Rates of Trauma Exposure, Posttraumatic Stress Disorder (PTSD), Depressive, and Anxiety Symptoms in Primary School Children: Findings Six Months before Covid-19 Pandemic (preprint)

Studies on mental health rates among primary school children are still limited particularly related to psychological trauma and its relationship to other mental health challenges. This is the first cross-sectional study examining the rates of trauma exposure, posttraumatic stress disorder (PTSD), depressive, and anxiety symptoms in primary school children before covid-19 pandemic in Malaysia. Two hundred and twenty-one students participated in this study. They were recruited from four primary schools that volunteered to participate in the study. PTSD) Checklist for DSM-5 (PCL-5), Child PTSD Symptoms Scale-5 (CPSS-5), The Center for Epidemiologic Studies Depression Scale version (CESD) and the Spence Children's Anxiety Scale (SCAS) were used to survey psychological symptoms. Most of the students, or 54.3% of them, have experienced at least one traumatic event. Of 221 students, 39.4% reported having PTSD symptoms, 38% reported having depressive symptoms and 19% reported having anxiety symptoms. Female students were more likely to report PTSD symptoms compared to male students. The first regression analysis model showed that only depressive symptoms were significant predictors for PTSD. In the second model, religion, family income, anxiety and PTSD symptoms were significant predictors of depressive symptoms. In the third model, only depressive symptoms were significant predictors of anxiety. Findings, limitations, research future directions and recommendations were discussed.

Exploring the Efficacy of Shirodhara as an Add-on Therapy for Alleviating Post-COVID Anxiety and Depression: A Case Study (preprint)

Background This study explores post-COVID-19 psychological challenges in a 31-year-old female patient—manifesting as Anxiety, fatigue, weakness, irritability, anger, and concentration issues. The treatment approach combines SSRI and Clonazepam medications with Shirodhara therapy using Balashwagandhadi taila, presenting a novel and comprehensive intervention strategy.Methods The patient was evaluated using recognized scales, such as HAM-A, HDRS, PHQ-9, and QOL. Additionally, monitoring serum cortisol levels served as a potential physiological marker. The integrative treatment approach addresses psychological symptoms and potential underlying physiological mechanisms.Results Significant improvement is observed across various domains, evidenced by reduced HAM-A, HDRS, and PHQ-9 scores and enhanced QOL. Post-Shirodhara therapy, a notable increase in serum cortisol levels from 3.09 ug/dL to 11.76 ug/dL, suggesting a correlation with clinical improvements.Conclusion This case underscores Shirodhara's promising role as an adjunctive therapy for post-COVID-19 Anxiety and depression. Findings advocate further exploring integrative approaches in post-viral psychological care, emphasizing addressing psychological and potential physiological aspects for holistic recovery.

Modeling the relative influence of socio-demographic variables on post-acute COVID-19 quality of life: an application to settings in Europe, Asia, Africa, and South America (preprint)

Long-term COVID-19 complications are a globally pervasive threat, but their plausible social drivers are often not prioritized. Here, we use data from a multinational consortium to quantify the relative contributions of social and clinical factors to differences in quality of life among participants experiencing long COVID and measure the extent to which social variables impacts can be attributed to clinical intermediates, across diverse contexts. In addition to age, neuropsychological and rheumatological comorbidities, educational attainment, employment status, and female sex were identified as important predictors of long COVID-associated quality of life days (long COVID QALDs). Furthermore, a great majority of their impacts on long COVID QALDs could not be tied to key long COVID-predicting comorbidities, such as asthma, diabetes, hypertension, psychological disorder, and obesity. In Norway, 90% (95% CI: 77%, 100%) of the effect of belonging to the highest versus lowest educational attainment quintile was not attributed to intermediate comorbidity impacts. The same was true for 86% (73%, 100%) of the protective effects of full-time employment versus all other employment status categories (excluding retirement) in the UK and 74% (46%,100%) of the protective effects of full-time employment versus all other employment status categories in a cohort of four middle-income countries (MIC). Of the effects of female sex on long COVID QALDs in Norway, UK, and the MIC cohort, 77% (46%,100%), 73% (52%, 94%), and 84% (62%, 100%) were unexplained by the clinical mediators, respectively. Our findings highlight that socio-economic proxies and sex may be as predictive of long COVID QALDs as commonly emphasized comorbidities and that broader structural determinants likely drive their impacts. Importantly, we outline a multi-method, adaptable causal machine learning approach for evaluating the isolated contributions of social disparities to long COVID quality of life experiences.

Health and wellbeing of staff working at higher education institutions globally during the post-COVID-19 pandemic period: Evidence from a cross-sectional study (preprint)

Background The ongoing global crisis of Higher Education (HE) institutions during the post-COVID-19 pandemic period has increased the likelihood of enduring psychological stressors for staff. This study aimed to identify factors associated with job insecurity, burnout, psychological distress and coping amongst staff working at HE institutions globally.Methods An anonymous cross-sectional study was conducted in 2023 with staff at HE institutions across 16 countries. Job insecurity was measured using the Job Insecurity Scale (JIS), burnout using the Perceived Burnout measure question, psychological distress using the Kessler Psychological Distress Scale (K10), and coping using the Brief Resilient Coping Scale. Multivariable logistic regression with a stepwise variable selection method was used to identify associations.Results A total of 2,353 staff participated; the mean age (± SD) was 43(± 10) years and 61% were females. Most staff (85%) did not feel job insecurity, one-third (29%) perceived burnout in their jobs, more than two-thirds (73%) experienced moderate to very high levels of psychological distress, and more than half (58%) exhibited medium to high resilient coping. Perceived job insecurity was associated with staff working in research [Adjusted Odds Ratio 1.37 (95% Confidence Intervals 1.04–1.81)] and part-time, having an academic appointment [2.45 (1.78–3.27)], perceived burnout and moderate to very high level of psychological distress. Perceived burnout was associated with being female [1.35 (1.12–1.63)], having a leadership appointment [1.30 (1.05–1.61)], perceived job insecurity, and moderate to very high levels of psychological distress. Staff with administrative roles [1.26 (1.04–1.52)], mental health issues [2.73 (1.79–4.15)], perceived job insecurity, and perceived burnout were associated with moderate to very high levels of psychological distress. Staff who perceived their mental health as good to excellent [3.36 (2.69–4.19)] were more likely to have medium to high resilient coping.Conclusions Factors identified in this study should be considered in reviewing and updating current support strategies for staff at HE institutions across all countries to reduce stress and burnout and improve wellbeing.

Survey analysis of patient satisfaction and sexual issues in the management of vulvar lichen sclerosus (preprint)

Objective Vulvar lichen sclerosus (VLS) is an underestimated chronic disease. It can cause significant symptom burden and sexual dysfunction. This study aimed to evaluate patient satisfaction and current challenges in the management of VLS in a certified dysplasia unit, particularly during the COVID-19 pandemic.Methods This survey analyzed patients who had been diagnosed with VLS and treated at our DKG-certified dysplasia unit. The study was conducted during the COVID-19 pandemic in the Department of Gynecology and Obstetrics at the University of Aachen. The questionnaire contained 43 questions covering general treatment, diagnostic delays, psychological and sexual issues and specific questions about the COVID-19 pandemic. The questionnaire was distributed between January 2021 and September 2023.Results This study included 103 patients diagnosed with VLS who were treated at our certified dysplasia unit. Overall, 48% of the patients were satisfied with the success of the therapy. Most participants reported psychological problems (36.8%), fear of cancer (53.3%), or sexual restrictions (53.3%). Among the patients, 38% were bothered by the regular application of topical cortisone. However, 72% were willing to undergo treatment for more than 24 months. The COVID-19 outbreak in March 2020 had a significant negative impact on general VLS care from the patient’s perspective (3,83/5 before vs. 3,67/5 after; p = 0.046). There was a general request for booklets to inform and educate patients about their disease. Furthermore, the respondents demanded a telephone hotline to answer the questions and wished for follow-up visits via e-mail to cope better with their current situation.Conclusion This study highlights the need for more effective treatments for VLS and an increased awareness of psychological and sexual distress. To ensure patient well-being and satisfaction, it is imperative to offer individualized care in a team of specialists from various disciplines.

The psychological consequences of the COVID-19 pandemic in adults treated for childhood cancer (preprint)

Objectives: Compared with the general population, childhood cancer survivors (CCS) could be at greater risk of psychological distress following the emergence of the COVID-19 pandemic. This cross-sectional study assessed the psychological consequences of COVID-19 on the mental health of CCS. Methods. In December 2020, we interviewed through an online self-report questionnaire 580 5-year CCS participating in the French Childhood Cancer Survivor Study (FCCSS) cohort. We first compared the mental health score of CCS with that observed in the French general population of the same age and gender. Subsequently, combining clinical and patient-reported outcomes, we studied predictors of the mental health score of CCS. Results. External comparisons revealed that the mental health score of CCS was similar to that observed in the general population. Among CCS, almost 42% stated that their psychological state had been worse during the lockdown. Predictors of poorer mental health included, among others, female gender, reporting a change of his/her occupational situation, having a relative who had been hospitalized or had died following COVID-19, and a greater perceived infection risk. Conclusion. Given the pre-existing vulnerability of some CCS to mental distress, the additional psychological consequences of COVID-19 in vulnerable survivors should receive attention from health care providers.

Exploration of Adolescent Depression Risk Prediction Based on Census Surveys and General Life Issues (preprint)

In contemporary society, the escalating pressures of life and work have propelled psychological disorders to the forefront of modern health concerns, an issue that has been further accentuated by the COVID-19 pandemic. The prevalence of depression among adolescents is steadily increasing, and traditional diagnostic methods, which rely on scales or interviews, prove particularly inadequate for detecting depression in young people. Addressing these challenges, numerous AI-based methods for assisting in the diagnosis of mental health issues have emerged. However, most of these methods center around fundamental issues with scales or use multimodal approaches like facial expression recognition. Diagnosis of depression risk based on everyday habits and behaviors has been limited to small-scale qualitative studies. Our research leverages adolescent census data to predict depression risk, focusing on children's experiences with depression and their daily life situations. We introduced a method for managing severely imbalanced high-dimensional data and an adaptive predictive approach tailored to data structure characteristics. Furthermore, we proposed a cloud-based architecture for automatic online learning and data updates. This study utilized publicly available NSCH youth census data from 2020 to 2022, encompassing nearly 150,000 data entries. We conducted basic data analyses and predictive experiments, demonstrating significant performance improvements over standard machine learning and deep learning algorithms. This affirmed our data processing method's broad applicability in handling imbalanced medical data. Diverging from typical predictive method research, our study presents a comprehensive architectural solution, considering a wider array of user needs.

PVT in patients presenting with post-acute sequelae of COVID-19 (preprint)

We investigated performance validity tests (PVTs) in patients presenting with new onset cognitive complaints associated with post-acute sequelae of COVID-19 infection (PASC). Retrospective data were obtained from IRB-approved registries. All patients completed the Victoria Symptom Validity Test (VSVT) in conjunction with a neuropsychological evaluation. A sub-analysis included 7 other PVT measures. The PASC sample was compared to an analogous multiple sclerosis (MS) sample with known PVT failure rates. The PASC sample consisted of 177 patients (49.4 ± 11.2 years), educated (14.7 ± 2.3 years), predominantly female (81.4%), and white, non-Hispanic (85.3%) patients. Seven percent of the PASC sample scored below the established VSVT hard item cut-off, and of those with invalid VSVT over 50% failed 3 or more additional PVTs. In comparison to a MS sample, the PASC sample reported comparable psychological symptoms, but were significantly less likely to produce invalid VSVT scores and seek disability benefits. This study provides a profile of PVTs in patients presenting with PASC. The general infrequence of invalid responding in this PASC sample (7%) is noteworthy compared to an MS sample and highlights the role of additional factors in non-credible response such as elevated psychological symptoms or pursuit of disability.

A qualitative exploration of the impact of the COVID-19 pandemic on gender-based violence against women living with HIV or tuberculosis in Timor Leste (preprint)

Violence against women or gender-based violence (GBV) is a major public health issue facing women and girls in different settings and is reported to have worsened globally during the COVID-19 pandemic. Despite the impact of the COVID-19 pandemic on increased violence against women in general, which has been reported in many settings globally, there is a paucity of evidence of its impact on violence against highly vulnerable women living with HIV or tuberculosis (TB). Using a qualitative design, this study aimed to explore the views and experiences of women living with HIV (n=19) or TB (n=23) in Timor Leste regarding the GBV they faced during the COVID-19 pandemic. They were recruited using the snowballing sampling technique. Data were collected using one-on-one in-depth interviews and focus group discussions. The five steps of qualitative data analysis suggested in Ritchie and Spencer’s analysis framework were employed to guide the analysis of the findings. Findings indicated that women in this study experienced intensified physical, verbal, sexual and psychological violence by their partners, spouses, in-laws, and parents or other family members during the COVID-19 pandemic. Several prominent risk factors that worsened violence against women during the pandemic were (i) HIV or TB-positive status, (ii) traditional gender roles or responsibilities and expectations, (iii) economic and financial difficulties reflected in the loss of jobs and incomes due to the pandemic, and (iv) individual factors such as jealousy and increased alcohol drinking developed during the lockdowns. The findings underscore the urgent need for multifaceted interventions to address GBV, which should encompass challenging traditional gender norms, addressing economic inequalities, and targeting individual-level risk factors. The findings also indicate the need for the development of robust monitoring and evaluation systems to assess the effectiveness of policies and interventions addressing GBV where the results can inform future improvement. The findings also indicate the need to include GBV in the protocol or guidelines for HIV and TB management. Future large-scale quantitative studies to capture the magnitude and specific drivers of GBV against women living with HIV and TB during the pandemic are recommended.

Knowing the Psychological Risks of Anti-epidemic Rescue Teams for COVID-19 by Simplified Risk Probability Scale (preprint)

Introduction: The COVID-19 pandemic has posed significant challenges to anti-epidemic rescue teams composed ofnon-medical professionals, such as security guards and volunteers. Our study aims to address how the Simplified Risk Probability Scale (SRPS), such as the Self-Assessed Anxiety Scale (SAS) and the Self-Assessed Depression Scale (SDS), can be used to assess the psychological risks of anti-epidemic rescue teams when facing COVID-19 and how to implement appropriate interventions for high-risk groups.  Methods: The study employed a cross-sectional study and collected data through an online survey. Participants were recruited through convenience sampling and were provided with informed consent. The survey included a COVID-19 self-made survey scale, as well as the SAS and SDS questionnaires to assess depression and anxiety symptoms. The study followed ethical standards and included 566 respondents from Lanzhou, China.  Results: 43.8% of anti-epidemic rescue team members experienced depression symptoms, while 33.3% experienced anxiety. The severity of depression and anxiety symptoms was positively correlated with the duration of work and the frequency of contact with COVID-19 patients. Female participants and those with lower education levels were more likely to experience thesesymptoms.  Conclusions: Our research has found that the psychological risks of rescue teams when facing COVID-19 come from anxiety and depression, and compelling psychological intervention can significantly reduce these risks. Overall, this study provides important insights into the psychological impact of the COVID-19 pandemic on anti-epidemic rescue teams and underscores the need for ongoing support and resources to protect the mental health of these essential workers.

Psychological impact of COVID-19 on frontline healthcare workers during the early months of the pandemic and responses to reduce the burden, helping to prepare for Disease X: A systematic Review (preprint)

ObjectiveThe COVID-19 pandemic placed enormous strain on healthcare workers (HCW) and systems. With currently over 766 million cases, a high risk of workplace-acquired infection and a constantly evolving disease trajectory, COVID-19 placed an incredible burden on frontline HCWs. Studies from previous pandemics highlight significant psychological distress in these workers, yet mental health remained a secondary consideration in many hospitals pandemic response. This review explores the psychological impact of COVID-19 on frontline HCWs during the early stages of the pandemic and describes responses implemented by health services to reduce this impact. Additionally, it aims to provide a framework for future evidence-based programs that support the wellbeing of frontline HCWs throughout the ongoing pandemic and into the future, helping to prepare for Disease X. MethodsA systematic review was completed using MEDLINE, CINHAL and Cochrane databases with bibliographic and grey literature searches. Results17 publications were included. Symptoms of psychological distress were reported in up to 70% of frontline HCWs, with as many as 50% suffering depression, 62% reporting anxiety and 45% of those requiring quarantine experiencing insomnia. Mindfulness training, safe rest areas, mental health practitioners and pandemic rostering are responses that have been implemented across health services during the pandemic, but their efficacy in reducing psychological burden has not been fully assessed. ConclusionsThe impact of COVID-19 has been enormous; however, its final toll remains unknown. High rates of psychological distress amongst frontline HCWs means the impact will extend far beyond the virus itself. Health services must implement evidence-based resilience strategies to ensure the safety of their frontline staff now and into the future.

Determinants of health-related quality of life in healthy children and adolescents during the COVID-19 pandemic: results from the longitudinal cohort study Ciao Corona (preprint)

Purpose: Understanding health-related quality of life (HRQOL) in children and adolescents, during a pandemic and afterwards, aids in understanding how circumstances in their lives impact their well-being. We aimed to identify determinants of HRQOL from a set of biological, psychological and social factors. Methods: Data was taken from a longitudinal sample (n = 1843) of children and adolescents enrolled in the prospective school-based cohort study Ciao Corona in Switzerland. The primary outcome was HRQOL, assessed using the KINDL total score and its subscales (each from 0, worst, to 100, best). Potential determinants, including biological (physical activity, screen time, sleep, chronic conditions, etc), psychological (sadness, anxiousness, stress) and social (nationality, parents education, etc) factors, were assessed in 2020 and 2021, and HRQOL in 2022. Determinants were identified in a data-driven manner using recursive partitioning to define homogeneous subgroups, stratified by school level. Results: Median KINDL total score in the empirically identified subgroups ranged from 68 to 83 in primary school children and from 69 to 82 in adolescents in secondary school. The psychological factors sadness, anxiousness and stress in 2021 were identified as the most important determinants of HRQOL in both primary and secondary school children. Other factors, such as physical activity, screen time, chronic conditions or nationality, were determinants only in individual subscales. Conclusion: Recent mental health, more than biological, physical or social factors, played a key role in determining HRQOL in children and adolescents during pandemic times. Public health strategies to improve mental health may therefore be effective in improving HRQOL in this age group.

Subphenotypes of Self-Reported Symptoms and Outcomes in Long COVID: a prospective cohort study with latent class analysis. (preprint)

Objective: To characterize subphenotypes of self-reported symptoms and outcomes(SRSOs) in Post-acute sequelae of COVID-19(PASC). Design: Prospective, observational cohort study of PASC subjects. Setting: Academic tertiary center from five clinical referral sources. Participants: Adults with COVID-19 [≥] 20 days before enrollment and presence of any new self-reported symptoms following COVID-19. Exposures: We collected data on clinical variables and SRSOs via structured telephone interviews and performed standardized assessments with validated clinical numerical scales to capture psychological symptoms, neurocognitive functioning, and cardiopulmonary function. We collected saliva and stool samples for quantification of SARS-CoV-2 RNA via qPCR. Primary and Secondary outcomes of measure: Description of PASC SRSOs burden and duration, derivation of distinct PASC subphenotypes via latent class analysis (LCA), and relationship between viral load with SRSOs and PASC subphenotypes. Results: Baseline data for 214 individuals were analyzed. The study visit took place at a median of 197.5 days after COVID-19 diagnosis, and participants reported ever having a median of 9/16 symptoms (interquartile range 6-11) after acute COVID, with muscle-aches, dyspnea, and headache being the most common. Fatigue, cognitive impairment, and dyspnea were experienced for a longer time. Participants had a lower burden of active symptoms (median 3, interquartile range 1-6) than those ever experienced (p<0.001). Unsupervised LCA of symptoms revealed three clinically-active PASC subphenotypes: a high burden constitutional symptoms (21.9%) , a persistent loss/change of smell and taste (20.6%) , and a minimal residual symptoms subphenotype (57.5%). Subphenotype assignments were strongly associated with self-assessments of global health, recovery and PASC impact on employment (p<0.001). Viral persistence (5.6% saliva and 1% stool samples positive) did not explain SRSOs or subphenotypes. Conclusions: We identified distinct PASC subphenotypes and highlight that although most symptoms progressively resolve, specific PASC subpopulations are impacted by either high burden of constitutional symptoms or persistent olfactory/gustatory dysfunction, requiring prospective identification and targeted preventive or therapeutic interventions.

Mental health status and related factors influencing healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis (preprint)

Background: The mental health of healthcare workers during the coronavirus-2019 pandemic was seriously affected, and the risk of mental health problems was high. The present study sought to systematically evaluate the mental health problems of healthcare workers worldwide during the pandemic and to determine the latest global frequency of COVID-19 associated mental health problems. Methods: Data in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Elsevier, MEDLINE, PubMed, PsycINFO and the Web of Science before November 11, 2022, were systematically searched. Cohort, case-control and cross-sectional studies were included. The meta-analysis used a random effects model to synthesize the comprehensive prevalence rate of mental health problems. Subgroup analyses were performed based on time of data collection; whether the country was or was not developed; continent; doctors and nurses; doctors/nurses vs. other healthcare workers; and psychological evaluation scale. Results: A total of 161 studies were included, including 341,014 healthcare workers worldwide, with women accounting for 82.8%. Occupationally, 16.2% of the healthcare workers were doctors, 63.6% were nurses and 13.3% were other medical staff. During the pandemic, 47% (95% confidence interval [CI], 35-60%) of healthcare workers reported job burnout, 38% (95% CI, 35-41%) experienced anxiety, 34% (95% CI 30-38%) reported depression, 30% (95% CI, 29-31%) had acute stress disorder, and 26% (95% CI, 21-31%) had post-traumatic stress disorder. Conclusions: The study found that there were common mental health problems among health care workers during the COVID-19 pandemic. The most common was job burnout, followed by anxiety, depression, acute stress and post-traumatic stress disorder. Although the global pandemic has been brought under control, its long-term impact on the mental health of healthcare workers cannot be ignored. Additional research is required to develop measures to prevent, monitor and treat psychological disorders among healthcare workers.

Follow-Up In Patients With Respiratory Disability After ARDS Related To COVID-19: A Systematic Review (preprint)

Introduction: Acute Respiratory Distress Syndrome (ARDS) is an acute inflammatory pulmonary process that leads to protein-rich, non-hydrostatic pulmonary edema, undesirable hypoxemia, and lung stiffness. Due to COVID-19, a significant proportion of people who will require hospitalization to treat COVID-19, between 15%-30%, will develop severe respiratory failure, ARDS, and an increased likelihood of intubation for mechanical respiratory support. Aim: To investigate the pulmonary function in COVID-19-related ARDS survivors after hospitalization. Methods: A search was performed on the Greek and international literature, as well as at the online Databases PubMed, Cochrane, Embase, and Google Scholar. Exclusion and integration criteria were set for the studies found, and a flow chart was created for the studies included. Results: Through the search, 352 articles were found matching the subject under study, and after further evaluation, four articles were included. The majority of the articles highlight that after ARDS occurs due to COVID-19, patients face impaired pulmonary function in combination with other physical and psychological symptoms like weakness, anxiety, depression, and generalized functional disability. Conclusions: It is a fact that COVID-19 disease, in severe form and following the need for hospitalization due to the development of ARDS, results in an increased likelihood of prolonged occurrence of some symptoms of impaired respiratory function. Impaired CO2 diffusion is observed in the majority of studies as well as impaired respiratory function regarding prolonged imaging findings and impaired physical function. Keywords: ARDS, SARS-CoV-2, ICU, COVID-19, follow up, respiratory function

Protocol for an ABT study: the role of emotional processing in Art Brut therapy for college students during the COVID-19 pandemic (preprint)

Background COVID-19 is both a global health emergency and a major psychological crisis event, and its negative effects on college students' mental health continue to persist after more than three years. Previous studies[1, 2] suggest that the overall psychological health status of students in colleges has been poor during the COVID-19 pandemic, especially among those vulnerable to emotional problems. Interventions are needed to improve the psychological health of college students. This study was designed to determine the potential role of art brut therapy as a positive psychological health approach for university students. Methods A sample of university students (n = 120) will be recruited and assigned to an Offline Art Brut Group (OFABG), Online Art Brut Group (OABG), or a control group (CG) with no intervention. Prior to inclusion in the Time 1 assessment, potential subjects will be screened for eligibility requirements via an online survey. Once recruited, participants will finish the Time 1 assessment; then, the two experimental groups will receive art brut therapy once a week for 16 weeks. After the 16-week intervention, subjects will complete the Time 2 assessment. Every assessment will include both psychological and physiological measures. Symptom Checklists 90 (SCL-90) and the Positive Affect and Negative Affect Scale (PANAS) will be used to measure the psychological effects of art brut therapy in college students, while the level of cortisol in saliva samples and interleukin 6 (IL-6) in blood samples will be used to examine the physiological effects. Discussion This study will articulate the impact of art brut therapy on both psychological conditions and physiological markers associated with emotions, and it will also explore the feasibility and effectiveness of online art brut therapy. The results will determine the efficacy of a low-cost, easy-to-implement, accessible and engaging psychological health intervention for university students with emotional challenges during the COVID-19 pandemic. Trial registration Chinese Clinical Trial Registry, ChiCTR2200062802, August 19th, 2022.

Psychological Treatment of Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia Using an Integrative Approach.

Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is characterized by persistent, unwanted physiological genital arousal (i.e., sensitivity, fullness, and/or swelling) in the absence of sexual excitement or desire which can persist for hours to days and causes significant impairment in psychosocial well-being (e.g., distress) and daily functioning. The etiology and course of PGAD/GPD is still relatively unknown and, unsurprisingly, there are not yet clear evidence-based treatment recommendations for those suffering from PGAD/GPD. We present the case of a 58-year-old woman with acquired persistent genital arousal disorder, which began in March 2020; she believed she developed PGAD/GPD due to a period of significant distress and anxiety related to the COVID-19 pandemic. After seeking medical diagnosis and treatment from multiple healthcare providers and trying a combination of pharmacological and medical treatment modalities, she presented for psychological treatment. An integrative therapy approach (3 assessment sessions, 11 treatment sessions), which included cognitive behavior therapy, distress tolerance and emotion regulation skills from dialectical behavior therapy, and mindfulness practice, was utilized. The patient reported improvements anecdotally (e.g., decreased impact on occupational and social functioning, greater self-compassion, less frequent and shorter duration of PGAD/GPD flare-ups, improved ability to cope with PGAD/GPD symptoms, and decreased need for sleeping medication) and on self-report measures (e.g., lower PGAD/GPD catastrophizing, lower anxiety and depression, and greater overall quality of life).We report the use of an integrative (i.e., psychoeducational, cognitive behavioral, dialectical behavioral, and mindfulness-based) intervention, which may be an effective psychological treatment for PGAD/GPD.

Long term health related quality of life in the covid-19 patients based on severity of disease (preprint)

Background: The COVID-19 pandemic affects all aspects of the patient's health. This study aimed to investigate the relationship between disease severity and long term health-related quality of life (HRQOL) in patients who have been discharged for 6 months. Methods: In this historical cohort study, 192 patients with a history of severe and 192 patients with a history of non-severe COVID-19, who had been discharged at least 6 months before the interview, using the convenient sampling method and through the information registered in Medical care monitoring center(MCMC) of Shiraz's hospitals, in the Shiraz , a city in the sought part of Iran country in 2020, were selected. Data was collected through Telephone-based interview. The short form of the 12-item health-related quality of life (SF-12) questionnaire was used to measure the health-related quality of life. Mean (SD), frequency (percentage) were used to description. Chi-square test, independent samples t-test, Fisher's exact test, and multiple linear regression model was used to inferential statistics. All statistical analyzes were performed in SPSS software version 24, considering a significance level of 0.05. Results: Generally out of 384 patients, 79.95% (307 people) were married and mean (SD) of age was 53.95 (15.87). Most of the patients in the two groups were male (57.81% in severe and 51.04% in non-severe disease group). Independent samples t-test showed that the mean of quality of life score in patients with severe type was significantly lower compared to patients with non-severe (p<0.001, 34.45(6.59) versus 39.64 (5.07)). Results of multiple linear regression also showed that the severity of the disease had a significant negative effect on HRQOL of patients (p<0.001, B=-4.84). Conclusion: Our finding showed that HRQOL in patients with a non-severe level of COVID -19 was significantly higher than in patients with a severe level. Therefore, it seems Necessary to consider a policy for development of a kind of social, psychological or medical support for improving the HRQOL of patients with severe disease.

Difference in the Risk of Discrimination on Psychological Distress Experienced by Early Wave Infected and Late Wave Infected COVID-19 Survivors (preprint)

The psychological distress experienced by coronavirus disease of 2019 (COVID-19) survivors after recovery from the illness is amplified by discrimination endured because of their infection status. However, the difference in the risk of facing discrimination and risk of experiencing psychological distress in the early and late waves of the COVID-19 pandemic remain unclear. This study aimed to investigate whether the risk of facing discrimination because of infection status was lower in the early or late waves and whether risk of discrimination on psychological distress was more serious in later, rather than earlier waves. We conducted two online surveys to collect data from survivors divided into two groups. The participants with scores of five or more on the Kessler Psychological Distress Scale were identified as having experienced psychological distress. The participants were identified as having experienced discrimination based on infection status if they had endured being blamed, some type of discrimination, or having themselves or their families maligned. The timing of infection was split into infected during early waves of the pandemic for 2021 participants and infected during later waves of the pandemic for 2022 participants. Modified Poisson regression analyses were performed using experiences of discrimination as dependent variables and timing of infection as independent variables. Modified Poisson regression analyses were further performed using the presence of psychological distress as a dependent variable and experiences of discrimination and timing of infection as dependent variables, in addition to interaction effect of these independent variables. The data of 6,010 participants who were infected in early waves and 5,344 participants who were infected in later waves were analyzed. The risks of being blamed, some forms of discrimination, and participants and their families being maligned were significantly lower in the group who were infected in later waves than those infected in earlier waves. Experiences of discrimination were highly associated with psychological distress in those infected in later waves than those infected in earlier waves, while only being blamed showed a significant association. Risk of discrimination was found to be lower in those infected in later waves, whereas risk of discrimination on psychological distress was shown to be more serious in those infected in later waves. Therefore, we submit that it is more important to support COVID-19 survivors who face discrimination, than it is to attempt to decrease the current discriminatory climate caused by the COVID-19 pandemic.

Psychological Impacts of COVID-19 and Its Associated Factors Among People Living in Abha City, Saudi Arabia (preprint)

Background: The novel coronavirus (COVID-19) infection is primarily transmitted through respiratory droplets from an infected person and contact with tainted surfaces or items. Social distancing became the primary measure of preventing the spread of COVID-19, with the principal aim being to reduce the probability of contact with an already infected person. Social distancing can be distressing, as it is against the community's way of life. Saudi Arabia imposed a curfew and suspended all religious, entertainment, sporting, and mass congregations. The daily updates on COVID-19 infection and mortality are upsetting and further, aggravate depression and anxiety. With this background, this study was planned with the following objectives. To determine the sociodemographic profile of the study participants, to find the prevalence of psychological morbidity, and to measure the association between the sociodemographic details, COVID-19 associated factors, and psychological effects among Abha citizens during the COVID-19 pandemic. Methodology: A descriptive cross-sectional community-based study was conducted in the Abha city population from August 2021 to July 22. This study followed snowball sampling, the data was collected using an online Google form the link was shared in WhatsApp groups and through emails to contacts, asking friends to share it with their friends, until reaching the adequate sample size the responses were accepted. Results: A total of 530 participated, and their age ranged from 19 -70 years. Many of the participants (34.5%, n=183) belonged to 36-45 years old. Most of the responders were 69.8% married and Females (69.2%, n=367). Half of the participants had been quarantined (49.6%), and 51.5% were scared from fear of COVID-19. 64.8% of the participants had depression; 14.2%, 20.8%, 13.6%, and 16.2% had mild, moderate, severe, and extremely severe depression, respectively. Around 58.2% of participants suffered from anxiety; 5.8% experienced mild anxiety, 21.7% moderate anxiety, and 30.7% severe anxiety. The proportion of stress among the participants was 45.0%; 10.8% had mild stress, 9.4% had moderate stress, and 24.5% had severe to extremely severe stress. Conclusions: COVID-19 poses mental health problems among individuals and communities. There is a need to find the more susceptible individuals for mental health issues or other psychological disorders. Mental health and psychological problems can be resolved with health education, counseling, and appropriate interventions to curb the negative health impacts of COVID-19.