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1.
Tohoku J Exp Med ; 255(1): 71-77, 2021 09.
Article in English | MEDLINE | ID: covidwho-1496650

ABSTRACT

COVID-19 has caused an unprecedented global pandemic. Premenstrual symptoms include mood-related, behavioral, and physical symptoms that are limited to the luteal phase of the menstrual cycle. Psychosocial stress is a risk factor for premenstrual symptoms. The aim of this study was to examine the association between premenstrual symptoms and stress caused by COVID-19. We analyzed data from 871 students with regular menstrual cycles who completed the Premenstrual Symptoms Questionnaire (PSQ), Fear of COVID-19 Scale, and Impact of Event Scale-Revised version (IES-R). The total PSQ score was significantly higher in women with COVID-19-induced posttraumatic stress symptoms (PTSS) than in non-PTSS groups. Compared with pre-pandemic data (2019), the total PSQ score did not change in non-PTSS, but increased in PTSS groups. All symptoms were more severe in PTSS groups than in non-PTSS groups. Compared with 2019, PTSS groups had more severe symptoms for all symptoms except 'physical symptoms' and 'decreased social activity', and non-PTSS groups only exhibited improvements in the 'decreased social activity'. Multiple regression analysis revealed that the IES-R score was a significant exacerbation factor of the total PSQ score, along with age and menstrual pain. This study revealed the association between pandemic-associated PTSS and the severity of premenstrual symptoms.


Subject(s)
COVID-19/complications , Premenstrual Syndrome/etiology , SARS-CoV-2 , Stress Disorders, Post-Traumatic/etiology , Adolescent , COVID-19/epidemiology , COVID-19/psychology , Cross-Sectional Studies , Fear , Female , Humans , Japan/epidemiology , Menstrual Cycle , Pandemics , Premenstrual Syndrome/epidemiology , Risk Factors , Severity of Illness Index , Stress Disorders, Post-Traumatic/epidemiology , Students , Surveys and Questionnaires
2.
Psychosom Med ; 83(4): 338-344, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1494128

ABSTRACT

OBJECTIVE: Persistent somatic symptoms, such as pain and fatigue, have been referred to as somatization. Somatization is commonly associated with histories of trauma and posttraumatic stress disorder (PTSD). Although previous research has demonstrated that PTSD can predict somatic problems, there has been no examination of this at the level of PTSD symptom clusters and multidimensional assessment of somatic symptoms. We examined the association between the three International Classification of Disease (11th Edition) PTSD symptom clusters (reexperiencing in the here and now, avoidance, and sense of threat), measured in relation to the COVID-19 pandemic as the stressor, and somatic symptoms while statistically adjusting for confounding variables. METHODS: Participants were a nationally representative sample of 1041 adults from the general population of the Republic of Ireland. Physical health problems across the domains of pain, gastrointestinal, cardiopulmonary, and fatigue were assessed by the Patient Health Questionnaire, and PTSD symptoms were assessed using the International Trauma Questionnaire. RESULTS: Sense of threat was associated with the presence of pain (ß = 0.254), fatigue (ß = 0.332), gastrointestinal (ß = 0.234), and cardiovascular symptoms (ß = 0.239). Avoidance was associated with pain (ß = 0.347). Reexperiencing was not associated with any physical health variable. CONCLUSIONS: In the context of COVID-19, the sense of threat symptoms in PTSD is most strongly related to somatic problems. Findings suggest that interventions addressing sense of threat symptoms might provide relief from somatization.


Subject(s)
COVID-19/psychology , Fear/psychology , Medically Unexplained Symptoms , Stress Disorders, Post-Traumatic/etiology , Adolescent , Adult , Aged , COVID-19/complications , Female , Humans , Ireland/epidemiology , Male , Middle Aged , Pandemics , Stress Disorders, Post-Traumatic/epidemiology , Surveys and Questionnaires , Young Adult
3.
Ann Med ; 53(1): 1924-1934, 2021 12.
Article in English | MEDLINE | ID: covidwho-1493393

ABSTRACT

INTRODUCTION: The SARS-CoV-2 pandemic has forced healthcare providers to reorganize their activities to protect the population from infection, postponing or suspending many medical procedures. Patients affected by chronic conditions were among the most affected. In the case of catastrophes, women have a higher lifetime prevalence of post-traumatic stress disorder (PTSD), and those with endometriosis have higher anxiety levels, making them fragile in such circumstances. MATERIALS AND METHODS: In this cross-sectional study, conducted in May 2020, we considered all women aged ≥18 years, followed up at our referral centre for endometriosis. Patients were sent an anonymous 6-section questionnaire via email, containing different validated tools for the evaluation of anxiety levels and the risk of PTSD. A multivariable linear regression was performed to assess the impact of patients' characteristics on the distress caused by the SARS-COV-2 pandemic. RESULTS: Among the 468 women recruited, 68.8% were quite-to-extremely worried about not being able to access gynaecologic care, with almost one-third of them scoring ≥33 on the IES-R. Older age and increased levels of anxiety were associated with higher risks of PTSD (age: b = 0.28, 95% CI = 0.12 - 0.44; GAD-7: b = 1.71, 95% CI = 1.38 - 2.05), with up to 71.8% of patients with severe anxiety (GAD-7 > 15) having an IES-R score ≥33 suggestive for PTSD. Women who could leave home to work showed lower levels of PTSD (b = -4.79, 95% CI = -8.44 to - 1.15, ref. unemployed women). The implementation of telemedicine in routine clinical practice was favourably viewed by 75.6% of women. DISCUSSION: Women with endometriosis are particularly exposed to the risk of PTSD during the SARS-CoV-2 pandemic, especially if they are older or have higher levels of anxiety. Gynaecologists should resort to additional strategies, and telemedicine could represent a feasible tool to help patients cope with this situation.KEY MESSAGESThe COVID-19 pandemic significantly impacted the lives of women with endometriosis, who appeared to have a considerable risk of PTSD.Older age, higher anxiety levels and unemployment were independently associated with the risk of developing PTSD.Clinicians should develop successful alternative strategies to help patients cope with this situation, and telemedicine might represent an applicable and acceptable solution.


Subject(s)
Anxiety/epidemiology , COVID-19/prevention & control , Endometriosis/therapy , Health Services Accessibility/standards , Stress Disorders, Post-Traumatic/epidemiology , Adult , Age Factors , Anxiety/diagnosis , Anxiety/etiology , Anxiety/psychology , COVID-19/epidemiology , COVID-19/transmission , Communicable Disease Control/standards , Cross-Sectional Studies , Endometriosis/psychology , Female , Health Services Accessibility/organization & administration , Humans , Internet/statistics & numerical data , Male , Middle Aged , Pandemics/prevention & control , Prevalence , Risk Management , SARS-CoV-2/pathogenicity , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/psychology , Surveys and Questionnaires/statistics & numerical data , Telemedicine/organization & administration , Telemedicine/standards , Young Adult
4.
PLoS One ; 16(10): e0259012, 2021.
Article in English | MEDLINE | ID: covidwho-1480465

ABSTRACT

OBJECTIVES: This study aims to investigate the potential factors associated with mental health outcomes among Chinese adults during the Coronavirus disease 2019 (COVID-19) epidemic. METHODS: This is an online cross-sectional survey conducted among Chinese adults in February 2020. Outcome measurements included the three-item UCLA Loneliness Scale (UCLA-3), two-item Patient Health Questionnaire (PHQ-2), two-item Generalized Anxiety Disorder Questionnaire (GAD-2), and two items from the Clinician-Administered Post-traumatic Stress Disorder (PTSD) Scale. COVID-19 related factors, physical health, lifestyle, and self-efficacy were also measured. Univariable and multivariable logistic regressions were performed. RESULTS: This study included 1456 participants (age: 33.8±10.5 years; female: 59.1%). The prevalence of depressive symptoms, anxiety symptoms, loneliness, and PTSD symptoms were 11.3%, 7.6%, 38.7%, and 33.9%, respectively. In multivariable analysis, loneliness was associated with being single, separated/divorced/widowed, low level of education, current location, medication, more somatic symptoms, lower self-efficacy, and going out frequently. Depression was associated with fear of infection, binge drinking, more somatic symptoms, lower self-efficacy, and longer screen time. Anxiety was associated with more somatic symptoms and lower self-efficacy. PTSD symptoms were associated with more somatic symptoms, lower self-efficacy, higher perceived risk of infection, fear of infection, and self-rated more negative influence due to the epidemic (p<0.05). CONCLUSIONS: Mental health problems during the COVID-19 epidemic were associated with various biopsychosocial and COVID-19 related factors. Psychological interventions should be aware of these influencing factors and prioritize support for those people at higher risk.


Subject(s)
COVID-19 , Depression , Loneliness , SARS-CoV-2 , Stress Disorders, Post-Traumatic , Adult , COVID-19/epidemiology , COVID-19/psychology , China/epidemiology , Cross-Sectional Studies , Depression/epidemiology , Depression/etiology , Depression/psychology , Female , Humans , Male , Prevalence , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/psychology
5.
Int J Clin Pract ; 75(11): e14880, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1476236

ABSTRACT

INTRODUCTION: Outbreaks of infectious diseases have negative effects on mental health. Currently, there is very little information about the psychological effects of the COVID-19 pandemic on adolescents and associated factors affecting their mental health. The aim of the present study is to determine the severity of anxiety, depression and post-traumatic stress disorder (PTSD) symptoms in adolescents during the COVID-19 outbreak, and to investigate the associated factors with these symptoms. METHODS: The present study was conducted with a total of 447 adolescents. Psychiatric symptoms were evaluated by the use of DSM-5 Level 2 Anxiety Scale, DSM-5 Level 2 Depression Scale and National Stressful Events Survey PTSD Short Scale. The association between age, gender, residential area, presence of COVID-19 in the participant, presence of COVID-19 in the family or environment and psychiatric symptoms were evaluated with linear regression analysis. RESULTS: The mean age of participants was 15.06, and 38.3% of the participants were men and 61.7% were women. The rate of participants with moderate or high levels of anxiety, depression and PTSD symptoms was 28%, 37.6% and 28.5%, respectively. High age and living in an urban area were associated with increased anxiety, depression and PTSD symptoms. In addition, female gender was associated with increased depression symptoms, and the presence of COVID-19 in the family or environment was associated with increased anxiety symptoms. CONCLUSION: The present study shows that adolescents have serious levels of anxiety, depression and PTSD symptoms during the COVID-19 pandemic. These results emphasise the need for mental health interventions that are appropriate for the characteristics of this age group.


Subject(s)
COVID-19 , Stress Disorders, Post-Traumatic , Adolescent , Anxiety/epidemiology , Anxiety/etiology , Cross-Sectional Studies , Depression/epidemiology , Depression/etiology , Disease Outbreaks , Female , Humans , Male , Pandemics , SARS-CoV-2 , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology , Stress, Psychological
6.
BMJ Open ; 11(10): e049472, 2021 10 07.
Article in English | MEDLINE | ID: covidwho-1462960

ABSTRACT

OBJECTIVES: Post-traumatic stress disorder (PTSD) is commonly experienced in the aftermath of major incidents such as terrorism and pandemics. Well-established principles of response include effective and scalable treatment for individuals affected by PTSD. In England, such responses have combined proactive outreach, screening and evidence-based interventions (a 'screen-and-treat' approach), but little is known about its cost-effectiveness. The objective of this paper is to report the first systematic attempt to assess the cost-effectiveness of this approach. METHODS: A decision modelling analysis was undertaken to estimate the costs per quality-adjusted life-year (QALY) gained from a screen-and-treat approach compared with treatment-as-usual, the latter involving identification of PTSD by general practitioners and referral to psychological therapy services. Model input variables were drawn from relevant empirical studies in the context of terrorism and the unit costs of health and social care in England. The model was run over a 5-year time horizon for a hypothetical cohort of 1000 exposed adults from the perspective of the National Health Service and Personal Social Services in England. RESULTS: The incremental cost per QALY gained was £7931. This would be considered cost-effective 88% of the time at a willingness-to-pay threshold of £20 000 per QALY gained, the threshold associated with the National Institute for Health and Care Excellence in England. Sensitivity analysis confirmed this result was robust. CONCLUSIONS: A screen-and-treat approach for identifying and treating PTSD in adults following terrorist attacks appears cost-effective in England compared with treatment-as-usual through conventional primary care routes. Although this finding was in the context of terrorism, the implications might be translatable into other major incident-related scenarios including the current COVID-19 pandemic.


Subject(s)
COVID-19 , Stress Disorders, Post-Traumatic , Adult , Cost-Benefit Analysis , Humans , Pandemics , Quality-Adjusted Life Years , SARS-CoV-2 , State Medicine , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/therapy
7.
Crit Care Med ; 49(9): 1427-1438, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1434524

ABSTRACT

OBJECTIVE: Determine the characteristics of postintensive care syndrome in the cognitive, physical, and psychiatric domains in coronavirus disease 2019 ICU survivors. DESIGN: Single-center descriptive cohort study from April 21, to July 7, 2020. SETTING: Critical care recovery clinic at The Mount Sinai Hospital in New York City. PATIENTS: Adults who had critical illness due to coronavirus disease 2019 requiring an ICU stay of 7 days or more and who agreed to a telehealth follow-up in the critical care recovery clinic 1-month post hospital discharge. INTERVENTIONS: None. MEASURES AND MAIN RESULTS: Patient-reported outcome measures assessing physical and psychiatric domains were collected electronically, a cognitive test was performed by a clinician, and clinical data were obtained through electronic medical records. Outcome measures assessed postintensive care syndrome symptoms in the physical (Modified Rankin Scale, Dalhousie Clinical Frailty Scale, Neuro-Quality of Life Upper Extremity and Lower Extremity Function, Neuro-Quality of Life Fatigue), psychiatric (Insomnia Severity Scale; Patient Health Questionnaire-9; and Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), and cognitive (Telephone Montreal Cognitive Assessment) domains. The 3-Level Version of Euro-QoL-5D was used to assess the physical and psychiatric domains. A diagnosis of postintensive care syndrome was made in cases with evidence of impairment in at least one postintensive care syndrome domain. We included 45 patients with a mean (sd) age of 54 (13) years, and 73% were male. Ninety-one percent of coronavirus disease 2019 ICU survivors fit diagnostic criteria for postintensive care syndrome. 86.7 % had impairments in the physical domain, 22 (48%) reported impairments in the psychiatric domain, and four (8%) had impairments on cognitive screening. We found that 58% had some degree of mobility impairment. In the psychiatric domain, 38% exhibited at least mild depression, and 18 % moderate to severe depression. Eighteen percent presented Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, scores suggestive of posttraumatic stress syndrome diagnosis. In the Telephone Montreal Cognitive Assessment, 9% had impaired cognition. CONCLUSIONS: Survivors of critical illness related to coronavirus disease 2019 are at high risk of developing postintensive care syndrome. These findings highlight the importance of planning for appropriate post-ICU care to diagnose and treat this population.


Subject(s)
COVID-19/complications , Critical Illness , COVID-19/psychology , COVID-19/therapy , Cognitive Dysfunction/epidemiology , Cognitive Dysfunction/etiology , Cohort Studies , Critical Care , Female , Humans , Intensive Care Units , Male , Middle Aged , New York City , Patient Reported Outcome Measures , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology , Survivors/psychology
8.
PLoS One ; 16(8): e0255774, 2021.
Article in English | MEDLINE | ID: covidwho-1352706

ABSTRACT

INTRODUCTION: Illnesses requiring hospitalization are known to negatively impact psychological well-being and health-related quality of life (HRQoL) after discharge. The impact of hospitalization during the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) pandemic on psychological well-being and health-related quality of life is expected to be higher due to the exceptional circumstances within and outside the hospital during the pandemic surge. The objective of this study was to quantify psychological distress up to three months after discharge in patients hospitalized during the first coronavirus disease 2019 (COVID-19) pandemic wave. We also aimed to determine HRQoL, to explore predictors for psychological distress and HRQoL, and to examine whether psychological distress was higher in COVID-19 confirmed patients, and in those treated in Intensive Care Units (ICUs). METHODS: In this single-center, observational cohort study, adult patients hospitalized with symptoms suggestive of COVID-19 between March 16 and April 28, 2020, were enrolled. Patients were stratified in analyses based on SARS-CoV-2 PCR results and the necessity for ICU treatment. The primary outcome was psychological distress, expressed as symptoms of post-traumatic stress disorder (PTSD), anxiety, and depression, up to three months post-discharge. Health-related quality of life (HRQoL) was the secondary outcome. Exploratory outcomes comprised predictors for psychological distress and HRQoL. RESULTS: 294 of 622 eligible patients participated in this study (median age 64 years, 36% female). 16% and 13% of these patients reported probable PTSD, 29% and 20% probable anxiety, and 32% and 24% probabledepression at one and three months after hospital discharge, respectively. ICU patients reported less frequently probable depression, but no differences were found in PTSD, anxiety, or overall HRQoL. COVID-19 patients had a worse physical quality of life one month after discharge, and ICU patients reported a better mental quality of life three months after discharge. PTSD severity was predicted by time after discharge and being Caucasian. Severity of anxiety was predicted by time after discharge and being Caucasian. Depression severity was predicted by time after discharge and educational level. CONCLUSION: COVID-19 suspected patients hospitalized during the pandemic frequently suffer from psychological distress and poor health-related quality of life after hospital discharge. Non-COVID-19 and non-ICU patients appear to be at least as affected as COVID-19 and ICU patients, underscoring that (post-)hospital pandemic care should not predominantly focus on COVID-19 infected patients.


Subject(s)
COVID-19/diagnosis , Psychological Distress , Quality of Life , Adult , Aged , Aged, 80 and over , Anxiety/etiology , COVID-19/complications , COVID-19/epidemiology , COVID-19/virology , Cohort Studies , Depression/etiology , Female , Hospitalization , Humans , Intensive Care Units , Male , Middle Aged , Pandemics , Patient Discharge , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , Stress Disorders, Post-Traumatic/etiology
9.
PLoS One ; 16(8): e0255440, 2021.
Article in English | MEDLINE | ID: covidwho-1341504

ABSTRACT

INTRODUCTION: The COVID-19 pandemic resulted in quarantine/lockdown measures in most countries. Quarantine may create intense psychological problems including post-traumatic stress disorder (PTSD) especially for the vulnerable critically developing children/adolescents. Few studies evaluated PTSD associated with infectious disasters but no Saudi study investigated PTSD associated with COVID-19 in children/adolescents. This study was undertaken to screen for PTSD in children/adolescent in Saudi Arabia to identify its prevalence/risk factors during COVID-19 pandemic and its quarantine. METHODS: A cross-sectional survey was conducted after 2 months form start of quarantine for COVID-19 pandemic utilizing the original English version and an Arabic translated version for the University of California at Los Angeles Brief COVID-19 Screen for Child/Adolescent PTSD that can be parent-reported or self-completed by older children/adolescents. Participants (Saudi citizens/non-Saudi residents) were approached online via social media. RESULTS: Five hundred and thirty seven participants were enrolled. The participants were 262 boys and 275 girls with a mean age of 12.25±3.77 years. Symptoms of no, minimal, mild and potential PTSD were identified in 15.5%, 44.1%, 27.4% and 13.0% of children/adolescents, respectively. The age, gender, school grade, and residence were not predictive of PTSD symptoms. Univariate analysis of risk factors for PTSD revealed that work of a close relative around people who might be infected was significantly different between groups of PTSD symptoms, but this difference disappeared during multivariate analysis. Children/adolescents of Saudi citizens had significantly lower median total PTSD score than children/adolescents of expatriate families (p = 0.002). CONCLUSION: PTSD associated with the COVID-19 and its resultant quarantine shouldn't be overlooked in different populations as it is expected in a considerable proportion of children/adolescents with variable prevalence, risk factors and severity. Parents/healthcare providers must be aware of PTSD associated with COVID-19 or similar disasters, so, they can provide children/adolescent with effective coping mechanisms.


Subject(s)
COVID-19/psychology , Stress Disorders, Post-Traumatic/epidemiology , Stress, Psychological/epidemiology , Adaptation, Psychological/physiology , Adolescent , COVID-19/epidemiology , Child , Communicable Disease Control/statistics & numerical data , Cross-Sectional Studies , Female , Humans , Male , Pandemics , Psychology, Child , Quarantine/psychology , Quarantine/statistics & numerical data , Saudi Arabia/epidemiology , Stress Disorders, Post-Traumatic/etiology
10.
Eur J Gen Pract ; 27(1): 184-190, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1334099

ABSTRACT

BACKGROUND: Healthcare professionals (HCPs) in family medicine (FM) in Croatia work in a demanding environment caused by the SARS-CoV-2 pandemic. Besides particular circumstances in healthcare, an unknown virus, social distancing, and homeschooling, the capital was hit with the earthquake during the lockdown. OBJECTIVES: To assess the prevalence of stress, anxiety, depression, posttraumatic stress disorder (PTSD) and the influence of demographic characteristics, professional differences, medical history, and specific stressors on the psychological outcomes. METHODS: A cross-sectional study with the online questionnaire containing the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Event Scale-Revised (IES-R) was conducted from 1st to 15 May 2020 in FM. RESULTS: HCPs (534, 35% response rate), predominantly female (84.5%), participated in the research. High prevalence of stress (30.9%), anxiety (33.1%), depression (30.7%), and PTSD (33.0%) were found. Female participants had higher results in the anxiety subscale of DASS-21 and IES-R scores. Pre-existing conditions were associated with higher levels of stress, anxiety, depression, and PTSD. The IES-R score for PTSD showed borderline correlation (p = 0.053) with working in regions with the highest incidence of COVID-19. Having schoolchildren made a difference on a stress subscale in DASS-21 (p < 0.043), but the earthquake did not have an impact. CONCLUSION: Family physicians and nurses in FM in Croatia are under a great mental load during the COVID-19 outbreak. Results suggest that HCPs of the female sex, with pre-existing chronic conditions, work in regions with a high incidence of SARS-CoV-2 or have schoolchildren at greater risk of the poor psychological outcome.


Subject(s)
Anxiety/etiology , COVID-19/psychology , Depression/etiology , Nurses/psychology , Occupational Stress/etiology , Physicians, Family/psychology , Stress Disorders, Post-Traumatic/etiology , Adolescent , Adult , Anxiety/diagnosis , Anxiety/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , Croatia/epidemiology , Cross-Sectional Studies , Depression/diagnosis , Depression/epidemiology , Disasters , Disease Outbreaks/prevention & control , Earthquakes , Female , Health Surveys , Humans , Logistic Models , Male , Middle Aged , Occupational Stress/diagnosis , Occupational Stress/epidemiology , Prevalence , Psychological Tests , Risk Factors , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/epidemiology , Young Adult
11.
Riv Psichiatr ; 56(4): 189-197, 2021.
Article in English | MEDLINE | ID: covidwho-1325469

ABSTRACT

BACKGROUND: Evidence highlights healthcare workers (HCWs) facing outbreaks, particularly the ongoing covid-19 pandemic, are at increased risk of negative mental health outcomes, particularly post-traumatic stress symptoms (PTSS), anxiety and depression. Data from previous outbreaks highlighted the risk for a negative impact on HCWs' social and occupational functioning, but scant data have investigated this issue in the framework of the covid-19 pandemic. A number of effective interventions have been proposed to support mental health and well-being of HCWs in emerging infectious outbreaks, but it is important to acknowledge the differential impact of mental disorders on different dimensions of functioning. METHODS: The study explored the associations between work and social functioning and PTSS, depression and anxiety in a sample of 265 frontline HCWs employed at a major university hospital in Italy (Pisa), facing the first period of the covid-19 pandemic. Individuals were assessed by means of the Impact of Event Scale-Revised (IES-R) for PTSS, the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, the General Anxiety Disorder-7 Item (GAD-7) for anxiety symptoms and the Work and Social Adjustment Scale (WSAS) to assess work and social functioning. RESULTS: Higher levels of functioning impairment were found among individuals with moderate to severe acute PTSS, depressive and anxiety symptoms with respect to those without. Acute PTSS and depressive symptoms were predictive factors of impairment in each domain of functioning analyzed. Anxiety symptoms were associated with impairment in both work and home management activities. Frontline activity was associated with impairment in both private and social leisure activities. CONCLUSIONS: Long-term perspective studies are warranted to better investigate the psychopathological burden on HCWs' work and social functioning and to promote adequate intervention strategies.


Subject(s)
Anxiety/etiology , COVID-19/psychology , Depression/etiology , Health Personnel/psychology , SARS-CoV-2 , Stress Disorders, Post-Traumatic/etiology , Adaptation, Psychological , Adult , Anxiety/epidemiology , COVID-19/complications , Depression/epidemiology , Diagnostic Self Evaluation , Family Relations , Female , Hospitals, University , Humans , Interpersonal Relations , Italy/epidemiology , Male , Middle Aged , Occupations , Pandemics , Psychosocial Support Systems , Social Adjustment , Social Change , Stress Disorders, Post-Traumatic/epidemiology , Surveys and Questionnaires , Uncertainty , Workload
12.
Riv Psichiatr ; 56(4): 182-188, 2021.
Article in Italian | MEDLINE | ID: covidwho-1325468

ABSTRACT

INTRODUCTION: Italy, one of the first countries to be heavily hit by the spread of the new Coronavirus, has activated precautionary measures aimed at limiting its spread. This emergency situation may be cause of psychological distress in the general population. Therefore, the Italian Twins Registry has decided to carry out an epidemiological study to investigate the social and mental health impact of the covid-19 pandemic on Italian adults. METHODS: The study has a longitudinal design and is aimed at twins of all ages residing in Italy. An online questionnaire was administered to collect information on socio-economic and health status of the participants, as well as of the households during the lockdown, and on the impact of the pandemic on participants' lives. Levels and prevalence of symptoms of anxiety, stress and depression were measured using validated instruments, such as the STAI-6, IES-R and PHQ-9. This article shows the results of the first wave of the survey (June 2020). RESULTS: A total of 2589 twins participated in the study, with a mean age of 45 years (range 18-93 years). Covid-19's prevalence among respondents was less than 1% and about 13% of the subjects reported that, at least, one of the household's members had symptoms of covid-19. Sixty percent of the participants changed the place and way of working and a third of the sample had to completely suspend their work. About half of the sample showed symptoms of an anxiety disorder and about 10% of the subjects had symptoms of a probable post-traumatic stress or depressive disorder. Higher mean scores on the three assessment instruments were observed among women, subjects with a low level of education and those residing in the Southern of Italy. Anxiety symptoms decreased with age. CONCLUSION: The study shows that the pandemic has had important repercussions on the socio-economic condition and mental health of the Italian population and suggests that some individuals are more vulnerable than others.


Subject(s)
COVID-19/epidemiology , Diseases in Twins/epidemiology , SARS-CoV-2 , Social Change , Adolescent , Adult , Aged , Aged, 80 and over , Anxiety/epidemiology , Anxiety/etiology , COVID-19/psychology , Depression/epidemiology , Depression/etiology , Educational Status , Humans , Interpersonal Relations , Italy/epidemiology , Middle Aged , Occupations , Pandemics , Prevalence , Quarantine , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology , Young Adult
13.
PLoS Med ; 18(6): e1003621, 2021 06.
Article in English | MEDLINE | ID: covidwho-1315878

ABSTRACT

BACKGROUND: Globally, 235 million people are impacted by humanitarian emergencies worldwide, presenting increased risk of experiencing a mental disorder. Our objective was to test the effectiveness of a brief group psychological treatment delivered by trained facilitators without prior professional mental health training in a disaster-prone setting. METHODS AND FINDINGS: We conducted a cluster randomized controlled trial (cRCT) from November 25, 2018 through September 30, 2019. Participants in both arms were assessed at baseline, midline (7 weeks post-baseline, which was approximately 1 week after treatment in the experimental arm), and endline (20 weeks post-baseline, which was approximately 3 months posttreatment). The intervention was Group Problem Management Plus (PM+), a psychological treatment of 5 weekly sessions, which was compared with enhanced usual care (EUC) consisting of a family psychoeducation meeting with a referral option to primary care providers trained in mental healthcare. The setting was 72 wards (geographic unit of clustering) in eastern Nepal, with 1 PM+ group per ward in the treatment arm. Wards were eligible if they were in disaster-prone regions and residents spoke Nepali. Wards were assigned to study arms based on covariate constrained randomization. Eligible participants were adult women and men 18 years of age and older who met screening criteria for psychological distress and functional impairment. Outcomes were measured at the participant level, with assessors blinded to group assignment. The primary outcome was psychological distress assessed with the General Health Questionnaire (GHQ-12). Secondary outcomes included depression symptoms, posttraumatic stress disorder (PTSD) symptoms, "heart-mind" problems, social support, somatic symptoms, and functional impairment. The hypothesized mediator was skill use aligned with the treatment's mechanisms of action. A total of 324 participants were enrolled in the control arm (36 wards) and 319 in the Group PM+ arm (36 wards). The overall sample (N = 611) had a median age of 45 years (range 18-91 years), 82% of participants were female, 50% had recently experienced a natural disaster, and 31% had a chronic physical illness. Endline assessments were completed by 302 participants in the control arm (36 wards) and 303 participants in the Group PM+ arm (36 wards). At the midline assessment (immediately after Group PM+ in the experimental arm), mean GHQ-12 total score was 2.7 units lower in Group PM+ compared to control (95% CI: 1.7, 3.7, p < 0.001), with standardized mean difference (SMD) of -0.4 (95% CI: -0.5, -0.2). At 3 months posttreatment (primary endpoint), mean GHQ-12 total score was 1.4 units lower in Group PM+ compared to control (95% CI: 0.3, 2.5, p = 0.014), with SMD of -0.2 (95% CI: -0.4, 0.0). Among the secondary outcomes, Group PM+ was associated with endline with a larger proportion attaining more than 50% reduction in depression symptoms (29.9% of Group PM+ arm versus 17.3% of control arm, risk ratio = 1.7, 95% CI: 1.2, 2.4, p = 0.002). Fewer participants in the Group PM+ arm continued to have "heart-mind" problems at endline (58.8%) compared to the control arm (69.4%), risk ratio = 0.8 (95% CI, 0.7, 1.0, p = 0.042). Group PM+ was not associated with lower PTSD symptoms or functional impairment. Use of psychosocial skills at midline was estimated to explain 31% of the PM+ effect on endline GHQ-12 scores. Adverse events in the control arm included 1 suicide death and 1 reportable incidence of domestic violence; in the Group PM+ arm, there was 1 death due to physical illness. Study limitations include lack of power to evaluate gender-specific effects, lack of long-term outcomes (e.g., 12 months posttreatment), and lack of cost-effectiveness information. CONCLUSIONS: In this study, we found that a 5-session group psychological treatment delivered by nonspecialists modestly reduced psychological distress and depression symptoms in a setting prone to humanitarian emergencies. Benefits were partly explained by the degree of psychosocial skill use in daily life. To improve the treatment benefit, future implementation should focus on approaches to enhance skill use by PM+ participants. TRIAL REGISTRATION: ClinicalTrials.gov NCT03747055.


Subject(s)
Depression/therapy , Mental Health , Natural Disasters , Problem Solving , Psychotherapy, Brief , Psychotherapy, Group , Relief Work , Stress Disorders, Post-Traumatic/therapy , Stress, Psychological/therapy , Adaptation, Psychological , Adolescent , Adult , Aged , Aged, 80 and over , Depression/diagnosis , Depression/etiology , Depression/psychology , Female , Functional Status , Humans , Male , Middle Aged , Nepal , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/psychology , Stress, Psychological/diagnosis , Stress, Psychological/etiology , Stress, Psychological/psychology , Time Factors , Treatment Outcome , Young Adult
14.
J Trauma Stress ; 34(4): 701-710, 2021 08.
Article in English | MEDLINE | ID: covidwho-1303282

ABSTRACT

As a result of the COVID-19 pandemic, many individuals have experienced disruptions in social, occupational, and daily life activities. Individuals with mental health difficulties, particularly those with elevated posttraumatic stress symptoms (PTSS), may be especially vulnerable to increased impairment as a result of COVID-19. Additionally, demographic factors, such as age, gender, and race/ethnicity, may impact individual difficulties related to the pandemic. The current study examined the concurrent and prospective associations between posttraumatic stress disorder (PTSD) symptoms, broader anxiety and depression symptoms, and COVID-19-related disability. Participants recruited through Amazon's Mechanical Turk (N = 136) completed questionnaire batteries approximately 1 month apart during the COVID-19 pandemic (i.e., Wave 1 and Wave 2). The results indicated that PTSD, anxiety, and depressive symptoms were all associated with increased COVID-19-related disability across assessment points, rs = .44-.68. PTSD symptoms, specifically negative alterations in cognition and mood, significantly predicted COVID-19-related disability after accounting for anxiety and depressive symptoms as well as demographic factors, ßs = .31-.38. Overall, these findings suggest that individuals experiencing elevated PTSS are particularly vulnerable to increased functional impairment as a result of COVID-19 and suggest a need for additional outreach and clinical care among individuals with elevated PTSD symptoms during the pandemic.


Subject(s)
COVID-19/psychology , Disabled Persons/psychology , Stress Disorders, Post-Traumatic/psychology , Adult , Anxiety/diagnosis , Anxiety/etiology , Anxiety/psychology , COVID-19/epidemiology , Crowdsourcing/methods , Depression/diagnosis , Depression/etiology , Depression/psychology , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2 , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/etiology , Surveys and Questionnaires , United States/epidemiology
15.
Am J Trop Med Hyg ; 105(3): 701-707, 2021 07 08.
Article in English | MEDLINE | ID: covidwho-1302663

ABSTRACT

Since COVID-19 currently has no proven cure but high morbidity and mortality, many people are living in fear of the virus along with other mental health challenges induced by the lockdowns and social distancing. Hence, this study aims to provide evidence on the co-occurrence and inter-relations between the fear of COVID-19, post-traumatic stress symptoms, and psychological distress in adherence to preventive health behavior among Nigerians. It also seeks to determine whether this process differs for men and women. The sample comprised 1,172 consenting young adults (mean age = 22.9 ± 6.6 years, 54.5% females) selected using a snowball sampling technique. Structural equation modeling (SEM) was used to test the mediation model of post-traumatic stress symptoms and psychological distress as parallel and serial mediators of the relationship between the fear of COVID-19 and preventive health behavior. The indirect effect of the fear of COVID-19 on preventive health behavior across gender was tested using moderation analysis. Results showed that post-traumatic stress symptoms and psychological distress serially and fully, in causal order, mediated the association between the fear of COVID-19 and preventive health behavior, and gender moderated the mediation effects. The research provides evidence that the fear of COVID-19 could trigger preventive health behavior through post-traumatic stress symptoms but reduces it through psychological distress, whereas the fear of COVID-19 has a slightly more positive impact on preventive health behavior among men.


Subject(s)
COVID-19/prevention & control , COVID-19/psychology , Fear , Health Behavior , SARS-CoV-2 , Adolescent , Female , Humans , Male , Nigeria , Psychological Distress , Stress Disorders, Post-Traumatic/etiology , Young Adult
16.
Psychiatr Pol ; 54(2): 187-198, 2020 Apr 30.
Article in English, Polish | MEDLINE | ID: covidwho-1290639

ABSTRACT

Human confrontation with such a stressor as the COVID-19 pandemic outbreak, caused by SARS-CoV-2 virus, manifested in severe acute respiratory distress, results also in the decrease of fitness and mental resistance on an unprecedented scale and with difficult to estimate consequences [1]. More important than the intensity of the disorder is its prevalence. When we compare our current knowledge of the impact of the pandemic on the development of mental disorders with the findings of research on acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) over the last 40 years, it may turn out that they are different from each other, the symptomatic spectrum of mental disorders varies and the possibilities of an effective treatment are very limited. We cannot rule out that a new diagnostic category for specific mental disorders resulting from the COVID-19 pandemic may emerge in the near future. This paper presents the extent of the impact of the pandemic on the development of mental instability and current diagnostic possibilities. Subpopulations necessary for planning short-term intervention in the organisational, informative and medical areas were identified. A psychiatric guide for immediate support and assistance was proposed.


Subject(s)
Betacoronavirus , Coronavirus Infections/psychology , Health Status , Mental Health/statistics & numerical data , Pneumonia, Viral/psychology , Stress Disorders, Post-Traumatic/etiology , COVID-19 , Coronavirus Infections/epidemiology , Humans , Pandemics , Pneumonia, Viral/epidemiology , Risk Factors , SARS-CoV-2 , Stress Disorders, Post-Traumatic/prevention & control , Stress, Psychological/etiology
17.
Semin Nephrol ; 41(3): 253-261, 2021 05.
Article in English | MEDLINE | ID: covidwho-1287646

ABSTRACT

Across the world, challenges for clinicians providing health care during the coronavirus disease 2019 (COVID-19) pandemic are highly prevalent and have been widely reported. Perspectives of provider groups have conveyed wide-ranging experiences of adversity, distress, and resilience. In understanding and responding to the emotional and psychological implications of the pandemic for renal clinicians, it is vital to recognize that many experiences also have been ethically challenging. The COVID-19 pandemic has prompted rapid and extensive transformation of health care systems and widely impacted care provision, heightening the risk of barriers to fulfillment of ethical duties. Given this, it is likely that some clinicians also have experienced moral distress, which can occur if an individual is unable to act in accordance with their moral judgment owing to external barriers. This review presents a global perspective of potential experiences of moral distress in kidney care during the COVID-19 pandemic. Using nephrology cases, we discuss why moral distress may be experienced by health professionals when withholding or withdrawing potentially beneficial treatments owing to resource constraints, when providing care that is inconsistent with local prepandemic best practice standards, and when managing dual professional and personal roles with conflicting responsibilities. We argue that in addition to responsive and appropriate health system supports, resources, and education, it is imperative for health care providers to recognize and prevent moral distress to foster the psychological well-being and moral resilience of clinicians during extended periods of crisis within health systems.


Subject(s)
COVID-19 , Kidney Diseases/therapy , Morals , Nephrology , Occupational Stress/etiology , Psychological Distress , Stress Disorders, Post-Traumatic/etiology , Adult , Aged, 80 and over , Bioethical Issues , Delivery of Health Care/ethics , Female , Humans , Male , Middle Aged , Nephrology/ethics
18.
Occup Environ Med ; 78(11): 801-808, 2021 11.
Article in English | MEDLINE | ID: covidwho-1286749

ABSTRACT

OBJECTIVES: This study reports preliminary findings on the prevalence of, and factors associated with, mental health and well-being outcomes of healthcare workers during the early months (April-June) of the COVID-19 pandemic in the UK. METHODS: Preliminary cross-sectional data were analysed from a cohort study (n=4378). Clinical and non-clinical staff of three London-based NHS Trusts, including acute and mental health Trusts, took part in an online baseline survey. The primary outcome measure used is the presence of probable common mental disorders (CMDs), measured by the General Health Questionnaire. Secondary outcomes are probable anxiety (seven-item Generalised Anxiety Disorder), depression (nine-item Patient Health Questionnaire), post-traumatic stress disorder (PTSD) (six-item Post-Traumatic Stress Disorder checklist), suicidal ideation (Clinical Interview Schedule) and alcohol use (Alcohol Use Disorder Identification Test). Moral injury is measured using the Moray Injury Event Scale. RESULTS: Analyses showed substantial levels of probable CMDs (58.9%, 95% CI 58.1 to 60.8) and of PTSD (30.2%, 95% CI 28.1 to 32.5) with lower levels of depression (27.3%, 95% CI 25.3 to 29.4), anxiety (23.2%, 95% CI 21.3 to 25.3) and alcohol misuse (10.5%, 95% CI 9.2 to 11.9). Women, younger staff and nurses tended to have poorer outcomes than other staff, except for alcohol misuse. Higher reported exposure to moral injury (distress resulting from violation of one's moral code) was strongly associated with increased levels of probable CMDs, anxiety, depression, PTSD symptoms and alcohol misuse. CONCLUSIONS: Our findings suggest that mental health support for healthcare workers should consider those demographics and occupations at highest risk. Rigorous longitudinal data are needed in order to respond to the potential long-term mental health impacts of the pandemic.


Subject(s)
COVID-19/psychology , Health Personnel/psychology , Pandemics , Adult , Anxiety/epidemiology , Anxiety/etiology , COVID-19/epidemiology , Cross-Sectional Studies , Depression/epidemiology , Depression/etiology , Female , Health Personnel/statistics & numerical data , Humans , Male , Middle Aged , Occupational Diseases/epidemiology , Occupational Diseases/etiology , Occupational Diseases/psychology , Pandemics/statistics & numerical data , Prevalence , Psychology , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology , Suicidal Ideation , Surveys and Questionnaires , United Kingdom/epidemiology
19.
Med Lav ; 112(3): 241-249, 2021 Jun 15.
Article in English | MEDLINE | ID: covidwho-1278862

ABSTRACT

BACKGROUND: In March 2020, the World Health Organisation (WHO) declared the novel coronavirus (COVID-19) outbreak a global pandemic. Healthcare professionals directly involved in diagnosing, treating and caring for patients with COVID-19 are at risk of developing post-traumatic stress disorder (PTSD). OBJECTIVE: This study investigated the prevalence of PTSD among nurses working in a COVID hospital and evaluated associated factors. METHODS: A descriptive cross-sectional study was conducted at Crema Hospital and the Impact of Event Scale - Revised (IES-R) was administered. Data collection took place from July to September 2020, during which 275 questionnaires were distributed. RESULTS: Of the total sample, 39.88% received a provisional PTSD diagnosis deserving of further analysis. Nurses stated that they were predominantly overwhelmed by intrusive thoughts (M = 1.55). Working in the emergency department during the COVID-19 pandemic (OR=2.40; p=0.02), irregular work shifts (OR=5.41; p=0.01) and coming from a mental health ward (OR=3.80; p=0.02) increased the risk of receiving a provisional PTSD diagnosis. Our findings showed significantly higher IES-R scores among women than among men (p = 0.01). The activities that caused the most distress were related to technical skills required for managing ventilation and intubation devices. CONCLUSIONS: The results of the study highlighted the presence of considerable psychological distress in the sample. There is an urgent need to monitor the short- and long-term consequences of the COVID-19 pandemic and implement early intervention measures.


Subject(s)
COVID-19 , Nurses , Stress Disorders, Post-Traumatic , Cross-Sectional Studies , Female , Hospitals , Humans , Male , Pandemics , SARS-CoV-2 , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology
20.
Med Sci Monit ; 27: e929454, 2021 Jun 30.
Article in English | MEDLINE | ID: covidwho-1278721

ABSTRACT

BACKGROUND COVID-19 (coronavirus disease 2019) broke out in China. This study was to investigate the situation of mental health status among medical staff following COVID-19. MATERIAL AND METHODS A cross-sectional study was conducted through structured questionnaires to collect the demographical information of the participating medical staff via WeChat following COVID-19 crisis. The Center for Epidemiologic Studies-Depression Scale (CES-D), impact of events scale revised (IES-R), and Pittsburgh Sleep Quality Index (PSQI) scale were used to evaluate depression, post-traumatic stress disorder (PTSD) symptoms, and sleep quality, respectively. 95% confidence intervals (CI) were calculated. RESULTS A total of 597 medical staff's information was included for the statistical analysis, and found 45.23% of subjects had PTSD symptoms, the mean PSQI score was 6.320±3.587. The results of multivariable analysis implied that medical workers who did not participate in the Hubei aid program (ß=4.128; 95% CI, 0.983-7.272; P=0.010) and PTSD symptoms (ß=7.212; 95% CI, 4.807-9.616; P<0.001) were associated with a higher tendency to depression. The PSQI score was linearly related to the CES-D score (ß=1.125; 95% CI, 0.804-1.445; P<0.001). Subgroup analysis showed that medical workers who did not participate in the Hubei aid program, no traumatic experience before COVID-19 outbreaks, and PTSD symptoms may affect the tendency to depression in females, but not in males. PSQI score was linearly related to the CES-D score both in males and females. CONCLUSIONS The medical staff with PTSD symptoms and higher PSQI score may have a higher tendency to depression following COVID-19 outbreaks.


Subject(s)
COVID-19 , Depression , Medical Staff , Sleep Wake Disorders , Stress Disorders, Post-Traumatic , Adult , COVID-19/epidemiology , COVID-19/psychology , China/epidemiology , Cross-Sectional Studies , Depression/diagnosis , Depression/epidemiology , Depression/etiology , Female , Humans , Male , Medical Staff/psychology , Medical Staff/statistics & numerical data , Mental Health/statistics & numerical data , Occupational Health/statistics & numerical data , Psychiatric Status Rating Scales , SARS-CoV-2 , Sex Factors , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/epidemiology , Sleep Wake Disorders/etiology , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology , Surveys and Questionnaires
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