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1.
Eur J Psychotraumatol ; 12(1): 1984049, 2021.
Article in English | MEDLINE | ID: covidwho-1506934

ABSTRACT

Background: Frontline healthcare workers, recovered COVID+ patients who had severe illness, and close others of COVID+ patients who have recovered or died are at risk for clinical levels of mental health symptoms in the context of the COVID-19 pandemic. RESTORE (Recovering from Extreme Stressors Through Online Resources and E-health) was specifically designed for this context. RESTORE is a transdiagnostic guided online intervention adapted from evidence-based cognitive-behavioural therapies. Objectives: RESTORE was designed to address depression, anxiety, and posttraumatic stress disorder symptoms associated with exposure to COVID-19-related traumatic and extreme stressors, and to overcome multiple barriers to accessing psychotherapies. Method: This paper describes the intervention components and platform, as well as the principles used to develop RESTORE. Current research and future directions in developing and testing RESTORE are outlined. Results: Preliminary data from an initial uncontrolled trial evaluating RESTORE in frontline healthcare workers is highly promising. Conclusion: We believe RESTORE has great potential to provide accessible, evidence-based psychological intervention to those in great need.


Antecedentes: Los trabajadores de salud de primera línea, los pacientes de COVID positivo recuperados que tenían una enfermedad grave y las personas cercanas a los pacientes de COVID positivo que se han recuperado o fallecido están en riesgo de presentar niveles clínicos de síntomas de salud mental en el contexto de la pandemia de COVID-19. RESTORE (por sus siglas en inglés: Recovering from Extreme Stressors Through Online Resources and E-health: Recuperación de estresores extremos a través de recursos en línea y salud electrónica) fue diseñada específicamente para este contexto. RESTORE es una intervención en línea guiada transdiagnóstica adaptada de terapias cognitivo-conductuales basadas en la evidencia.Objetivos: RESTORE fue diseñado para abordar la depresión, la ansiedad y los síntomas del trastorno de estrés postraumático asociados con la exposición a factores estresantes traumáticos y extremos relacionados con COVID-19, y para superar múltiples barreras para acceder a psicoterapias.Método: Este artículo describe los componentes y la plataforma de la intervención, así como los principios utilizados para desarrollar RESTORE. Se describen las investigaciones actuales y las direcciones futuras para desarrollar y testear RESTORE.Resultados: Los datos preliminares de un ensayo inicial no controlado que evalúa RESTORE en trabajadores de salud de primera línea son muy prometedores.Conclusión: Creemos que RESTORE tiene un gran potencial para brindar una intervención psicológica accesible y basada en la evidencia a quienes más lo necesitan.背景: 在 COVID-19 疫情背景下, 一线医护人员, 重症 COVID+ 康复患者以及已康复或死亡的 COVID+ 患者的其他亲友都有出现临床心理健康症状的风险。 RESTORE (通过在线资源和电子健康从极端应激源中恢复) 专为这种情况而设计。 RESTORE 是一种改编自循证认知行为疗法的跨诊断指导的在线干预。目的: RESTORE 旨在致力于 COVID-19 相关创伤性和极端应激源暴露相关的抑郁, 焦虑和创伤后应激障碍症状, 并克服心理治疗可得性的多种障碍。方法: 本文介绍了干预组成和平台, 以及用于开发RESTORE的原则。概述了开发和测试 RESTORE 的当前研究和未来方向。结果: 来自评估一线医护人员 RESTORE 的初始非对照试验的初步数据大有前景。结论: 我们相信 RESTORE 有很大的潜力为急需帮助者提供易得, 询证的心理干预。.


Subject(s)
Anxiety/therapy , COVID-19/psychology , Cognitive Behavioral Therapy , Depression/therapy , Health Personnel/psychology , Internet-Based Intervention , Stress Disorders, Post-Traumatic/therapy , Anxiety/psychology , COVID-19/epidemiology , Depression/psychology , Humans , Mental Health , Pandemics , SARS-CoV-2 , Stress Disorders, Post-Traumatic/psychology
2.
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
3.
Sch Psychol ; 36(5): 293-302, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1442723

ABSTRACT

Emerging evidence suggests the coronavirus disease 2019 (COVID-19) pandemic is adversely affecting adolescents' mental health and health behaviors, particularly among those with preexisting mental health conditions and from lower socioeconomic backgrounds. However, direct tests of changes in health outcomes among vulnerable adolescents from before to during COVID-19 are limited. In addition, little is known about how to buffer adolescents, particularly those who are most vulnerable, against stress-related decrements in health. This randomized controlled trial begins to fill these gaps in the literature by exploring changes in mental health, health behaviors, executive function, emotion regulation, and mindfulness among vulnerable adolescents involved in a mentoring program during the COVID-19 pandemic. It also examined to what extent there were protective benefits of incorporating mindfulness training within a mentoring program for buffering adolescents from negative pandemic health effects. Thirty-five adolescents (Mage = 12.9, 37% female) and 32 parents (Mage = 44.75, 80% female) completed questionnaires at baseline (February 2020) and follow-up (July 2020). There were few significant reductions in health; instead, on average, youth reported improvements in sleep, emotion regulation, executive function, and mindfulness over time. Adolescents randomized to mentoring + mindfulness displayed significantly less posttraumatic stress disorder (PTSD) symptomatology and emotional impulsivity at follow-up, compared to the mentoring-as-usual condition. These pilot findings suggest that mentoring with a mindfulness training component may offer an effective strategy for protecting adolescents from deteriorations in health outcomes during COVID-19. Further, there may be unique benefits of mindfulness training for vulnerable youth as a way to adapt to stressful events. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
Adolescent Behavior/physiology , COVID-19 , Emotional Regulation/physiology , Executive Function/physiology , Impulsive Behavior/physiology , Mentoring , Mindfulness , Stress Disorders, Post-Traumatic/therapy , Adolescent , Adult , Child , Female , Follow-Up Studies , Humans , Male , Middle Aged , Outcome Assessment, Health Care
4.
J Dual Diagn ; 17(3): 181-192, 2021.
Article in English | MEDLINE | ID: covidwho-1393102

ABSTRACT

Mobile mental health apps can help bridge gaps in access to care for those with substance use disorders and dual diagnoses. The authors describe a portfolio of free, publicly available mobile mental health apps developed by the National Center for PTSD. The authors also demonstrate how this suite of primarily non-substance use disorder-specific mobile mental health apps may support the active ingredients of substance use disorder treatment or be used for self-management of substance use disorder and related issues. The potential advantages of these apps, as well as limitations and considerations for future app development, are discussed.


Subject(s)
Mobile Applications , Self-Management , Stress Disorders, Post-Traumatic , Substance-Related Disorders , Humans , Mental Health , Stress Disorders, Post-Traumatic/complications , Stress Disorders, Post-Traumatic/therapy , Substance-Related Disorders/complications , Substance-Related Disorders/therapy
5.
Bull World Health Organ ; 99(8): 572-582, 2021 Aug 01.
Article in English | MEDLINE | ID: covidwho-1352784

ABSTRACT

Objective: To investigate the effectiveness of community-based mental health interventions by professionally trained, lay counsellors in low- and middle-income countries. Methods: We searched PubMed®, Cochrane Central Register of Controlled Trials, PROSPERO and EBSCO databases and professional section publications of the United States National Center for PTSD for randomized controlled trials of mental health interventions by professionally trained, lay counsellors in low- and middle-income countries published between 2000 and 2019. Studies of interventions by professional mental health workers, medical professionals or community health workers were excluded because there are shortages of these personnel in the study countries. Additional data were obtained from study authors. The primary outcomes were measures of post-traumatic stress disorder, depression, anxiety and alcohol use. To estimate effect size, we used a random-effects meta-analysis model. Findings: We identified 1072 studies, of which 19 (involving 20 trials and 5612 participants in total) met the inclusion criteria. Hedges' g for the aggregate effect size of the interventions by professionally trained, lay counsellors compared with mostly either no intervention or usual care was -0.616 (95% confidence interval: -0.866 to -0.366). This result indicates a significant, medium-sized effect. There was no evidence of publication bias or any other form of bias across the studies and there were no extreme outliers among the study results. Conclusion: The use of professionally trained, lay counsellors to provide mental health interventions in low- and middle-income countries was associated with significant improvements in mental health symptoms across a range of settings.


Subject(s)
Counselors , Mental Health , Stress Disorders, Post-Traumatic/therapy , Adolescent , Adult , Child , Community Mental Health Services , Humans , Male , Middle Aged , Rwanda
6.
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
7.
Medicine (Baltimore) ; 100(4): e24447, 2021 Jan 29.
Article in English | MEDLINE | ID: covidwho-1299015

ABSTRACT

BACKGROUND: The present study aimed to systematically analyze the effects of mind-body exercise on PTSD symptom, depression and anxiety among patients with post-traumatic stress disorder (PTSD) and to provide a scientific evidence-based exercise prescription. Meanwhile, it will also help reduce the global mental health burden of COVID-19. METHODS: Both Chinese and English databases (PubMed, Web of Science, the Cochrane Library, EMBASE, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang) were used as sources of data to search for randomized controlled trials (RCTs) published between January 1980 to September 2020 relating to the effects of mind-body exercise on PTSD symptom, depression and anxiety in PTSD patients. CONCLUSION: This systematic review and meta-analysis will provide stronger evidence on the effectiveness and safety of mind-body exercise for PTSD symptoms in PTSD patients. SYSTEMATIC REVIEW REGISTRATION: INPLASY2020120072.


Subject(s)
Anxiety Disorders/therapy , COVID-19/psychology , Depression/therapy , Mind-Body Therapies , Research Design , Stress Disorders, Post-Traumatic/therapy , Humans , Meta-Analysis as Topic , Pandemics , SARS-CoV-2 , Systematic Reviews as Topic
8.
J Affect Disord ; 293: 141-147, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1272500

ABSTRACT

BACKGROUND: With the global attack of Coronavirus Disease 2019 (COVID-19), cases with Post-traumatic Stress Disorder (PTSD) have been increasing steadily, which seriously affects the quality of life of patients and as such, seeking effective treatments is an urgent matter. Narrative Exposure Therapy (NET) is a typical cognitive behavioral therapy targeting trauma-related psychological disorders and may be an effective intervention. METHODS: A total of 111 COVID-19 patients near the discharge stage with positive screening results for posttraumatic stress symptoms (PTSS) were randomly assigned (1:1) to either the study group or the control group. The study group received NET and personalized psychological intervention, while the control group only received personalized psychological intervention. PTSS, depression, anxiety and sleep quality were measured pre- and post-intervention to evaluate the effect of NET. This trial was registered with the International Standard Randomized Clinical Trial Registry (No. ChiCTR2000039369). RESULTS: NET participants showed a significantly greater PTSS reduction in comparison with the control group after the intervention. Improvement in sleep quality, anxiety and depression after the intervention were pronounced but not significantly different between the two treatment groups. LIMITATIONS: The assessors weren't blinded for the convenience of measurement and protection of participants' psychological security. CONCLUSIONS: NET likely had a positive impact on PTSS of COVID-19 patients. Clinical staff should consider applying NET to improve the psychological well-being of patients who have experienced an epidemic such as COVID-19.


Subject(s)
COVID-19 , Implosive Therapy , Narrative Therapy , Stress Disorders, Post-Traumatic , Humans , Quality of Life , SARS-CoV-2 , Stress Disorders, Post-Traumatic/therapy
9.
Infect Dis Poverty ; 10(1): 69, 2021 May 17.
Article in English | MEDLINE | ID: covidwho-1232440

ABSTRACT

BACKGROUND: COVID-19 can lead to increased psychological symptoms such as post-traumatic stress disorder (PTSD), depression, and anxiety among patients with COVID-19. Based on the previous mindfulness-based interventions proved to be effective, this protocol reports a design of a randomized controlled trial aiming to explore the efficacy and possible mechanism of a mindful living with challenge (MLWC) intervention developed for COVID-19 survivors in alleviating their psychological problems caused by both the disease and the pandemic. METHODS: In April 2021, more than 1600 eligible participants from Hubei Province of China will be assigned 1:1 to an online MLWC intervention group or a waitlist control group. All participants will be asked to complete online questionnaires at baseline, post-program, and 3-month follow-up. The differences of mental health status (e.g. PTSD) and physical symptoms including fatigue and sleeplessness between the COVID-19 survivors who receiving the online MLWC intervention and the control group will be assessed. In addition, the possible mediators and moderators of the link between the MLWC intervention and target outcomes will be evaluated by related verified scales, such as the Five Facets Mindfulness Questionnaire. Data will be analyzed based on an intention-to-treat approach, and SPSS software will be used to perform statistical analysis. DISCUSSION: The efficacy and potential mechanism of MLWC intervention in improving the quality of life and psychological status of COVID-19 survivors in China are expected to be reported. Findings from this study will shed light on a novel and feasible model in improving the psychological well-being of people during such public health emergencies. Trial registration Chinese Clinical Trial Registry (ChiCTR), ChiCTR2000037524; Registered on August 29, 2020, http://www.chictr.org.cn/showproj.aspx?proj=60034 .


Subject(s)
Anxiety , COVID-19/psychology , Depression , Internet-Based Intervention , Mindfulness , Stress Disorders, Post-Traumatic , Anxiety/etiology , Anxiety/therapy , China/epidemiology , Depression/etiology , Depression/therapy , Humans , Mental Health , Quality of Life , Randomized Controlled Trials as Topic , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/therapy , Surveys and Questionnaires
10.
BMC Res Notes ; 14(1): 176, 2021 May 10.
Article in English | MEDLINE | ID: covidwho-1223779

ABSTRACT

OBJECTIVE: This randomised controlled trial (RCT) aimed to investigate the effects of a simple cognitive task intervention on intrusive memories ("flashbacks") and associated symptoms following a traumatic event. Patients presenting to a Swedish emergency department (ED) soon after a traumatic event were randomly allocated (1:1) to the simple cognitive task intervention (memory cue + mental rotation instructions + computer game "Tetris" for at least 20 min) or control (podcast, similar time). We planned follow-ups at one-week, 1-month, and where possible, 3- and 6-months post-trauma. Anticipated enrolment was N = 148. RESULTS: The RCT was terminated prematurely after recruiting N = 16 participants. The COVID-19 pandemic prevented recruitment/testing in the ED because: (i) the study required face-to-face contact between participants, psychology researchers, ED staff, and patients, incurring risk of virus transmission; (ii) the host ED site received COVID-19 patients; and (iii) reduced flow of patients otherwise presenting to the ED in non-pandemic conditions (e.g. after trauma). We report on delivery of study procedures, recruitment, treatment adherence, outcome completion (primary outcome: number of intrusive memories during week 5), attrition, and limitations. The information presented and limitations may enable our group and others to learn from this terminated study. Trial registration ClinicalTrials.gov: NCT04185155 (04-12-2019).


Subject(s)
COVID-19 , Stress Disorders, Post-Traumatic , Cognition , Emergency Service, Hospital , Humans , SARS-CoV-2 , Stress Disorders, Post-Traumatic/therapy
11.
Phys Ther ; 101(6)2021 06 01.
Article in English | MEDLINE | ID: covidwho-1140006

ABSTRACT

OBJECTIVE: The purpose of this case report is to provide the clinical presentation and physical therapist management for a patient with post-COVID syndrome. Secondarily, the report highlights the importance of assessing cognitive and emotional health in patients with post-COVID syndrome. METHODS (CASE DESCRIPTION): A 37-year-old woman tested positive for SARS-CoV-2 and developed mild COVID-19 disease but did not require supplemental oxygen or hospitalization. The patient experienced persistent symptoms, including dyspnea, headaches, and cognitive fog. On day 62, they participated in an outpatient physical therapist evaluation that revealed deficits in exercise capacity, obtaining 50% of their age-predicted 6-minute walk distance. They had minor reductions in muscle strength and cognitive function. Self-reported quality of life was 50, and they scored above established cut-off scores for provisional diagnosis of posttraumatic stress disorder (PTSD). RESULTS: The patient participated in biweekly physical therapist sessions for 8 weeks, which included aerobic training, strengthening exercises, diaphragmatic breathing techniques, and mindfulness training. Metabolic equivalent for task levels increased with variability over the course of the program. The patient's muscle strength, physical function, and exercise capacity improved. 6-Minute walk distance increased by 199 m, equating to 80% of their age-predicted distance. Quality of life and PTSD scores did not improve. At evaluation after physical therapy, the patient was still experiencing migraines, dyspnea, fatigue, and cognitive dysfunction. CONCLUSION: This case report described the clinical presentation and physical therapist management of a person with post-COVID syndrome, a novel health condition for which little evidence exists to guide rehabilitation examination and interventions. Physical therapists should consider cognitive function and emotional health in their plan of care for patients with post-COVID syndromes. IMPACT: This case alerts physical therapists to post-COVID syndrome-which can include debilitating symptoms of decreased aerobic tolerance, anxiety, PTSD, and cognitive dysfunction-and to the role that therapists can play in assessing these symptoms and managing these patients.


Subject(s)
COVID-19/complications , Physical Therapy Modalities , Adult , COVID-19/therapy , Cognitive Dysfunction/therapy , Cognitive Dysfunction/virology , Dyspnea/therapy , Dyspnea/virology , Female , Humans , Pandemics , Quality of Life , SARS-CoV-2 , Stress Disorders, Post-Traumatic/therapy , Stress Disorders, Post-Traumatic/virology , Surveys and Questionnaires , Syndrome , Walk Test
12.
Depress Anxiety ; 38(6): 639-647, 2021 06.
Article in English | MEDLINE | ID: covidwho-1139225

ABSTRACT

BACKGROUND: Veterans have higher rates of anxiety, depression, and posttraumatic stress disorder (PTSD), and may be vulnerable to mental health consequences of the Covid-19 pandemic. More than half of veterans who meet mental illness criteria do not seek help. This study screened for clinical symptoms and evaluated the efficacy of a brief, online social-contact-based video intervention in increasing treatment-seeking intentions among veterans. We hypothesized that the video-based intervention would increase treatment-seeking intentions more than written vignette and control conditions. METHODS: One hundred seventy-two veterans were randomized to either a (a) brief video-based intervention; (b) written vignette intervention, or (c) nonintervention control group. In the 3-min video, a veteran previously diagnosed with PTSD described his symptom reactivation by Covid-19, his barriers to care, and how therapy helped him to cope. Assessments were conducted at baseline, postintervention, and at 14- and 30-day follow-ups. RESULTS: A total of 91 (53%) veterans reported high levels of clinical symptoms, especially those self-reporting Covid-19 exposure. The brief video-based intervention yielded greater increase in treatment-seeking intentions among veterans. Within the video group, women showed an increase in treatment-seeking intentions from baseline to postintervention only, whereas men showed a more sustained effect, from baseline to Day 14. CONCLUSIONS: Surveyed veterans reported high symptoms levels. A brief video intervention increased treatment-seeking intention, likely through identification and emotional engagement with the video protagonist. This easily disseminable video-based intervention has the potential to increase likelihood of seeking care. Future research should examine longer term sustainability and changes in help-seeking behavior.


Subject(s)
COVID-19 , Stress Disorders, Post-Traumatic , Veterans , Female , Humans , Intention , Male , Pandemics , Patient Acceptance of Health Care , SARS-CoV-2 , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/therapy
14.
Rev Mal Respir ; 38(1): 114-121, 2021 Jan.
Article in French | MEDLINE | ID: covidwho-1065568

ABSTRACT

The French-speaking Respiratory Medicine Society (SPLF) proposes a guide for the management of possible respiratory sequelae in patients who have presented with SARS-CoV-2 pneumonia (COVID-19). The proposals are based on known data from previous epidemics, preliminary published data on post COVID-19 follow-up and on expert opinion. The proposals were developed by a group of experts and then submitted, using the Delphi method, to a panel of 22 pulmonologists. Seventeen proposals were validated ranging from additional examinations after the minimum assessment proposed in the SPLF monitoring guide, to inhaled or systemic corticosteroid therapy and antifibrotic agents. These proposals may evolve over time as knowledge accumulates. This guide emphasizes the importance of multidisciplinary discussion.


Subject(s)
COVID-19/complications , Cough/therapy , Dyspnea/therapy , Lung/diagnostic imaging , Administration, Inhalation , Bronchial Hyperreactivity/diagnosis , Bronchial Hyperreactivity/therapy , Cough/etiology , Delphi Technique , Dyspnea/etiology , Glucocorticoids/therapeutic use , Humans , Lung/virology , Nebulizers and Vaporizers , Oxygen Inhalation Therapy , Patient Care Team , Protein Kinase Inhibitors/therapeutic use , Respiratory Therapy , SARS-CoV-2 , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/therapy , Time Factors , Tomography, X-Ray Computed
15.
Health Informatics J ; 26(4): 3201-3214, 2020 12.
Article in English | MEDLINE | ID: covidwho-1067149

ABSTRACT

Rates of PTSD remain elevated among U.S. Veterans, highlighting a need for innovative management tools. Previous studies have shown mobile apps to have positive effects on PTSD symptoms, but few apps have been examined systematically. This pilot study evaluated the perceived effectiveness and usability of Mindset, a novel mobile app that monitors user stress level via heart rate to encourage e-therapy use. The study sample included 30 community-residing Veterans who completed baseline assessments. They used the Mindset app and associated smartwatch until their approximate 1-month follow-up. Self-reported assessments included pre- and post-deployment experiences; experience with Mindset; and standard screeners for PTSD (PCL-M), anxiety (GAD-7), depression (PHQ-9), and alcohol use problems (AUDIT). Among the 24 participants who completed follow-up interviews, a significant decrease (p < 0.05) was found in PCL-M, PHQ-9, and modified AUDIT scores. Respondents reported moderate to high acceptance and satisfaction with Mindset features, though considerable frustration with the associated smartwatch. These findings highlight mHealth apps such as Mindset as potentially useful tools for PTSD and depression symptom management. These findings are also encouraging in the context of the current COVID-19 pandemic, which may accelerate further innovation and implementation of mHealth technologies to improve mental health self-care.


Subject(s)
Mental Health , Mobile Applications , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/therapy , Telemedicine/methods , Veterans/psychology , Adult , Alcoholism/epidemiology , Alcoholism/therapy , Anxiety/epidemiology , Anxiety/therapy , COVID-19/epidemiology , Depression/epidemiology , Depression/therapy , Female , Heart Rate/physiology , Humans , Male , Pandemics , Patient Satisfaction , Pilot Projects , SARS-CoV-2 , Stress, Psychological/epidemiology , Stress, Psychological/physiopathology
16.
Encephale ; 46(3S): S3-S13, 2020 Jun.
Article in French | MEDLINE | ID: covidwho-1065044

ABSTRACT

OBJECTIVE: The lack of ressources and coordination to face the epidemic of coronavirus raises concerns for the health of patients with mental disorders in a country where we keep in memory the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims at proposing guidance to ensure mental health care during the SARS-CoV epidemy in France. METHODS: Authors performed a narrative review identifying relevant results in the scientific and medical literature and local initiatives in France. RESULTS: We identified four types of major vulnerabilities in patients suffering from mental disorders during this pandemic: (1) medical comorbidities that are more frequently found in patients suffering from mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which represent risk factors for severe infections with Covid-19; (2) age (the elderly constituting the population most vulnerable to coronavirus); (3) cognitive and behavioral troubles which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability due to stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly adapted to psychiatric establishments in a context of major shortage of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds are closed, wards have a high density of patients, mental health community facilities are closed, medical teams are understaffed and poorly trained to face infectious diseases. We could also face major issues in referring patients with acute mental disorders to intensive care units. To maintain continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of Covid+ units. These units are under the dual supervision of a psychiatrist and of an internist/infectious disease specialist; all new entrants should be placed in quarantine for 14 days; the nurse staff should benefit from specific training, from daily medical check-ups and from close psychological support. Family visits would be prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management should be organized with the possibility of home visits, in order to support them when they get back home and to help them to cope with the experience of confinement, which is at risk to induce recurrences of mental disorders. The total or partial closure of mental health community facilities is particularly disturbing for patients but a regular follow-up is possible with telemedicine and should include the monitoring of the suicide risk and psychoeducation strategies; developing support platforms could also be very helpful in this context. Private psychiatrists have also a crucial role of information with their patients on confinement and barrier measures, but also on measures to prevent the psychological risks inherent to confinement: maintenance of sleep regularity, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic. DISCUSSION: French mental healthcare is now in a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the containment of the general population.


Subject(s)
Betacoronavirus , Continuity of Patient Care/organization & administration , Coronavirus Infections/epidemiology , Mental Disorders/therapy , Mental Health Services/organization & administration , Pandemics , Pneumonia, Viral/epidemiology , Aftercare , Age Factors , Aged, 80 and over , Antiviral Agents/pharmacokinetics , Antiviral Agents/therapeutic use , COVID-19 , Child , Cognition Disorders/epidemiology , Cognition Disorders/therapy , Comorbidity , Coronavirus Infections/psychology , Drug Interactions , France/epidemiology , Hospital Units/organization & administration , Hospitals, Psychiatric/organization & administration , Humans , Infection Control/methods , Mental Disorders/epidemiology , Mental Disorders/etiology , Mental Health Services/supply & distribution , Patient Care Team , Patient Compliance , Pneumonia, Viral/psychology , Prisoners/psychology , SARS-CoV-2 , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/therapy , Stress, Psychological/etiology , Stress, Psychological/therapy , Substance-Related Disorders/epidemiology , Substance-Related Disorders/therapy , Suicide/prevention & control , Vulnerable Populations
17.
Semin Perinatol ; 44(7): 151279, 2020 11.
Article in English | MEDLINE | ID: covidwho-1044689

ABSTRACT

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.


Subject(s)
COVID-19 , Compassion Fatigue/psychology , Obstetrics , Physicians/psychology , Pregnancy Complications/psychology , Pregnant Women/psychology , Psychological Trauma/psychology , Anxiety/psychology , Anxiety/therapy , Compassion Fatigue/therapy , Depression/psychology , Depression/therapy , Female , Humans , Mental Health , Mental Health Services , Organizational Policy , Pregnancy , Pregnancy Complications/therapy , Psychological Trauma/therapy , Psychotherapy , Psychotherapy, Group , SARS-CoV-2 , Sleep Wake Disorders , Stress Disorders, Post-Traumatic/psychology , Stress Disorders, Post-Traumatic/therapy , Stress Disorders, Traumatic, Acute/psychology , Stress Disorders, Traumatic, Acute/therapy , Telemedicine , Visitors to Patients
18.
Aust J Gen Pract ; 49(12): 785-789, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1005381

ABSTRACT

BACKGROUND: The COVID-19 pandemic has caused unprecedented stress globally, and the associated medical and health-related traumatic experiences pose significant risks for the development of post-traumatic stress disorder (PTSD), and the exacerbation of pre-existing PTSD, among patients, general practitioners (GPs) and healthcare staff. OBJECTIVE: The aim of this article is to provide guidance to GPs and healthcare staff working in Australia about the diagnosis and treatment of both newly developed and pre-existing PTSD in the COVID-19 context. Case studies are presented; the authors discuss whether pandemic-related PTSD is different to PTSD caused by different types of traumatic exposure, and the associated implications for treatment. DISCUSSION: The role of GPs in the management of PTSD during the COVID-19 pandemic remains central, involving early detection, assessment and referral. Moreover, health professionals are not immune to the mental health effects of the pandemic and are encouraged to maintain their wellbeing and to seek professional treatment if needed.


Subject(s)
COVID-19/psychology , Mental Health Services/trends , Pandemics , Stress Disorders, Post-Traumatic/therapy , Australia , COVID-19/complications , Humans , Primary Health Care/methods , Primary Health Care/trends , Stress Disorders, Post-Traumatic/psychology
19.
Encephale ; 46(3): 193-201, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-888503

ABSTRACT

OBJECTIVE: The lack of resources and coordination to face the coronavirus epidemic raises concerns for the health of patients with mental disorders in a country where we still have memories of the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims to propose guidance to ensure mental health care during the SARS-CoV epidemic in France. METHODS: The authors performed a narrative review identifying relevant results in the scientific and medical literature and in local initiatives in France. RESULTS: We identified four types of major vulnerabilities among patients with mental disorders during this pandemic: (1) medical comorbidities that are more frequently found among patients with mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which are risk factors for severe covid-19 infection; (2) age (the elderly form the population most vulnerable to the coronavirus); (3) cognitive and behavioural disorders, which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability as a result of stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly suited to psychiatric establishments in a context of major shortages of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds have been closed, wards have high densities of patients, mental health community facilities are closed, and medical teams are understaffed and poorly trained to face infectious diseases. There are also major issues when referring patients with acute mental disorders to intensive care units. To maintain the continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of "COVID+ units". These units are under the dual supervision of a psychiatrist and an internist/infectious disease specialist; all new entrants are placed in quarantine for 14 days; the nursing staff receives specific training, daily medical check-ups and close psychological support. Family visits are prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management are organized with the possibility of home visits, in order to support patients when they get back home and to help them cope with the experience of confinement, which is liable to induce recurrences of mental disorders. The total or partial closure of community mental health facilities is particularly disturbing for patients, but a regular follow-up is possible with telemedicine and should include the monitoring of suicide risk and psycho-education strategies; developing support platforms could also be very helpful in this context. Private practice psychiatrists also have a crucial role of information towards their patients on confinement and barrier measures, and also on measures to prevent the psychological risks inherent in confinement: maintenance of regular sleep r, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic. DISCUSSION: French mental healthcare is now facing a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the confinement of the general population.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Mental Disorders/therapy , Mental Health , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Aged , Aged, 80 and over , COVID-19 , Epidemics , France/epidemiology , Hospitals, Psychiatric/organization & administration , Hospitals, Psychiatric/standards , Hospitals, Psychiatric/statistics & numerical data , Humans , Mental Disorders/epidemiology , Mental Disorders/prevention & control , Pandemics , Psychotic Disorders/epidemiology , Psychotic Disorders/therapy , Quarantine/psychology , Quarantine/statistics & numerical data , Risk Factors , SARS-CoV-2 , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/therapy , Suicide/prevention & control , Suicide/statistics & numerical data
20.
Br J Psychiatry ; 218(2): 75-76, 2021 02.
Article in English | MEDLINE | ID: covidwho-890130

ABSTRACT

Besides a global health crisis, the COVID-19 pandemic has potential to have a severe and long-lasting psychological impact on frontline healthcare workers such as paramedics. It is imperative to shed light on these mental health issues and employ interventions to protect the mental wellness of this vulnerable group of healthcare workers.


Subject(s)
COVID-19 , Emergency Medical Technicians/psychology , Mental Disorders/therapy , Occupational Diseases/therapy , Adult , Depressive Disorder/therapy , Humans , Mental Disorders/etiology , Mental Disorders/prevention & control , Occupational Diseases/prevention & control , Occupational Stress/therapy , Psychological Trauma/therapy , Psychosocial Intervention , Stress Disorders, Post-Traumatic/therapy , Suicide/prevention & control
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