Psychological impact of COVID-19 in the Swedish population: Depression, anxiety, and insomnia and their associations to risk and vulnerability factors.

BACKGROUND: The 2019 coronavirus disease (COVID-19) pandemic, with its associated restrictions on daily life, is like a perfect storm for poor mental health and wellbeing. The purpose of this study was therefore to examine the impacts of COVID-19 on mental health and wellbeing during the ongoing pandemic in Sweden. METHOD: Standardized measures of depression, anxiety, and insomnia as well as measures of risk and vulnerability factors known to be associated with poor mental health outcomes were administered through a national, online, cross-sectional survey (n = 1,212; mean age 36.1 years; 73% women). RESULT: Our findings show significant levels of depression, anxiety, and insomnia in Sweden, at rates of 30%, 24.2%, and 38%, respectively. The strongest predictors of these outcomes included poor self-rated overall health and a history of mental health problems. The presence of COVID-19 symptoms and specific health and financial worries related to the pandemic also appeared important. CONCLUSIONS: The impacts of COVID-19 on mental health in Sweden are comparable to impacts shown in previous studies in Italy and China. Importantly, the pandemic seems to impose most on the mental health of those already burdened with the impacts of mental health problems. These results provide a basis for providing more support for vulnerable groups, and for developing psychological interventions suited to the ongoing pandemic and for similar events in the future.

Is returning to work during the COVID-19 pandemic stressful? A study on immediate mental health status and psychoneuroimmunity prevention measures of Chinese workforce.

This study aimed to quantify the immediate psychological effects and psychoneuroimmunity prevention measures of a workforce returning to work during the COVID-19 epidemic. Workforce returning to work was invited to complete an online questionnaire regarding their attitude toward the COVID-19 epidemic and return-to-work along with psychological parameters including the Impact of Event Scale-Revised, Depression, Anxiety, Stress Scale- 21 (DASS-21) and Insomnia Severity Index (ISI). Psychoneuroimmunity prevention measures include precautions at personal and organization levels. From 673 valid questionnaires, we found that 10.8% of respondents met the diagnosis of post-traumatic stress disorder (PTSD) after returning to work. The respondents reported a low prevalence of anxiety (3.8%), depression (3.7%), stress (1.5%) and insomnia (2.3%). There were no significant differences in the severity of psychiatric symptoms between workers/technicians and executives/managers. >95% reported psychoneuroimmunity prevention measures including good ventilation in the workplace and wore a face mask as protective. Factors that were associated with the severity of psychiatric symptoms in the workforce were marital status, presence of physical symptom, poor physical health and viewing return to work as a health hazard (p < 0.05). In contrast, personal psychoneuroimmunity prevention measures including hand hygiene and wearing face masks as well as organizational measures including significant improvement of workplace hygiene and concerns from the company were associated with less severe psychiatric symptoms (p < 0.05). Contrary to expectations, returning to work had not caused a high level of psychiatric symptoms in the workforce. The low prevalence of psychiatric symptoms could be due to confidence instilled by psychoneuroimmunity prevention measures before the resumption of work. Our findings would provide information for other countries during the COVID-19 pandemic.

Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study.

The severe 2019 outbreak of novel coronavirus disease (COVID-19), which was first reported in Wuhan, would be expected to impact the mental health of local medical and nursing staff and thus lead them to seek help. However, those outcomes have yet to be established using epidemiological data. To explore the mental health status of medical and nursing staff and the efficacy, or lack thereof, of critically connecting psychological needs to receiving psychological care, we conducted a quantitative study. This is the first paper on the mental health of medical and nursing staff in Wuhan. Notably, among 994 medical and nursing staff working in Wuhan, 36.9% had subthreshold mental health disturbances (mean PHQ-9: 2.4), 34.4% had mild disturbances (mean PHQ-9: 5.4), 22.4% had moderate disturbances (mean PHQ-9: 9.0), and 6.2% had severe disturbance (mean PHQ-9: 15.1) in the immediate wake of the viral epidemic. The noted burden fell particularly heavily on young women. Of all participants, 36.3% had accessed psychological materials (such as books on mental health), 50.4% had accessed psychological resources available through media (such as online push messages on mental health self-help coping methods), and 17.5% had participated in counseling or psychotherapy. Trends in levels of psychological distress and factors such as exposure to infected people and psychological assistance were identified. Although staff accessed limited mental healthcare services, distressed staff nonetheless saw these services as important resources to alleviate acute mental health disturbances and improve their physical health perceptions. These findings emphasize the importance of being prepared to support frontline workers through mental health interventions at times of widespread crisis.

Mental status of patients with chronic insomnia in China during COVID-19 epidemic.

AIM: To study the sleep and mental health of chronic insomnia patients in China during coronavirus disease in 2019 (COVID-19) epidemic. METHODS: A total of 764 patients with chronic insomnia were included in this study. From 17 January 2020 to 24 January 2020, insomnia, anxiety and physical symptoms were evaluated online, and they were followed up for 4 and 8 weeks. Main outcomes and indicators were assessed using the Pittsburgh Sleep Quality Index (PSQI) and each factor score, the General Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-15 (PHQ-15), respectively. In addition, insomnia, anxiety and physical symptoms were assessed at baseline and at the end of fourth and eighth weeks. Wilcoxon signed rank test was used to compare the changes in patients' scale scores at different time points. RESULTS: Among the 764 participants, there were 755 and 738 evaluators who completed the fourth and eighth weeks, respectively, and the questionnaire completion rates were 98.82% and 96.60%, respectively. Among them, there are 459 (60.0%) aged 41-60 years old, 546 (71.5%) women, 218 (28.5%) men and 313 (41%) college degrees. After 8 weeks of follow-up, the differences in sleep status, anxiety symptoms and physical symptoms were statistically significant. Among the factors of PSQI, there were differences in subjective sleep quality, sleep latency, sleep duration, sleep disturbance (disorder), sleep efficiency and daytime function. At 4 weeks of follow-up, there was a statistically significant difference in the use of hypnotic drugs; at 8 weeks of follow-up, there was no statistically significant difference in the use of hypnotic drugs. CONCLUSION: Under the influence of the COVID-19, the sleep status and anxiety of patients with chronic insomnia are affected by the epidemic.

Developing mental health nursing strategies for the inbound quarantined population in China during the COVID-19 global pandemic.

OBJECTIVE: The aim of the study was to develop mental health nursing strategies for the inbound quarantined population based on the results of a survey study and frontline nursing experiences. SUBJECTS AND METHODS: A mixed research method was selected, we collected data by questionnaires from 128 quarantined people, and by semi-structured interviews from 5 registered nurses. Generalized anxiety disorder-7 (GAD-7), the patient health questionnaire-9 (PHQ-9), the Pittsburgh Sleep Quality Index (PSQI), Social Support Rating Scale (SSRS) were used in the quantitative research to identify the prevalence of psychological issues and risk factors. Semi-structured interviews were conducted in the qualitative study to conclude nursing experiences from RNs. RESULTS: The overall prevalence of anxiety, depression, and insomnia were 34%, 41%, and 18% respectively. Binary logistic regression analysis showed that social support, urban residence, and chronic disease were associated with mental health problems in certain aspects. Three themes were emerged from the analysis of RNs interviews: personality, chronic diseases, and social support. CONCLUSIONS: The prevalence of mental health issues in the inbound quarantined population was the same as the general population in the initial stage of COVID-19 outbreak, and significantly lower than people who lived in high-risk areas. Living in urban areas, with chronic diseases, and obtaining less social support are the risk factors. Finally, four nursing strategies were proposed by the research team for mental health well-being.

Psychological state of a sample of patients with mood disorders during the first French COVID-19 lockdown.

Since the beginning of the COVID-19 pandemic, evidence shows the negative psychological impact of lockdown measures in the general population. It is also important to identify predictors of psychological distress in vulnerable people, particularly patients with history of depressive episodes (the most prevalent psychiatric disorder), in order to adapt mental health strategies for future lockdown measures. This study aim was to (1) compare in 69 healthy controls (HC) and 346 patients with a major depressive episode in the two previous years (PP) self-reported psychological symptoms (depression, anxiety, insomnia, suicidal ideation, traumatic stress, anger) and living conditions during the first national French lockdown, and (2) identify predictors of significant psychological distress in PP. The levels of psychological symptoms were very low in HC compared with PP, independently of the living conditions. Half of PP had no psychiatric contact during the lockdown. Loneliness and boredom were independent predictors of depression, anxiety and insomnia, whereas daily physical activity was a protective factor. Virtual contacts protected against suicidal ideation. Our results highlight the need of specific strategies to target loneliness and boredom and to improve care access, including telepsychiatry. Longitudinal studies must investigate the COVID-19 pandemic psychological impact in clinical samples.

The prevalence of insomnia among health care workers amid the COVID-19 pandemic: An umbrella review of meta-analyses.

BACKGROUND: Health care workers (HCWs) during the COVID-19 pandemic experience numerous psychological problems, including stress and anxiety. These entities can affect their sleep quality and predispose them to insomnia. The aim of the present study was to investigate the prevalence of insomnia among HCWs during the COVID-19 crisis via an umbrella review. METHODS: The PRISMA guideline was used to conduct this review. By searching relevant keywords in databases of Scopus, PubMed, Web of Science, and Google Scholar, studies that reported the prevalence of insomnia among HCWs during the COVID-19 pandemic (January 2020 to the end of January 2021) and had been published in English were identified and evaluated. The random effects model was used for meta-analysis, and the I2 index was used to assess heterogeneity. The Egger test was used to determine publication bias. Based on the results of the primary search, 96 studies were identified, and ultimately 10 eligible studies entered the meta-analysis phase. RESULTS: The results of the umbrella review of meta-analyses showed that the prevalence of insomnia among HCWs during the COVID-19 pandemic was 36.36% (95% CI: 33.36-39.36, I2 = 59.6%, p = 0.006). CONCLUSIONS: The results of this umbrella review of meta-analyses showed a relatively high prevalence of insomnia among HCWs during the COVID-19 pandemic. As insomnia can be associated with other psychological problems, policymakers and health managers should regularly screen HCWs for psychological disorders as well as a possible tendency for suicide. Furthermore, by treating insomnia, one can reduce the incidence of these psychological disorders.

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

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

The psychological impact of the COVID-19 pandemic on pregnant women.

The aim was to examine the psychological effects caused by the COVID-19 pandemic on pregnant women, as well as the factors influencing these effects. The study design was cross-sectional and the participants were 200 pregnant women. The first group called the Pandemic Group (PG) included 100 women who were evaluated with psychological assessment instruments during the COVID-19 pandemic. The second group titled Pre-Pandemic Group (PPG) consisted of 100 women who were evaluated prior to the pandemic. Perceived stress, prenatal concerns and psychopathological symptoms were evaluated and compared. Pandemic Group scored significantly higher than Pre-Pandemic Group in the depression dimension of the SCL-90, in the phobic anxiety dimension, and in the Perceived Stress Scale. In addition, insomnia, along with having recently suffered the loss of a loved one explained 25% of the score variance in the depression dimension of the SCL-90. Insomnia also explained 13% of the variance of the results found in the Perceived Stress Scale. The fear of contagion by COVID-19 increased the scores obtained in the phobic anxiety dimension, explaining 11% of the variance. Thus, the COVID-19 pandemic could produce an increase in psychopathological symptomatology and stress, which can lead to negatively affecting pregnant women's mental health.

Demographic, psychological, chronobiological, and work-related predictors of sleep disturbances during the COVID-19 lockdown in Italy.

The first COVID-19 contagion wave caused unprecedented restraining measures worldwide. In Italy, a period of generalized lockdown involving home confinement of the entire population was imposed for almost two months (9 March-3 May 2020). The present is the most extensive investigation aimed to unravel the demographic, psychological, chronobiological, and work-related predictors of sleep disturbances throughout the pandemic emergency. A total of 13,989 Italians completed a web-based survey during the confinement period (25 March-3 May). We collected demographic and lockdown-related work changes information, and we evaluated sleep quality, insomnia and depression symptoms, chronotype, perceived stress, and anxiety using validated questionnaires. The majority of the respondents reported a negative impact of confinement on their sleep and a delayed sleep phase. We highlighted an alarming prevalence of sleep disturbances during the lockdown. Main predictors of sleep disturbances identified by regression models were: female gender, advanced age, being a healthcare worker, living in southern Italy, confinement duration, and a higher level of depression, stress, and anxiety. The evening chronotype emerged as a vulnerability factor, while morning-type individuals showed a lower predisposition to sleep and psychological problems. Finally, working from home was associated with less severe sleep disturbances. Besides confirming the role of specific demographic and psychological factors in developing sleep disorders during the COVID-19 pandemic, we propose that circadian typologies could react differently to a particular period of reduced social jetlag. Moreover, our results suggest that working from home could play a protective role against the development of sleep disturbances during the current pandemic emergency.

Coronavirus anxiety and exhaustion among Polish front-line healthcare workers - the mediation effect of insomnia.

OBJECTIVES: The study aimed to investigate the direct and indirect - mediated through insomnia - effect of coronavirus anxiety on exhaustion, from the perspective of Hobfoll's theory of conservation of resources (COR). According to the COR theory, critical events (e.g., the coronavirus epidemic) make people fearful of losing their valuable resources. A prolonged state of anxiety may lead to sleeping troubles, which over time results in an increase in exhaustion. MATERIAL AND METHODS: Data were collected from 440 Polish healthcare providers, including nurses and midwives, doctors, paramedics, medical assistance workers, and wardens. Three measures were used: the Coronavirus Anxiety Scale, the Copenhagen Psychosocial Questionnaire (the sleeping trouble subscale) and the Oldenburg Burnout Inventory (the exhaustion subscale). Hypotheses were tested using structural equation modeling. RESULTS: The obtained results fully support the hypotheses. Both the direct and indirect relationships between coronavirus anxiety and exhaustion were observed. Specifically, high coronavirus anxiety increased insomnia, which in turn contributed to the development of exhaustion. CONCLUSIONS: The results are consistent with the COR theory. Prolonged coronavirus anxiety and sleeping problems depleted healthcare providers' resources and made them feel exhausted. Exhaustion among these workers can have serious consequences not only for themselves but also for the health of their patients. Therefore, research into effective ways to deal with coronavirus anxiety is needed. Int J Occup Med Environ Health. 2021;34(2):263-73.

Self-help cognitive behavioral therapy application for COVID-19-related mental health problems: A longitudinal trial.

BACKGROUND AND AIM: Recently, the availability and usefulness of mobile self-help mental health applications have increased, but few applications deal with COVID-19-related psychological problems. This study explored the intervention efficacy of a mobile application on addressing psychological problems related to COVID-19. METHODS: A longitudinal control trial involving 129 Chinese participants with depression symptoms was conducted through the mobile application "Care for Your Mental Health and Sleep during COVID-19" (CMSC) based on WeChat. Participants were divided into two groups: mobile internet cognitive behavioral therapy (MiCBT) and wait-list. The primary outcome was improvement in depression symptoms. Secondary outcomes included improvement in anxiety and insomnia. The MiCBT group received three self-help CBT intervention sessions in one week via CMSC. RESULTS: The MiCBT group showed significant improvement in depression and insomnia (allP < 0.05) compared with the wait-list group. Although both groups showed significant improvement in anxiety at the intervention's end, compared with the wait-list group, the MiCBT group had no significant advantage. Correlation analysis showed that improvement in depression and anxiety had a significant positive association with education level. Changes in insomnia were significantly negatively correlated with anxiety of COVID-19 at the baseline. CMSC was considered helpful (n=68, 81.9 %) and enjoyable (n=54, 65.9 %) in relieving depression and insomnia during the COVID-19 outbreak. CONCLUSIONS: CMSC is verified to be effective and convenient for improving COVID-19-related depression and insomnia symptoms. A large study with sufficient evidence is required to determine its continuous effect on reducing mental health problems during the pandemic.

A mediating role for mental health in associations between COVID-19-related self-stigma, PTSD, quality of life, and insomnia among patients recovered from COVID-19.

INTRODUCTION: Patients with COVID-19 often suffer from psychological problems such as post-traumatic stress disorder (PTSD) and self-stigmatization that may negatively impact their quality of life and sleep. This study examined mental health as a potential mediating factor linking self-stigmatization and PTSD to quality of life and sleep. METHODS: Using a cross-sectional design, 844 people who had recovered from COVID-19 were called and interviewed. Data were collected using structured scales. Structural equation modeling was applied to assess fitness of a mediation model including self-stigma and PTSD as independent factors and quality of life and insomnia as dependent variables. RESULTS: Mental health, COVID-19-related self-stigma, and mental quality of life were associated. Insomnia, PTSD, and COVID-19-related self-stigma displayed significant direct associations (r = .334 to 0.454; p < .01). A mediation model indicated satisfactory goodness of fit (CFI = 0.968, TLI = 0.950, SRMR = 0.071, RMSEA = 0.068). Mental health as a mediator had negative relationships with COVID-19-related self-stigma, PTSD, and insomnia and positive associations with quality of life. CONCLUSION: Mental health may mediate effects of COVID-19-related self-stigma and PTSD on quality of life and insomnia. Designing programs to improve mental health among patients with COVID-19 may include efforts to reduce negative effects of PTSD and COVID-19-related self-stigma on quality of life and insomnia.

Insomnia during the COVID-19 pandemic: the role of depression and COVID-19-related risk factors.

The COVID-19 pandemic has resulted in dramatic changes to sleep patterns and higher prevalence of insomnia, which threaten overall mental and physical health. We examined whether safety behaviors in response to COVID-19, worry in response to COVID-19, and depression predicted insomnia, with age, race, and sex as covariates. A community sample from the United States (n = 321, Mage = 40.02, SD = 10.54; 53.6% female) recruited using online crowdsourcing completed self-report measures in May of 2020 and again three months later. At baseline, our model accounted for 68.1% of the variance in insomnia, with depression as the only significant predictor (ß = .70, p < .001). In the longitudinal analyses, only baseline insomnia symptoms predicted 3-month follow-up insomnia symptoms (ß = .70, p < .001; 67.1% of variance). Of note, COVID-19 worry and some COVID-19 safety behaviors were related to 3-month follow-up safety behaviors, but not insomnia. Our findings demonstrated that depression is an important factor to consider for concurrent insomnia symptoms. Our results have implications regarding the development of interventions for insomnia during the COVID-19 pandemic and suggest that clinicians should consider depression when assessing for and treating insomnia symptoms.

The impact of COVID-19 on subthreshold depressive symptoms: a longitudinal study.

AIMS: The coronavirus disease 2019 (COVID-19) pandemic represents an unprecedented threat to mental health. Herein, we assessed the impact of COVID-19 on subthreshold depressive symptoms and identified potential mitigating factors. METHODS: Participants were from Depression Cohort in China (ChiCTR registry number 1900022145). Adults (n = 1722) with subthreshold depressive symptoms were enrolled between March and October 2019 in a 6-month, community-based interventional study that aimed to prevent clinical depression using psychoeducation. A total of 1506 participants completed the study in Shenzhen, China: 726 participants, who completed the study between March 2019 and January 2020 (i.e. before COVID-19), comprised the 'wave 1' group; 780 participants, who were enrolled before COVID-19 and completed the 6-month endpoint assessment during COVID-19, comprised 'wave 2'. Symptoms of depression, anxiety and insomnia were assessed at baseline and endpoint (i.e. 6-month follow-up) using the Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder-7 (GAD-7) and Insomnia Severity Index (ISI), respectively. Measures of resilience and regular exercise were assessed at baseline. We compared the mental health outcomes between wave 1 and wave 2 groups. We additionally investigated how mental health outcomes changed across disparate stages of the COVID-19 pandemic in China, i.e. peak (7-13 February), post-peak (14-27 February), remission plateau (28 February-present). RESULTS: COVID-19 increased the risk for three mental outcomes: (1) depression (odds ratio [OR] = 1.30, 95% confidence interval [CI]: 1.04-1.62); (2) anxiety (OR = 1.47, 95% CI: 1.16-1.88) and (3) insomnia (OR = 1.37, 95% CI: 1.07-1.77). The highest proportion of probable depression and anxiety was observed post-peak, with 52.9% and 41.4%, respectively. Greater baseline resilience scores had a protective effect on the three main outcomes (depression: OR = 0.26, 95% CI: 0.19-0.37; anxiety: OR = 1.22, 95% CI: 0.14-0.33 and insomnia: OR = 0.18, 95% CI: 0.11-0.28). Furthermore, regular physical activity mitigated the risk for depression (OR = 0.79, 95% CI: 0.79-0.99). CONCLUSIONS: The COVID-19 pandemic exerted a highly significant and negative impact on symptoms of depression, anxiety and insomnia. Mental health outcomes fluctuated as a function of the duration of the pandemic and were alleviated to some extent with the observed decline in community-based transmission. Augmenting resiliency and regular exercise provide an opportunity to mitigate the risk for mental health symptoms during this severe public health crisis.

Psychologic distress and sleep quality among adults in Turkey during the COVID-19 pandemic.

OBJECTIVE: The sudden novel coronavirus disease 2019 (COVID-19) pandemic has created a negative effect on the mental health of the public. In this study, in relation to the pandemic, psychological distress, sleep quality and affecting factors in adults were examined. METHODS: Using the convenience sampling method, the Pittsburgh Sleep Quality Index and questionnaires to determine psychological distress levels and sociodemographic characteristics were distributed online to 405 participants. RESULTS: The mean psychological distress score of the participants was 34.55 ± 8.07, while their mean sleep quality score was 6.39 ± 3.31. The prevalence of poor sleep quality was 55.1%. The psychological distress scores were higher among the men than the women, married participants than single ones, those with children than those without children and those who were employed than those who were not. The sleep quality of the single participants and the participants with low education levels was poorer. The sleep quality of those who left work in the pandemic period was poorer than those who were working from home/office and those who were already not employed before the pandemic. The sleep quality of those not working in the field of health was better than healthcare professionals and those not working at all. The scores for psychological distress were positively correlated with gender and negatively correlated with sleep quality levels. CONCLUSION: Our findings showed that the COVID-19 pandemic had a negative effect on the psychological distress and sleep quality of adults. It is recommended for healthcare professionals to take the necessary psychosocial precautions.

Acute psychological impact on COVID-19 patients in Hubei: a multicenter observational study.

We conducted a multicentre cross-sectional survey of COVID-19 patients to evaluate the acute psychological impact on the patients with coronavirus disease 2019 (COVID-19) during isolation treatment based on online questionnaires from 2 February to 5 March 2020. A total of 460 COVID-19 patients from 13 medical centers in Hubei province were investigated for their mental health status using online questionnaires (including Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Patient Health Questionnaire-15, and Insomnia Severity Index scales). Among all 460 COVID-19 patients, 187 (40.65%) of them were healthcare workers (HCWs). 297 (64.57%) of them were females. The most common psychological problems were somatization symptoms (66.09%, n = 304), followed by depression (53.48%, n = 246), anxiety (46.30%, n = 213), problems of insomnia (42.01%, n = 171), and then self-mutilating or suicidal thoughts (23.26%, n = 107). Of all the patients, 15.65% (n = 72) had severe somatization symptoms, and 2.83% (n = 13) had severe (almost every day) self-mutilating or suicidal thoughts. The most common psychological problems for HCWs were somatization symptoms (67.84%, n = 125), followed by depression (51.87%, n = 97), anxiety (44.92%, n = 84), problems of insomnia (36.18%, n = 55), and then self-mutilating or suicidal thoughts (20.86%, n = 39). Patients with lower education levels were found to be associated with higher incidence of self-mutilating or suicidal thoughts (odds ratio [OR], 2.68, 95% confidence interval [95% CI], 1.66-4.33 [P < 0.001]). Patients with abnormal body temperature were found to be associated with higher incidence of self-mutilating or suicidal thoughts (OR, 3.97, 95% CI, 2.07-7.63 [P < 0.001]), somatic symptoms (OR, 2.06, 95% CI, 1.20-3.55 [P = 0.009]) and insomnia (OR, 1.66, 95% CI, 1.04-2.65 [P = 0.033]). Those with suspected infected family members displayed a higher prevalence of anxiety than those without infected family members (OR, 1.61, 95% CI, 1.1-2.37 [P = 0.015]). Patients at the age of 18-44 years old had fewer somatic symptoms than those aged over 45 years old (OR, 1.91, 95% CI, 1.3-2.81 [P = 0.001]). In conclusion, COVID-19 patients tended to have a high prevalence of adverse psychological events. Early identification and intervention should be conducted to avoid extreme events such as self-mutilating or suicidal impulsivity for COVID-19 patients, especially for those with low education levels and females who have undergone divorce or bereavement.

Google Trends reveals increases in internet searches for insomnia during the 2019 coronavirus disease (COVID-19) global pandemic.

STUDY OBJECTIVES: The 2019 coronavirus disease (COVID-19) has become a global health and economic crisis. Recent evidence from small samples suggest that it has increased mood and sleep disturbances, including insomnia, around the world. This study aimed to estimate the effect of COVID-19 on insomnia levels worldwide and in the United States during the acute phase of the pandemic. METHODS: We analyzed search query data recorded between January 2004 and May 2020 from Google Trends and Google Keyword Planner for the search term "insomnia". RESULTS: The number of search queries for insomnia has increased over the past decade and is greater than the number of search queries for other major sleep disorders. The COVID-19 pandemic increased search queries for insomnia both worldwide and in the United States, with the number in the United States increasing by 58% during the first 5 months of 2020 compared with the same months from the previous 3 years. There is a robust diurnal pattern in insomnia search queries in the United States, with the number of queries peaking around 3 am and the overall pattern remaining stable during the pandemic. CONCLUSIONS: These results highlight the impact the COVID-19 pandemic has had on sleep health and the urgent need for making effective interventions accessible. Future studies will be needed to determine whether the increase in insomnia symptoms will persist and lead to higher rates of chronic insomnia in the population.

Infodemia: Another Enemy for Romanian Frontline Healthcare Workers to Fight during the COVID-19 Outbreak.

Background and Objectives: The population has been overwhelmed with false information related to the Coronavirus disease (COVID-19) crisis, spreading rapidly through social media and other channels. We aimed to investigate if frontline healthcare workers affected by infodemia show different psychological consequences than frontline clinicians who do not declare to be affected by false news related to the COVID-19 pandemic. Materials and Methods: One hundred twenty-six frontline healthcare workers from the Intensive Care Unit (ICU) and Emergency Departments in Romania completed a survey to assess stress, depression, anxiety, and sleep disorders, between March and April 2020. We split the sample of frontline healthcare workers into two groups based on the self-evaluated criteria: if they were or were not affected by infodemia in their activity. Results: Considering limitations such as the cross-sectional design, the lack of causality relationship, and the sample size, the results show that, the frontline medical workers who declared to be affected by false news were significantly more stressed, felt more anxiety, and suffered more from insomnia than healthcare workers who are not affected by false information related to pandemic time. Conclusions: The infodemia has significant psychological consequences such as stress, anxiety, and insomnia on already overwhelmed doctors and nurses in the outbreak of the COVID-19 crisis. These findings suggest that medical misinformation's psychological implications must be considered when different interventions regarding frontline healthcare workers during the COVID-19 pandemic are implemented.

COVID-19 Pandemic Stressors and Psychological Symptoms in Breast Cancer Patients.

BACKGROUND: The current Coronavirus disease 2019 (COVID-19) pandemic is a highly stressful event that may lead to significant psychological symptoms, particularly in cancer patients who are at a greater risk of contracting viruses. This study examined the frequency of stressors experienced in relation to the ongoing coronavirus pandemic and its relationship with psychological symptoms (i.e., anxiety, depression, insomnia, fear of cancer recurrence) in breast cancer patients. METHODS: Thirty-six women diagnosed with a non-metastatic breast cancer completed the Insomnia Severity Index, the Hospital Anxiety and Depression Scale, the severity subscale of the Fear of Cancer Recurrence Inventory, and the COVID-19 Stressors Questionnaire developed by our research team. Participants either completed the questionnaires during (30.6%) or after (69.4%) their chemotherapy treatment. RESULTS: Results revealed that most of the participants (63.9%) have experienced at least one stressor related to the COVID-19 pandemic (one: 27.8%, two: 22.2%, three: 11.1%). The most frequently reported stressor was increased responsibilities at home (33.3%). Higher levels of concerns related to the experienced stressors were significantly correlated with higher levels of anxiety, depressive symptoms, insomnia, and fear of cancer recurrence, rs(32) = 0.36 to 0.59, all ps < 0.05. CONCLUSIONS: Cancer patients experience a significant number of stressors related to the COVID-19 pandemic, which are associated with increased psychological symptoms. These results contribute to a better understanding of the psychological consequences of a global pandemic in the context of cancer and they highlight the need to better support patients during such a challenging time.