Exploring the Health Literacy and Health Situation of School Principals and Vice Principals in Punjab, Pakistan: Insights from an Online-Based Survey during the COVID-19 Pandemic (preprint)

Background This study aimed to evaluate health literacy and general health status among school principals and vice principals in Pakistan, 1) to identify work-related factors associated with them, and 2) to determine their association with physical and mental health, particularly in the context of the COVID-19 pandemic.Methods An online-based cross-sectional survey was conducted among 350 school principals and vice principals in Punjab province, Pakistan. The study was conducted under the COVID Global Health Literacy Network. Data related to socio-demographic characteristics, health literacy, general health status, chronic illnesses and impairment, well-being, psychosomatic complaints, and emotional exhaustion were collected. We applied bivariate analyses as well as binary and multivariable logistic regression analyses.Results Over half of the respondents (66.6%) had sufficient levels of health literacy. A good general health status was reported by 80.3%. One of the strongest predictors of health literacy and general health status was school position (principals vs. vice principals). Additionally, those with sufficient health literacy were less likely to have frequent emotional exhaustion; while those having good general health status were less likely to report low well-being, frequent emotional exhaustion, and psychosomatic complaints. The study also found that females were less likely to have a good general health status (OR = 0.45) and were more likely to have frequent emotional exhaustion (OR = 1.75) as well as psychosomatic complaints (OR = 1.94) than males.Conclusions Limited health literacy in school leaders requires interventions for better decision-making on health matters, emphasizing the need for targeted training programs.

Psychosomatic health complaints among children and adolescents during the COVID-19 pandemic – Results of the longitudinal German COPSY study (preprint)

Background The period throughout the coronavirus disease 2019 (COVID-19) pandemic presented major challenges for children’s and adolescents’ wellbeing and psychosocial adjustment and had a great impact on their mental health. Psychosomatic health complaints are highly common in childhood and adolescence and present an important indicator of mental health and wellbeing.Methods The nationwide, longitudinal COPSY-study (COvid-19 and PSYchological Health) has monitored changes in mental health among children and adolescents in Germany since the beginning of the COVID-19 pandemic in five survey waves (2020–2022). In total, n = 1673 children and adolescents aged 11 years and older and their parents participated in at least one survey wave. Self-reported psychosomatic health complaints were assessed in each survey wave, using a modified version of an internationally validated eight-item symptom checklist (HBSC-SCL). A mixed model panel regression analysis was conducted to examine longitudinal changes in psychosomatic health complaints and to identify psychosocial and pandemic-related risk factors as well as resources. Risk estimations were used to explore the effect of a reported previous infection with COVID-19 on psychosomatic health complaints.Results Psychosomatic health complaints among children and adolescents increased over the course of the COVID-19 pandemic. Girls and children of mentally ill or highly burdened parents were at particular risk. A higher subjective perceived burden of the pandemic as well as COVID-19 related worries were significantly associated with a higher level of psychosomatic health complaints. Overall, Long-COVID was diagnosed by a clinical expert in 2.9% of children with previously reported COVID-19. An infection with COVID-19 was no significant risk factor for psychosomatic health complaints in general but increased the risk of sleeping difficulties and loss of concentration in autumn 2022. Personal resources, a positive family climate, and more perceived social support were significantly associated with less psychosomatic health complaints.Conclusions Three years after the start of the COVID-19 pandemic, children and adolescents are suffering from multiple psychosomatic health complaints. Medium and long-term consequences of the pandemic and associated measures are therefore suspected. Targeted health promotion and intervention strategies are needed to protect and maintain children’s and adolescents’ health.

Self-perceived impact of COVID-19 measures and adolescent mental health: gender, age and socioeconomic differences in 22 Countries (preprint)

Background The COVID-19-pandemic had a profound impact on the adolescents’ lives worldwide. In our study, we examined the self-perceived impact of the COVID-19 pandemic measures and its association with mental health and well-being among a representative sample of 13-and 15-years-old adolescents from 22 countries.Methods Data from the cross-national Health Behaviour in School-aged Children (HBSC) 2021/22 study was used (N = 67,544; 51.9% girls). Self-perceived impact of COVID-19 measures was assessed by 10 items asking about its impact on e.g., relationships with family and friends, health, or eating behaviours. Mental health was evaluated by loneliness, psychosomatic health complaints, and life satisfaction. First, a non-parametric multilevel latent class analysis considering individual, and country-levels was conducted to identify COVID-19 impact groups. Second, logistic regression models adjusted by age and socioeconomic status were applied in order to assess the association between COVID-19 impact classes and mental health. The regression analyses were stratified by gender.Results Three classes were identified on individual level encompassing a neutral (51%), negative (18%) or positive (31%) perception of COVID-19 impact. No heterogeneous results of distribution were found within and across countries. Within the positive impact class, social relationships were the most important dimension, whereas mental health problems were mostly represented within the negative impact class. Adolescents with a negative perception of the COVID-19 showed worse mental health than peers with a neutral or positive perception. Girls with a negative perception showed higher levels of loneliness and psychosomatic health complaints and lower life satisfaction compared to boys and peers with a neutral or positive perception. Older adolescents and those with a low socioeconomic status showed more loneliness and lower life satisfaction.Conclusions The impact of COVID-19 pandemic showed quite heterogeneous patterns both within and across countries. Support interventions and health promotion should focus especially on girls, older adolescents, and those with a low SES as they were at higher risk of suffering from pandemic measures and associated problems of loneliness, psychosomatic complaints, and low life satisfaction. Adolescents are able to reflect on measures that impact their health and therefore should be involved in the decision-making process.

The well-being and work-related stress of senior school leaders in Wales and Northern Ireland during the COVID-19 pandemic: A cross-sectional descriptive study (preprint)

The COVID-19 pandemic caused far-reaching societal changes, including significant educational impacts, affecting over 1.6 billion pupils and 100 million education practitioners globally. Senior school leaders were at the forefront; an occupation already reporting high work-related stress and large numbers leaving the profession preceding COVID-19, leaders were exposed to high demands relating to the numerous challenges they had to manage during a "crisis leadership" period. This cross-sectional descriptive study conducted through through the international COVID-HL network aimed to examine the well-being and work-related stress of senior school leaders (n=323) in Wales (n=172) and Northern Ireland (n=151) during COVID-19 (2021-2022). Findings suggest that senior school leaders reported high workloads (54.22{+/-}11.30 hours/week), low well-being (65.2% n=202, mean WHO-5 40.85{+/-}21.57), depressive symptoms (WHO-5 34.8% n=108) and high work-related stress (PSS-10: 29.91{+/-}4.92). High exhaustion (BAT: high/very high 89.0% n=285) and specific psychosomatic complaints (experiencing muscle pain 48.2% n=151) were also reported, and females had statistically higher outcomes in these areas. School leaders were engaging in self-endangering working behaviours; 74.7% (n=239) gave up leisure activities in favour of work and 63.4% (n=202) sacrificed sufficient sleep, which was statistically higher for females. These findings are concerning given that the UK is currently experiencing a "crisis" in educational leadership against a backdrop of pandemic-related pressures. Senior leaders high attrition rates further exacerbate this, proving costly to educational systems and placing additional financial and other pressures on educational settings and policy response. This has implications for senior leaders and pupil-level outcomes including health, well-being and educational attainment, requiring urgent tailored and targeted support from the education and health sectors. This is particularly pertinent for Wales and Northern Ireland as devolved nations in the UK, who are both implementing or contemplating major education system level reforms, including new statutory national curricula, requiring significant leadership, engagement and ownership from the education profession.

The dynamic changes of psychosomatic symptoms in three waves of COVID-19 outbreak and fatigue caused by enduring pandemic in China.

BACKGROUND: Two years have passed since the 2019 novel coronavirus disease (COVID-19) was first reported. The persistent pandemic might lead to severe psychosomatic problems and fatigue. In addition, the recent rapid rising COVID-19 cases in China have become a trending issue. Therefore, this study aimed to investigate the dynamic changes in psychosomatic problems at the initial and current stages of the pandemic. METHODS: Three waves of cross-sectional online survey were conducted during the initial COVID outbreak in China. The psychosomatic symptom scale (PSSS), perceived stress scale (PSS), and pandemic fatigue scale (PFS) were used to assess the psychosomatic problems, stress, and fatigue. RESULTS: 4317, 1096, and 2172 participants completed the first, second, and third surveys. The prevalence of psychosomatic disorder was 22 %, 28 %, and 39 %, respectively. The network structure of PSSS symptoms has not significantly changed as the pandemic progresses. However, the global strength of the PSSS networks, indicating the overall connectivity, in the third wave was significantly higher than in the first wave (s = 0.54, P = 0.007). The most central symptoms in the first and third wave networks were depressed mood and tiredness. The PFS score was higher in the people concerned with indirect impact than those concerned with health (P < 0.001). PFS has positive relationships with PSSS and PSS score (R = 0.41, P < 0.001 and R = 0.35, P < 0.001, respectively). CONCLUSIONS: The persistence of the pandemic caused critical psychosomatic issues, stress, and indirect burden over time, leading to inevitable fatigue. People endured needing immediate attention to prevent or reduce psychosomatic disorders.

[The impact of depression symptoms on postmorbid adaptation of patients who have undergone SARS-CoV-2 infection (assessment from the position of the multimorbidity model)]. / Vliyanie simptomov depressii na postmorbidnuyu adaptatsiyu patsientov, perenesshikh SARS-CoV-2-infektsiyu (otsenka s pozitsii modeli mul'timorbidnosti).

OBJECTIVE: To evaluate the impact of psychosomatic and anxiety symptoms of depression on the formation of postmorbid adaptation in patients who have undergone SARS-CoV-2 infection. MATERIAL AND METHODS: The data of 54 patients, aged 18-55 years, with a current depressive episode who had outpatient SARS-CoV-2 infection were analyzed. The Hamilton depression rating scale (HDRS) was used and somatic condition was assessed using a general assessment of the patient's function limitation at the stage of reconvalescence. A linear regression analysis was performed to assess the association of psychosomatic and anxiety symptoms with somatic condition in SARS-CoV-2 infection, regardless of other factors. RESULTS: The multimorbidity model took into account, in addition to SARS-CoV-2 caused by organic somatic disorders, psychosomatic manifestations (B=-1.9, p=0.004) and anxiety (B=-3.7, p=0.04) symptoms of depression. Somatic anxiety was significantly correlated with a pronounced impairment of postmorbid readaptation (p<0.05), while mental anxiety did not demonstrate such a relationship (p=0.46). The observed trend seems to be due to the overlap of manifestations of somatic anxiety with the construct of residual somatic symptoms, even though there is no multicollinearity between them. CONCLUSION: Identification of clusters of symptoms associated with reduced opportunities for full recovery in the SARS-CoV-2-postmorbid period can significantly help in providing a high-quality and targeted psychopharmacological care.

Worry and Psychosomatic Problems Among Adolescents in Sweden in the Wake of the COVID-19 Pandemic: Unequal Patterns Among Sociodemographic Groups?

PURPOSE: To analyze potential associations between sociodemographic factors and adolescents' worry about family finances and other types of worries during the COVID-19 pandemic and the potential associations between different worry themes and psychosomatic problems. METHODS: From December 2020 to March 2021, 3,068 16-17 years old students in Sweden completed a questionnaire about the impact of the COVID-19 pandemic on their schooling and everyday life. From April to June 2020, 70% of these students also responded to questions about their psychosomatic health. Logistic regression was applied to analyze the associations between sociodemographic factors and different worry themes and estimate the association between worry and psychosomatic problems. RESULTS: Across all 13 worry themes, girls reported worry to a higher degree than boys. In most of the cases, adolescents with a lower parental educational background or immigrant background reported more frequent worrying. This was most evident for worry about family finances. The differences between adolescents with a Swedish background and those with a foreign background were large except for worry about climate change. All worry themes were associated with the students' psychosomatic health. Those who often or always experienced worry were more likely to report psychosomatic problems. Worry about family finances showed the highest odds ratio and marginal effect. DISCUSSION: Worry about family finances during the COVID-19 pandemic turns out to be a strong and socially structured stressor that may widen the health inequalities among young people. This underlines the need for preventive and promoting measures aimed at supporting socioeconomic disadvantaged groups.

Work-Related Stress of Polish School Principals during the COVID-19 Pandemic as a Risk Factor for Burnout.

BACKGROUND: The ongoing COVID-19 pandemic has influenced educational systems worldwide. School principals coped with numerous significant challenges regarding school management during the epidemiological crisis that could generate a lot of work-related stress. Thus, the presented study examines Polish school principals' perceived stress and its association with exhaustion and psychosomatic complaints as burnout risk indicators. Principals' gender and age as sociodemographic control variables were also considered in this paper. METHODS: A cross-sectional online study was conducted in eight provinces of Poland from June to December 2021. The study was part of a global COVID-HL school principal survey under the global COVID-Health Literacy Research Network. Two subscales of the Perceived Stress Scale (PSS-10) (perceived helplessness [PH] and perceived self-efficacy [PSE]) were considered independent variables in relation to school principals' mental and physical exhaustion and psychosomatic complaints. Regression models consisting of two equations were used to test the relationship between variables. The first equation consists of the control variables (age, gender), and in the second equation, the independent variables (PH and PSE) were included in addition to the control variables. RESULTS: Almost 50% of school principals experienced a lack of control that caused anger and stress. Mental and physical exhaustion during the pandemic was often or always felt by 30% of respondents. Nearly half of Polish school principals experienced psychosomatic complaints in the form of muscle pain and headaches. PH, to a greater extent than PSE, was associated with mental and physical exhaustion and psychosomatic complaints. With age, the level of psychosomatic complaints and mental and physical exhaustion decreases, but it was higher among women. Regression analysis revealed significant associations between exhaustion and mental health outcomes, even after controlling for demographic variables Conclusion: This study showed that almost half of Polish school principals indicated a high frequency of perceived stress during the pandemic. PH was more substantially associated with mental and physical exhaustion in younger female principals than PSE. Younger female school principals reported more exhaustion and psychosomatic complaints. This finding should be the baseline information for policymakers to improve the wellbeing of Polish school principals and prevent the risk of burnout.

Impact of digital stress on negative emotions and physical complaints in the home office (preprint)

Due to the COVID-19 pandemic many employees perform under increasingly digital conditions. Enabling home office became mandatory for companies wherever possible in consideration of the ongoing pandemic. Simultaneously, studies report on digital stress. The current literature lacks investigations of digital stress on psychosomatic outcomes, emotions and disease. How has digital stress developed over the course of the pandemic? Does digital stress predict differences in negative emotions and physical complaints in the home office setting? To answer the research question we conducted an online survey among 441 employees in 2020 and 398 employees in 2022 from three municipal administrations in Germany, who were working from home at least occasionally. We used a cluster analysis to detect the cluster of digitally stressed employees. Regressions were performed on digital stress, negative emotions, and physical complaints. The analysis revealed an increase from 9 to 20 percent in digital stress, while negative emotions and physical complaints did not show evident differences. In the multivariate model we observe a change in the proportion of digitally stressed between 4 and 17 percent, while the control variables explain around 9 percent. Digital stress might be slightly predictive for negative emotions, but not for physical complaints. The study emphasizes rising digital stress, which contradicts an adaption to the digital working conditions within the observed period. The psychosomatic relations are low or lagged. Further research investigating on digital stress and countermeasures especially for working from home to prevent harmful long-term effects resulting from distress is needed.

Fear and Trembling While Working in a Pandemic: An Exploratory Meta-Analysis of Workers’ COVID-19 Distress (preprint)

The global COVID-19 pandemic has disrupted the lives of workers and taken its toll on health and well-being. In line with recent calls for more inductive and abductive occupational health science research, we exploratorily meta-analyzed workers’ COVID-19 distress, defined as psychological and psychosomatic strain contextualized to experiencing the virus and pandemic broadly. We identified many existing COVID-19 distress measures (e.g., Fear of COVID-19 Scale by Ahorsu et al., 2020; Coronavirus Anxiety Scale by Lee, 2020a) and correlates, including demographic variables (viz., gender, marital status, whether worker has children), positive well-being (e.g., quality of life, perceived social support, resilience), negative well-being (e.g., anxiety, depression, sleep problems), and work-related variables (e.g., job satisfaction, burnout, task performance). Additionally, we found preliminary evidence of subgroup differences by COVID-19 distress measure and country-level moderation moderators (viz., cultural values, pandemic-related government response) as well as COVID-19 distress’s incremental validity over and above anxiety and depression. The findings—based on k = 135 independent samples totaling N = 61,470 workers—were abductively contextualized with existing theories and previous research. We also call for future research to address the grand challenge of working during the COVID-19 pandemic and ultimately develop a cumulative occupational health psychology of pandemics.

[Psychosomatic-psychotherapeutic support for Covid-19 patients in domestic quarantine: a content analysis of supportive telephone calls]. / Psychosomatisch-psychotherapeutische Unterstützung von Covid-19-Patient:innen in häuslicher Quarantäne: Eine Inhaltsanalyse supportiver Telefongespräche.

Objectives: During their domestic quarantine, Covid-19 patients face major physical, psychological and social challenges. The description of support needs and specific topics brought to supportive conversations will be used to add to the body of knowledge about stressors and resources. Methods: A total of 109 telephone conversations with 69 quarantined Corona patients were documented by psychotherapists and physicians at Heidelberg University Hospital from November 2020 to April 2021. Subsequently, clinical documentations were analyzed according to a qualitative content analysis. Results: Most physical complaints related to cardio-respiratory symptoms (29 %), previous illnesses (24 %), and exhaustion or fatigue (16 %). On the psychological level, patients reported mainly anxiety (31 %) and depressive symptoms (16 %). On a social level, patients described stress related to family (56 %), work (20 %), and time in quarantine (16 %). Social support, individual coping strategies, a positive prognosis on the course of the corona disease, psychotherapy, and satisfactory medical care were mentioned as relieving factors. Therapeutic interventions aimed at stabilization and consisted of psychoeducation, relaxation techniques, and general counseling. Conclusions: The study shows that physical complaints, psychological symptoms, and social factors are brought into telephone support conversations. The support offer met a high demand and was well accepted.

Impacts of long-term coronavirus disease 2019 school closures on Japanese school children.

BACKGROUND: This study investigated the impact of coronavirus disease 2019 pandemic school closures on the mental health of school students with chronic diseases. METHODS: Questionnaires were distributed to students from 4th-9th grade diagnosed with chronic diseases at Osaka Medical College Hospital and their parents or caregivers. Questionnaires from 286 families were returned by mail after the schools reopened. The students were divided into the "psychosomatic disorder" group (group P, n = 42), the "developmental disorder" group (group D, n = 89), and the "other disease" group (group O, n = 155). Using students' self-reports on the Questionnaire for Triage and Assessment with 30 items, we assessed the proportion of students with a high risk of psychosomatic disorder in three groups. We investigated how the students requiring the support of somatic symptom (SS) felt about school during school closure. Further, using parents' and caregivers' answers, SS scores were calculated before and during school closure and after school reopening. RESULTS: The proportion of students with a high risk of developing psychosomatic disorder increased in all groups. For the students in Group P, the response "I did not want to think about school" indicated an increase in SS scores, and for the students in Group O, "I wanted to get back to school soon" indicated a decrease. Furthermore, especially in Group P students, SS scores decreased transiently during school closure and increased after school reopening. CONCLUSIONS: The impact of school closure on mental health differed depending on students' diagnoses and feelings about school during school closures.

Psychosomatic syndromes are associated with IL-6 pro-inflammatory cytokine in heart failure patients.

Psychosomatic syndromes have emerged as an important source of comorbidity in cardiac patients and have been associated with increased risk for adverse outcomes in patients with heart failure (HF). Understanding of the mechanisms underlying this connection is limited, however immune activity represents a possible pathway. While there have been numerous studies connecting immune activity to psychosomatic psychopathology, there is a lack of research on patients with HF. We examined forty-one consecutive outpatients affected by HF. We assessed psychosomatic psychopathology using the Diagnostic Criteria for Psychosomatic Research (DCPR) and the Patient Health Questionnaire-15 (PHQ-15). The Psychosocial Index (PSI) was used for assessing stress and psychosocial dimensions. Depression was evaluated with Beck Depression Inventory-II (BDI-II). Circulating levels of proinflammatory cytokines IL-6 and TNF-alpha were ascertained. Univariate and multivariable regression models were used to test for associations between inflammatory cytokines and psychosomatic psychopathology (i.e., DCPR syndromes, PHQ-15) and psychological dimensions (i.e., BDI-II, PSI). A significant positive correlation was found between IL-6 levels and psychosomatic psychopathology even when controlling for any confounding variables (i.e., Body-mass index (BMI), New York Heart Association (NYHA) class, smoking habits, alcohol consumption, statin use, aspirin use, beta blockers use, age, and gender). In contrast, the associations between TNF-alpha levels were non-significant. These findings can contribute to research in support of a psychoneuroimmune connection between psychosomatic psychopathology and HF. Findings also suggest the possibility that elevated IL-6 levels are more relevant for the pathogenesis of psychosomatic syndromes than for depression in patients with HF.

Frontline Healthcare workers suffering from psychosomatic disorders during COVID-19 (a pandemic): A Systematic review (preprint)

Purpose: The emergence of SARS CoV-2, has imposed high pressure on the healthcare system worldwide. As a consequence, frontline healthcare workers were impacted widely. The aim of this systematic review is to examine the impact of COVID-19 on mental status of FHW during pandemic. Methods: Databases such as PubMed, Scopus, google scholar were searched extensively from the date of inception till April 2021. All cross-sectional studies published in English assessing the mental condition and well-being of frontline caregivers during COVID-19 were included in the study. The quality assessment was done by Newcastle Ottawa scale. Results: Ten thousand eight hundred sixty-nine articles were found. After conscientious literature search, total 78 articles were included satisfying the objective of the review. The highest and lowest values for the rates of depression, anxiety and insomnia was found to be 99.51% & 6.07%, 85.7% & 73.6%, and 5.3% & 11.4%, respectively. Conclusion: It has been found that FHW were psychologically impacted by the pandemic. This could be due to lack of resources such as PPE, organizational support, inefficient relevant knowledge regarding the novel virus, its extremely indelible transmission rates, fear of contamination, stigmatization, and/or due to prevalence of ignorance by government and health policy makers. Prospero registration no- CRD42021244612 Key words; Mental disorders, Frontline healthcare workers, Psychosomatic disorders, psychological morbidities, COVID-19.

Intersections between pneumonia, lowered oxygen saturation percentage and immune activation mediate depression, anxiety and chronic fatigue syndrome-like symptoms due to COVID-19: a nomothetic network approach. (preprint)

Background: COVID-19 is associated with neuropsychiatric symptoms including increased depressive, anxiety and chronic fatigue-syndrome (CFS)-like physiosomatic (previously known as psychosomatic) symptoms. Aims: To delineate the associations between affective and CFS-like symptoms in COVID-19 and chest CT-scan anomalies (CCTAs), oxygen saturation (SpO2), interleukin (IL)-6, IL-10, C-Reactive Protein (CRP), albumin, calcium, magnesium, soluble angiotensin converting enzyme (ACE2) and soluble advanced glycation products (sRAGEs). Method: The above biomarkers were assessed in 60 COVID-19 patients and 30 heathy controls who had measurements of the Hamilton Depression (HDRS) and Anxiety (HAM-A) and the Fibromyalgia and Chronic Fatigue (FF) Rating Scales. Results: Partial Least Squares-SEM analysis showed that reliable latent vectors could be extracted from a) key depressive and anxiety and physiosomatic symptoms (the physio-affective or PA-core), b) IL-6, IL-10, CRP, albumin, calcium, and sRAGEs (the immune response core); and c) different CCTAs (including ground glass opacities, consolidation, and crazy paving) and lowered SpO2% (lung lesions). PLS showed that 70.0% of the variance in the PA-core was explained by the regression on the immune response and lung lesions latent vectors. Moreover, one common infection-immune-inflammatory (III) core underpins pneumonia-associated CCTAs, lowered SpO2 and immune activation, and this III core explains 70% of the variance in the PA core, and a relevant part of the variance in melancholia, insomnia, and neurocognitive symptoms. Discussion: Acute SARS-CoV-2 infection is accompanied by lung lesions and lowered SpO2 which both may cause activated immune-inflammatory pathways, which mediate the effects of the former on the PA-core and other neuropsychiatric symptoms due to SARS-CoV-2 infection.