively impacted QoL, some behavioural risk factors and healthcare utilisation in adults with type 2 diabetes. However, generalised anxiety and depressive symptoms remained relatively stable.

Women's postpartum experiences in Canada during the COVID-19 pandemic: a qualitative study.

BACKGROUND: The mental health of postpartum women has worsened during the COVID-19 pandemic; however, the experiences that underlie this remain unexplored. The purpose of this study was to examine how people in Canada who gave birth during the pandemic were affected by policies aimed at limiting interpersonal contact to reduce SARS-CoV-2 transmission in hospital and during the early weeks postpartum. METHODS: We took a social constructionist approach and used a qualitative descriptive methodology. Sampling methods were purposive and involved a mix of convenience and snowball sampling via social media and email. Study inclusion was extended to anyone aged 18 years or more who was located in Canada and was pregnant or had given birth during the COVID-19 pandemic. Data were obtained via semistructured qualitative telephone interviews conducted between June 2020 and January 2021, and were analyzed through thematic analysis. RESULTS: Sixty-five interviews were conducted; data from 57 women who had already delivered were included in our analysis. We identified the following 4 themes: negative postpartum experience in hospital owing to the absence of a support person(s); poor postpartum mental health, especially in women with preexisting mental health conditions and those who had had medically complicated deliveries; asking for help despite public health regulations that prohibited doing so; and problems with breastfeeding owing to limited in-person follow-up care and lack of in-person breastfeeding support. INTERPRETATION: Policies that restrict the presence of support persons in hospital and at home during the postpartum period appear to be causing harm. Measures to mitigate the consequences of these policies could include encouraging pregnant people to plan for additional postpartum support, allowing a support person to remain for the entire hospital stay and offering additional breastfeeding support.

How the experience of medical assistance in dying changed during the COVID-19 pandemic in Canada: a qualitative study of providers.

BACKGROUND: In March 2020, all levels of government introduced various strategies to reduce the impact of the COVID-19 pandemic. The purpose of this study was to document how the experience of providing medical assistance in dying (MAiD) changed during the COVID-19 pandemic. METHODS: We conducted a qualitative study using semistructured interviews with key informants in Canada who provided or coordinated MAiD before and during the COVID-19 pandemic. We interviewed participants from April to June 2020 by telephone or email. We collected and analyzed data in an iterative manner and reached theme saturation. Our team reached consensus on the major themes and subthemes. RESULTS: We interviewed 1 MAiD coordinator and 15 providers, including 14 physicians and 1 nurse practitioner. We identified 4 main themes. The most important theme was the perception that the pandemic increased the suffering of patients receiving MAiD by isolating them from loved ones and reducing available services. Providers were distressed by the difficulty of establishing rapport and closeness at the end of life, given the requirements for physical distancing and personal protective equipment. They were concerned about the spread of SARS-CoV-2, and found it difficult to enforce rules about distancing and the number of people present. Logistics and access to MAiD became more difficult because of the new restrictions, but there were many adaptations to solve these problems. INTERPRETATION: Providers and coordinators had many challenges in providing MAiD during the COVID-19 pandemic, including their perception that the suffering of their patients increased. Some changes in how MAiD is provided that have occurred during the pandemic, including more telemedicine assessments and virtual witnessing, are likely to remain after the pandemic and may improve service.

Parental perceptions of COVID-19-like illness in their children.

OBJECTIVES: The objective of the study is to explore parents' perceptions of COVID-19-like symptoms in their child and attitudes towards isolating from others in the household when unwell. STUDY DESIGN: The study used qualitative, semistructured interviews. METHODS: The study involved thirty semistructured telephone interviews with parents of children between 4 and 18 years. Thirty semistructured telephone interviews with parents of children between 4 and 18 years. RESULTS: We found four themes relating to symptom attribution ('normalising symptoms', 'err on the side of caution', 'experience of temperature', 'symptoms not normal for us'). In general, parents were more likely to attribute symptoms to COVID-19 if a temperature was present or the symptoms were perceived as 'unusual' for their family. Four themes relating to self-isolation ('difficult to prevent contact with children', 'isolation would be no different to lockdown life', 'ability to get food and supplies', 'limited space'). Parents believed they would find isolation within the household difficult or impossible if they had dependent children, had limited space or could not shop for groceries. CONCLUSIONS: The findings highlight complexities in symptom perception, attribution and household isolation. We suggest that they can be overcome by (a) providing better guidance on what symptoms require action, (b) providing guidance as to how to prevent infection within the household and (c) by supporting families with grocery shopping through a potential second or third wave.

Varieties of Experiences of Care.

The human sciences have witnessed a decades-long transition from an emphasis on theories centered on hermeneutics and the interpretation of meaning to a preoccupation with theories that privilege performance, action, and being/becoming. This essay develops out of the conceptual orientation of William James, which holds that all knowledge comes from experience, as well as the author's writings on what matters most to participants in local worlds. The essay shows how meaning and being/becoming are unified in moral life and understood as embodied and lived experiences of care and caregiving, and it draws upon the author's experience of being the primary family carer for his late wife, who died of early onset Alzheimer's disease, as well as his experience of self-isolation in the COVID-19 pandemic. The essay's intention is to advance theoretical questions raised in the author's 2019 book The Soul of Care: The Moral Education of a Husband and a Doctor.

[Appreciating COVID-19 as a child and adolescent psychiatrist on the move]. / Appréhender le COVID-19 au fil de l'eau en tant que psychiatre d'enfant et d'adolescent.

COVID-19 is a multi-organ disease due to an infection with the SARS-CoV2 virus. It has become a pandemic in early 2020. The disease appears less devastating in children and adolescents. However, stress, quarantine and eventually mourning have major impacts on development. It is difficult to describe what this pandemic implies for a child psychiatrist, other than by giving a first-hand account. I propose to go through the main ethical questions that have arisen; to describe how my hospital team has reorganized itself to meet the new demands and questions, in particular by opening a unit dedicated to people with autism and challenging behaviors affected by COVID-19; and to address, in a context of national discussion, how the discipline has sought to understand the conditions of a certain well-being during quarantine. Finally, I will try to conclude with more speculative reflections on re-opening.

[Psychopathological consequences of confinement]. / Conséquences psychopathologiques du confinement.

The psychological effects of isolation have already been described in the literature (polar expeditions, submarines, prison). Nevertheless, the scale of confinement implemented during the COVID-19 pandemic is unprecedented. In addition to reviewing the published studies, we need to anticipate the psychological problems that could arise during or at a distance from confinement. We have gone beyond the COVID-19 literature in order to examine the implications of the known consequences of confinement, like boredom, social isolation, stress, or sleep deprivation. Anxiety, post-traumatic stress disorder, depression, suicidal or addictive behaviours, domestic violence are described effects of confinement, but the mechanisms of emergence of these disorders and their interrelationships remain to be studied. For example, what are the mechanisms of emergence of post-traumatic stress disorders in the context of confinement? We also remind the reader of points of vigilance to be kept in mind with regard to eating disorders and hallucinations. Hallucinations are curiously ignored in the literature on confinement, whereas a vast literature links social isolation and hallucinations. Due to the broad psychopathological consequences, we have to look for these various symptoms to manage them. We quickly summarize the diagnostic and therapeutic approaches already in place, such as telemedicine, which is undergoing rapid development during the COVID-19 crisis.

The Psychological Burden of COVID-19 Stigma: Evaluation of the Mental Health of Isolated Mild Condition COVID-19 Patients.

BACKGROUND: The objective of this article is to assess the mental health issues of the mild condition coronavirus disease 2019 (COVID-19) patients admitted to a community treatment center (CTC) in Korea. METHODS: A total of 107 patients admitted to a CTC were included as the study population, and their mental health problems including depression (patient health questionnaire-9), anxiety (generalized anxiety disorder scale-7), post-traumatic stress disorder (PTSD) (PTSD checklist-5) and somatic symptoms (by patient health questionnaire-15) were evaluated every week during their stay. The stigma related to COVID-19 infection was evaluated with an adjusted version of the Middle East respiratory syndrome (MERS) stigma scale. RESULTS: During the first week of isolation, the prevalence of more-than-moderate depression was 24.3%, more-than-moderate anxiety was 14.9%, more-than-moderate somatic symptoms was 36.5% and possible PTSD was 5.6% of total population. For depression and anxiety, previous psychiatric history and stigma of COVID-19 infection were significant risk factors. For PTSD, previous psychiatric history and stigma of COVID-19 infection as well as total duration of isolation were found to be significant risk factors. Prevalence of depression, anxiety and possible PTSD remained similar across the four weeks of observations, though the prevalence of severe depression, increased after four weeks of stay. Somatic symptoms seemed to decrease during their stay. CONCLUSION: The results suggest that social mitigation of COVID-19 related stigma, as well as care of patients with pre-existing mental health problems are important mental health measures during this crisis period. It is also important that clinical guidelines and public health policies be well balanced over the protection of the public and those quarantined to minimize the negative psychosocial consequences from isolation of the patients.

The Impact of the first COVID-19 shelter-in-place announcement on social distancing, difficulty in daily activities, and levels of concern in the San Francisco Bay Area: A cross-sectional social media survey.

BACKGROUND: The U.S. has experienced an unprecedented number of orders to shelter in place throughout the ongoing COVID-19 pandemic. We aimed to ascertain whether social distancing; difficulty with daily activities; and levels of concern regarding COVID-19 changed after the March 16, 2020 announcement of the nation's first shelter-in-place orders (SIPO) among individuals living in the seven affected counties in the San Francisco Bay Area. METHODS: We conducted an online, cross-sectional social media survey from March 14 -April 1, 2020. We measured changes in social distancing behavior; experienced difficulties with daily activities (i.e., access to healthcare, childcare, obtaining essential food and medications); and level of concern regarding COVID-19 after the March 16 shelter-in-place announcement in the San Francisco Bay Area versus elsewhere in the U.S. RESULTS: In this non-representative sample, the percentage of respondents social distancing all of the time increased following the shelter-in-place announcement in the Bay Area (9.2%, 95% CI: 6.6, 11.9) and elsewhere in the U.S. (3.4%, 95% CI: 2.0, 5.0). Respondents also reported increased difficulty obtaining hand sanitizer, medications, and in particular respondents reported increased difficulty obtaining food in the Bay Area (13.3%, 95% CI: 10.4, 16.3) and elsewhere (8.2%, 95% CI: 6.6, 9.7). We found limited evidence that level of concern regarding the COVID-19 crisis changed following the announcement. CONCLUSION: This study characterizes early changes in attitudes, behaviors, and difficulties. As states and localities implement, rollback, and reinstate shelter-in-place orders, ongoing efforts to more fully examine the social, economic, and health impacts of COVID-19, especially among vulnerable populations, are urgently needed.

Effects of centralized isolation vs. home isolation on psychological distress in patients with COVID-19.

OBJECTIVE: This study aimed to evaluate the impact of isolation form on the recovery of psychological distress in patients with coronavirus disease 2019 (COVID-19) after being discharged from hospital. METHODS: Baseline survey was conducted from February 10, 2020 to February 25, 2020 in patients with COVID-19 in a designated hospital on the discharge day. After discharge, patients were free to choose whether isolate in a centralized isolation site (i.e. designated hotel) or their own home for another two weeks. A follow-up survey was conducted at the end of the 2-week post-discharge isolation. Depression, anxiety as well as self-rated health were assessed at both time points using the 9-item patient health questionnaire, 7-item generalized anxiety disorder scale and self-rated health scores, respectively. RESULTS: Fifty centrally isolated and 45 home isolated patients completed both the baseline and the follow-up assessments. Significant effects of time and time by isolation form were found on depression and anxiety levels, with a significant decrease in depression and anxiety shown in home isolated but not in centrally isolated patients. Besides, a significant time effect was identified on self-rated health with significant improvement found in home isolated but not in centrally isolated patients. CONCLUSIONS: Home isolation is superior to centralized isolation in the recovery of COVID-19-associated depression, anxiety as well as self-rated health. More attention needs to be paid to the psychological well-being of centrally isolated patients. A sustained and integrated rehabilitation plan is warranted for patients with COVID-19 to achieve both physical and psychological recovery.

Would we recover better sleep at the end of Covid-19? A relative improvement observed at the population level with the end of the lockdown in France.

BACKGROUND: The outbreak of the Covid-19 pandemic and the accompanying lockdown measures have had a major impact on societies around the world, leading to sleep problems for a large part of the population. In order to assess the sustainability of sleeping troubles related to the sanitary crisis, it was crucial to measure its prevalence after the end of the Covid-19 confinement. METHODS: As part of an epidemiological survey on Covid and Confinement (COCONEL), we enquired on sleep disorders using two items in 4 repetitive cross-sectional surveys. The first took place during the first week of the French confinement (March 31 to April 2; N = 1005 participants). The second took place in the middle of this period (April 15-17; N = 1005). The two last surveys were held at the end of the confinement (May 7-10; N = 2003) and one month after the end (June 10-12; N = 1736). Using a random constant, the mixed model took into account the longitudinal character of the last two waves (intra-individual correlations for individuals surveyed in waves 3 and 4). RESULTS: The prevalence of sleep problems significantly decreased during the last weeks of the confinement, and this trend was confirmed one month after the end of confinement. One quarter of the population reported that their sleep was better one month after the end of the confinement. Sleep improvement was reported more often by women and people aged less than 65. Such improvement was less frequent among those who were still highly exposed to the pandemic's media coverage after the end of the confinement. CONCLUSION: The possibility of recovering a good sleep largely depends on the type of sleep disorder. The decrease in sleep problems occurred mainly among people with mild sleep problems during the confinement. Further research is needed to assess the long-term effects of the Covid-19 pandemic and its confinement period on sleep quality in the general population.