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.

Improving modelling for epidemic responses: reflections from members of the UK infectious disease modelling community on their experiences during the COVID-19 pandemic (preprint)

The COVID-19 pandemic both relied and placed significant burdens on the experts involved from research and public health sectors. The sustained high pressure of a pandemic on responders, such as healthcare workers, can lead to lasting psychological impacts including acute stress disorder, post-traumatic stress disorder, burnout, and moral injury, which can impact individual wellbeing and productivity. As members of the infectious disease modelling community, we convened a reflective workshop to understand the professional and personal impacts of response work on our community and to propose recommendations for future epidemic responses. The attendees represented a range of career stages, institutions, and disciplines. This piece was collectively produced by those present at the session based on our collective experiences. Key issues we identified at the workshop were lack of institutional support, insecure contracts, unequal credit and recognition, and mental health impacts. Our recommendations include rewarding impactful work, fostering academia-public health collaboration, decreasing dependence on key individuals by developing teams, increasing transparency in decision-making, and implementing sustainable work practices. Despite limitations in representation, this workshop provided valuable insights into the UK COVID-19 modelling experience and guidance for future public health crises. Recognising and addressing the issues highlighted here is crucial, in our view, for ensuring the effectiveness of epidemic response work in the future.

Effects of modular new prone positioning tools in patients with acute respiratory distress syndrome due to COVID-19: A randomized controlled trial (preprint)

Background Prone position (PP) ventilation has become an effective and simple treatment for acute respiratory distress syndrome (ARDS) due to COVID-19; however, prolonged prone position not only leads to patient discomfort, but also reduces patient compliance, and is prone to causing adverse events such as pressure injuries, pain, and dizziness. We aim to explore the effects of modular new prone positioning tools in patients with ARDS due to COVID-19.Methods 168 patients with ARDS due to COVID-19 were selected; however, 92 were later disqualified. 76 patients were randomly assigned to the observation group (n = 38) and the control group (n = 38). The observation group used modular new prone positioning tools to implement prone ventilation therapy while the control group used soft pillows to implement prone ventilation therapy. Comfort indicators (including time spent implementing PP, duration of PP, number of postural adjustments during PP, and duration time when first needing to adjust position), adverse events (including artificial airway kinking, shortness of breath, dizziness, and stress injury), and efficacy indicators (including intubation and mortality) were collected. The feeling of comfort, the occurrence of adverse events, and the efficacy of two groups of patients were also evaluated.Results The observation group had shorter time spent implementing PP(2.74 ± 0.86 vs. 4.64 ± 1.02, P < 0.001), longer duration of PP (14.02 ± 1.01 vs. 13.03 ± 0.66, P < 0.001), duration time when first needing to adjust position (59.89 ± 12.73 vs. 36.57 ± 8.69, P < 0.001), and lower number of postural adjustments during PP (11.03 ± 2.67 vs. 17.95 ± 2.58, P < 0.001) in comparison with the control group. No significant differences in intubation (9 vs. 11, P = 0.602) and mortality (4 vs. 6, P = 0.602) were found in both groups. However, in terms of adverse events, the observation group showed lower artificial airway kinking (5 vs. 23, P < 0.001), pain (7 vs. 21, P = 0.001), shortness of breath (2 vs. 9, P = 0.022), dizziness (0 vs. 5, P = 0.021), and stress injury (7 vs. 26, P < 0.001) than the control group.Conclusion Utilizing modular new prone position tools to implement prone ventilation therapy not only improves the efficiency of prone position execution and patient comfort, but also reduces the incidence of adverse events. However, it cannot change the intubation rate and mortality rate of patients.

Acute stress disorder in patients with accidental traumatic fractures: What can we do.

AIM: To evaluate the potential influencing factors of acute stress disorder (ASD) in patients with accidental traumatic fractures to provide evidence for clinical nursing care. DESIGN: A retrospective study. METHODS: Patients with traumatic fractures treated in our hospital from 1 January 2020 to 30 November 2021 were included. The characteristics of ASD and no ASD patients were assessed. RESULTS: A total of 468 patients with traumatic fractures were included, the incidence of ASD was 28.20%. Logistic regression analysis showed that age ≤50 years (OR2.918, 95% CI1.994 ~ 3.421), female (OR2.074, 95% CI1.489 ~ 3.375), AIS-ISS at admission ≥20 (OR3.981, 95% CI2.188 ~ 5.091), VAS at admission≥7 (OR2.804, 95% CI2.027 ~ 3.467), introverted personality (OR1.722, 95%CI1.314 ~ 2.432) and CD-RISC at admission≤60 (OR3.026, 95% CI2.338 ~ 4.769) were the risk factors of ASD in patients with traumatic fractures (all p < .05). CONCLUSIONS: The development of ASD in patients with traumatic fractures is affected by multiple factors. Medical workers should take early and timely management and nursing measures for related risk factors to reduce the occurrence of ASD.

Psychological distress among health professional students during the COVID-19 outbreak.

BACKGROUND: Due to the drastic surge of COVID-19 patients, many countries are considering or already graduating health professional students early to aid professional resources. We aimed to assess outbreak-related psychological distress and symptoms of acute stress reaction (ASR) in health professional students and to characterize individuals with potential need for interventions. METHODS: We conducted a prospective cohort study of 1442 health professional students at Sichuan University, China. At baseline (October 2019), participants were assessed for childhood adversity, stressful life events, internet addiction, and family functioning. Using multivariable logistic regression, we examined associations of the above exposures with subsequent psychological distress and ASR in response to the outbreak. RESULTS: Three hundred and eighty-four (26.63%) participants demonstrated clinically significant psychological distress, while 160 (11.10%) met the criterion for a probable ASR. Individuals who scored high on both childhood adversity and stressful life event experiences during the past year were at increased risks of both distress (ORs 2.00-2.66) and probable ASR (ORs 2.23-3.10), respectively. Moreover, internet addiction was associated with elevated risks of distress (OR 2.05, 95% CI 1.60-2.64) and probable ASR (OR 2.15, 95% CI 1.50-3.10). By contrast, good family functioning was associated with decreased risks of distress (OR 0.43, 95% CI 0.33-0.55) and probable ASR (OR 0.48, 95% CI 0.33-0.69). All associations were independent of baseline psychological distress. CONCLUSIONS: Our findings suggest that COVID-19 related psychological distress and high symptoms burden of ASR are common among health professional students. Extended family and professional support should be considered for vulnerable individuals during these unprecedented times.

Impact of COVID-19-Related Stress and Lockdown on Mental Health Among People Living With HIV in Argentina.

BACKGROUND: The spread of severe acute respiratory syndrome coronavirus 2, causative agent of the coronavirus disease 2019 (COVID-19), has necessitated widespread lockdown to mitigate the pandemic. This study examines the influence of resilience on the impact of COVID-related stress and enforced lockdown on mental health, drug use, and treatment adherence among people living with HIV (PLWH) in Argentina. SETTING: PLWH residing predominantly in Buenos Aires Metropolitan Area and urban regions of Argentina were identified from a private clinic electronic database. METHODS: Participants completed an anonymous online survey to evaluate the impact of COVID-19 on economic disruption, resilience, mental health outcomes (depression, anxiety, stress, and loneliness), adherence to HIV treatment, and substance use. We performed ordinary least squares and logistic regressions to test whether resilient coping buffered the impact of economic disruption on mental health and drug use during quarantine. RESULTS: A total of 1336 PLWH aged 18-82 were enrolled. The impact of economic disruption on mental health ΔF(1,1321) = 8.86, P = 0.003 and loneliness ΔF(1,1326) = 5.77, P = 0.016 was buffered by resilience. A 3-way interaction between resilient buffering, stress, and sex was significant ΔF(1,1325) = 4.76, P = 0.029. Participants reported less than excellent adherence to medication (33%), disruption to mental health services (11%), and disruption to substance abuse treatment (1.3%) during lockdown. DISCUSSION: The impact of COVID-stress and lockdown on emotional distress seemed mitigated by resilience coping strategies, and the buffering impact of resilience on perceived stress was greater among women. Results highlight PLWH's capacity to adhere to treatment in challenging circumstances and the importance of developing resilience skills for better coping with stress and adversity.

Effect of Single Session Receptive Music Therapy on Anxiety and Vital Parameters in Hospitalized Covid-19 Patients: A Randomized Controlled Trial. (preprint)

Hospitalized COVID-19 patients are vulnerable to different degrees of stress disorders as well as depression, anxiety and fear. The aim of this study was to evaluate the feasibility of introducing Music therapy (MT) on site with Covid-19 patients and investigating the immediate effects a single session has on anxiety, heart rate (HR), oxygen saturation (O2Sat) and satisfaction compared to standard care. A randomized controlled trial of 40 patients was conducted. Participants were assigned to control group (CG) or the MT group (MG). MG received an individual single session of music therapy in presence. CG received standard care. MG and CG were subjected to identical measurements (pre-during-post) of the parameters STAI-Y, HR and O2Sat. Participants in MG were asked to fill in an optional open-ended question concerning their experience with MT. Significant difference in anxiety levels between scores in MG and CG (34.50 (23.25 - 40.00) vs 45.00(38, 25 - 54.00); p = 0.000) was observed. MG compared to CG had statistically significantly higher values of O2Sat (97.50 (96.25 - 99.00) versus 96.00 (96.00- 98.00); p = 0.026). Results show the feasibility of introducing MT as a supporting complementary/non-pharmacological intervention on site in Covid-19 patients. A single session of MT improves O2Sat and can significantly reduce anxiety.

Assessment of Neuroendocrine Changes and the Hypothalamo-Pituitary Autoimmunity in Patients With COVID-19 (preprint)

Purpose: The SARS-CoV-2 may affect the hypothalamic-pituitary axis and pituitary dysfunction may occur. Therefore, we investigated neuroendocrine changes, particularly, secondary adrenal insufficiency using a dynamic test and the role of autoimmunity in pituitary dysfunction in the patients with COVID-19. Methods: : The single-center, prospective, case-control study included PCR-confirmed COVID-19 patients and healthy controls. Basal hormone levels were measured and ACTH stimulation test was performed. Anti-pituitary (APA) and anti-hypothalamic antibodies (AHA) were also determined. Results: : We examined a total of 49 patients with COVID-19 and 28 healthy controls. The frequency of adrenal insufficiency in patients with COVID-19 was found as 8.2%. The patients with COVID-19 had lower free T 3 , IGF-1, total testosterone levels, and higher cortisol and prolactin levels when compared with controls. We also, demonstrated the presence of APA in three and AHA in one of four patients with adrenal insufficiency. Conclusions: : The COVID-19 may result in adrenal insufficiency, so the routine screening of adrenal functions is these patients is needed. Endocrine disturbances in COVID-19 are similar to those seen in acute stressful conditions or infections. Also, pituitary or hypothalamic autoimmunity may play a role in neuroendocrine abnormality in COVID-19.

The Potential Benefits of DEPOC in Mental Health Management During The COVID-19 Pandemic (preprint)

Background: Poor mental health management is a rising concern among healthcare practitioners, as threats of burnout, self-harm, and suicide are gradually becoming issues in the field and have been exacerbated by the COVID-19 pandemic. Acute stress management is increasingly important to prevent the development of post-traumatic stress disorder, and a simplified method for its strategic implementation is essential. Methods Providing a method for healthcare practitioners to manage stressful cases can simultaneously offer support in the critical moments following traumatic events while addressing the origins of burnout. The acronym DEPOC - Debriefing/Defusing, Experience extracted from the event, Personal stress management techniques, Outcome of the event was uncontrollable and Closure/Counsellor - offers a structured framework for healthcare practitioners to address their emotions following distressing incidents. DEPOC is available as a presentation and can be summarized into multilingual poster and pamphlet formats to be posted in high-impact areas. Results DEPOC was presented to nearly 200 medical practitioners and trainees who believed knowledge of the acronym would be beneficial prior to clinical experience, wishing they had known about DEPOC for prior traumatic experiences. The established feedback led us believe we must share the experience and supplementary posters on DEPOC, as it is a vital component in healthcare education regardless of how experienced a healthcare professional may deem themselves in coping. Conclusions The COVID-19 pandemic has left healthcare professionals vulnerable to developing acute stress disorders. DEPOC is a simplified example of a technique used to address stress in healthcare practitioners. By offering a multilingual, standardized method to manage the aftermath of traumatic events, DEPOC addresses this concern.

Effects of COVID-19 2021 lockdown on the sleep quality and mental health of undergraduate medical and dental students of Pakistan: A cross-sectional study. (preprint)

Background and objectivesThe COVID-19 pandemic has been recognized as a cause of direct and indirect psychological consequences that impact mental health such as acute stress disorders, anxiety, irritability, poor concentration, and insomnia. This study was planned to evaluate the sleep quality and mental health of undergraduate students amidst the COVID-19 lockdown of 2021. Materials and MethodsThis observational cross-sectional study was conducted in Lahore, Pakistan, where 261 undergraduate medical and dental students enrolled at a private medical and dental school were approached from March to May 2021. The Pittsburg Sleep Quality Index (PSQI) was used to identify the sleep quality along with the Generalized Anxiety Disorder Scale (GAD-7) to establish anxiety symptoms and the Physical Health Questionnaire (PHQ-9) for depression symptoms. ResultsThe results show that 212 (81.2%) female and 49 (18.8%) male students participated in the study. Of the participants 75.1% experienced poor sleep quality, 90% had symptoms of depression, and 85.4% had symptoms of anxiety. The mean score on the PSQI scale was 8.59{+/-}4.10, on the GAD-7 scale was 11.36{+/-}5.94 and on the PHQ-9 scale was 13.70{+/-}6.81. Multiple regression analysis showed that anxiety symptoms ({beta} = 0.315, p = 0.000) and depression symptoms ({beta} = 0.398, p = 0.000) were significant predictors of sleep quality amongst the undergraduate medical and dental students. ConclusionA high majority of the study participants are experiencing poor sleep quality along with suffering from depression and anxiety amidst the COVID-19 lockdown. It is concluded from the analysis that anxiety and depression symptoms are significant predictors of sleep quality. Relevant authorities need to set up systems that help undergraduate medical students in alleviating and coping with these symptoms midst the COVID-19 pandemic.

Detox Browser -- Towards Filtering Sensitive Content On the Web (preprint)

The annual consumption of web-based resources is increasing at a very fast rate, mainly due to an increase in affordability and accessibility of the internet. Many are relying on the web to get diverse perspectives, but at the same time, it can expose them to content that is harmful to their mental well-being. Catchy headlines and emotionally charged articles increase the number of readers which in turn increases ad revenue for websites. When a user consumes a large quantity of negative content, it adversely impacts the user's happiness and has a significant impact on his/her mood and state of mind. Many studies carried out during the COVID-19 pandemic has shown that people across the globe irrespective of their country of origin have experienced higher levels of anxiety and depression. Web filters can help in constructing a digital environment that is more suitable for people prone to depression, anxiety and stress. A significant amount of work has been done in the field of web filtering, but there has been limited focus on helping Highly Sensitive Persons (HSP's) or those with stress disorders induced by trauma. Through this paper, we propose detox Browser, a simple tool that enables end-users to tune out of or control their exposure to topics that can affect their mental well being. The extension makes use of sentiment analysis and keywords to filter out flagged content from google search results and warns users if any blacklisted topics are detected when navigating across websites

Influencing Factors of Acute Stress Disorder Among Frontline Nurses in Wuhan, China.

The current study aimed to investigate the influencing factors of acute stress disorder (ASD) in frontline nurses delivering care in a hospital for COVID-19 in Wuhan, China. In this cross-sectional study, 298 frontline nurses were surveyed during the first month of direct care delivery for patients with COVID-19 via the Stanford Acute Stress Reaction Questionnaire, Simplified Coping Style Questionnaire, and Multidimensional Scale of Perceived Social Support. Through logistic regression analysis, we identified the influencing factors of ASD. Our results showed that 13.8% of participants had ASD; frontline nurses were affected by ASD symptoms in different degrees; higher perceived social support from friends and colleagues were the major protective factors of ASD; and a negative coping style was a risk factor for ASD. Psychological crisis management interventions aimed at frontline nurses may be essential to prevent ASD during public health crisis events. [Journal of Psychosocial Nursing and Mental Health Services, 59(9), 38-47.].

Effects of the COVID-19 pandemic on acute stress disorder and career planning among healthcare students.

This study aimed to investigate the effects of COVID-19 on the prevalence of acute stress disorder and subsequent effects on career planning among healthcare students. A cross-sectional survey was conducted among 1158 healthcare students across five medical universities in February 2020. Acute stress disorder was assessed using the Stanford Acute Stress Response Questionnaire. Further data regarding COVID-19 knowledge, individual behaviours, occupational choices, and career planning were collected. Based on the results of the Stanford Acute Stress Response Questionnaire, the students were divided into high-risk and low-risk groups for acute stress disorder. The correlation between acute stress disorder and the impact on career planning was analysed. The high-risk group comprised 143 (12.3%) participants, while 1015 (87.7%) participants were in the low-risk group. Two factors increased the risk of acute stress disorder in the students, including 'I think the pandemic is far away from me' (B: 1.27, 95%CI: 1.60-7.87) and 'Physical contact with confirmed or suspected cases' (B: 2.49, 95%CI: 3.42-42.44). Those who obtained pandemic information from official media sources indicated a lower risk of acute stress disorder (B: -0.24, 95%CI: 0.49-1.26). The high-risk group was more likely to quit the medical profession after graduation. The COVID-19 pandemic may cause acute stress disorder among healthcare students and affect their career planning. Universities and relevant departments should provide more information and moral support for these students.

Acute Stress Disorder Among Frontline Health Professionals During the COVID-19 Outbreak: A Structural Equation Modeling Investigation.

OBJECTIVE: The outbreak of COVID-19 that commenced in December 2019 in Wuhan, China, has caused extensive public health concerns and posed substantial challenges to health professionals, especially for those in the center of the epidemic. The current study aimed to assess the prevalence, related factors, and mechanism of acute stress disorder (ASD) among health professionals in Wuhan during this critical period. METHODS: The study used a cross-sectional design. Self-administered questionnaires were distributed to the frontline health professionals in Wuhan hospitals from January 28 to February 1, 2020. Mental health-related measurements included ASD, depression, anxiety, conflict experiences, hostility, and psychosomatic symptoms. Structural equation modeling was used to analyze the factors associated with ASD among health professionals. RESULTS: A total of 332 frontline health professionals were included in the analysis (mean [standard deviation] age = 32.21 [8.77] years; 78.0% women). ASD was a prominent mental health problem in the health professionals surveyed, with a prevalence of 38.3%. Anxiety (24.7%) and depression (20.2%) were also common. Structural equation modeling analyses revealed that emotional distress (i.e., anxiety and depressive symptoms) fully mediated the association between conflicts with ASD (the standardized indirect coefficient ß = 0.47, p = .016). The most common reported symptom was chest pain (51.2%). ASD was significantly associated with psychosomatic symptoms. The majority (67.8%) reported being easily annoyed or irritated, and ASD was associated with hostility. CONCLUSIONS: During the COVID-19 outbreak, a substantial number of health professionals in Wuhan suffered from ASD. Furthermore, ASD was found to be associated with psychosomatic symptoms as well as the hostility. The poor mental health of health professionals has detrimental impacts both on the well-being of staff in health care systems and may adversely affect the quality of patient care. We call for interventions that aim to relieve the psychological and occupational stress. Considering that most of our participants were young, female frontline health professionals, the results may not be generalized to more heterogenous samples.

COVID-19-related psychiatric impact on Italian adolescent population: A cross-sectional cohort study.

We investigated the prevalence rate and sociodemographic correlates of COVID-19-related posttraumatic stress disorder (PTSD), and COVID-19-related acute stress disorder (ASD) among Italian adolescents, their level of stress, perception of parental stress, and connection with mental health. Adolescents aged 12-18 years compiled an online questionnaire designed through validated diagnostic instruments. We enrolled 1262 adolescents who declared that they had not experienced any previous traumatic events. Participants were divided into two groups: 118 adolescents with psychiatric problems (APP+) and 1144 without (APP-). In total, 79.52% reported isolated COVID-19-related ASD (29.48%) or PTSD symptoms (50.04%). One adolescent met the diagnosis of COVID-19-related ASD and two met the diagnosis of COVID-19-related PTSD, according to DSM-5. Adolescents with subthreshold COVID-19-related ASD and PTSD symptoms referred the highest levels of personal stress and adolescents with psychiatric/psychological conditions experienced higher stress. Health measures should be urgently employed prioritizing psychosocial stressors among adolescent population.

Addressing mental health in patients and providers during the COVID-19 pandemic.

The pandemic, and the associated changes to pregnancy and postpartum experiences, can lead to profound psychological reactions including panic, hyperarousal, sleep disturbance, anxiety, depression, and traumatic stress disorders. Providers face compassion fatigue and shared trauma. In this article, we describe the mental health outcomes known to date in regard to the novel coronavirus disease 2019 pandemic for obstetric patients and their providers as well as therapeutic approaches, including our novel embedded mental health service, to address these mental health needs.

Guidelines for identification, assessment and treatment of the post-traumatic stress disorder in children, youth and adults (Guidance for conducting memory work remotely) (preprint)

In the new reality of the pandemic caused by the new coronavirus disease COVID-19 psychotherapists provide clients therapy sessions remotely by different computer programmes. It is important to provide guidelines for the remotely provided cognitive-behavioural therapy for different mental disorders. In this article were adapted guidelines for remotely conducted memory work for the post-traumatic stress disorder elaborated by the Oxford Centre for Anxiety Disorders and Trauma. Special concepts were determined and explained for Georgian therapists.

Propensity to reappraise promotes resilience to stress-induced negativity bias (preprint)

Stress exposure is associated with an increased tendency to appraise ambiguous social stimuli as negative. However, it remains unknown whether tendencies to use emotion regulation strategies—such as cognitive reappraisal, which involves altering the meaning of affective stimuli—can buffer these stress effects on social evaluations. Here, we examined whether increased reappraisal use confers resilience against stress-induced negativity bias. In Study 1, healthy participants (n=43) rated the valence of emotionally ambiguous (surprised) faces before and after an acute stress or control manipulation and reported reappraisal habits. Increased negativity ratings were milder for stressed individuals that reported more habitual reappraisal use. In Study 2 (n=97), we extended this investigation to real-world perceived stress before and during the COVID-19 pandemic. We found that reappraisal tendency moderates the relationship between perceived stress and increased negativity bias. Collectively, these findings suggest that the propensity to reappraise attenuates stress-induced negativity bias when evaluating others under uncertainty.