Perceived Stress, Hope, and Health Outcomes Among Medical Staff in China During the COVID-19 Pandemic.

This study investigated the buffering role of hope between perceived stress and health outcomes among front-line medical staff treating patients with suspected COVID-19 infection in Shenzhen, China. In the cross-sectional study with online questionnaires, medical staff's perceived stress, anxiety, depression, sleep quality, and hope were measured by the 10-item Chinese Perceived Stress Scale, Hospital Anxiety and Depression Scale, the Pittsburgh Sleep Quality Index, and the Locus-of-Hope Scale, respectively. A total of 319 eligible front-line medical staff participated. The prevalence of anxiety (29.70%), depression (28.80%), poor sleep quality (38.90%) indicated that a considerable proportion of medical staff experienced mood and sleep disturbances during the COVID-19 pandemic. Internal locus-of-hope significantly moderated the effects of stress on anxiety, depression, and sleep quality. Moreover, external family locus-of-hope and external peer locus-of-hope significantly moderated the association between perceived stress and depression. The prevalence of symptoms indicates that both mental and physical health outcomes of front-line medical staff deserve more attention. Internal and external locus-of-hope functioned differently as protective factors for medical staffs' health and might be promising targets for intervention.

Stress, Burnout, and Coping Strategies of Frontline Nurses During the COVID-19 Epidemic in Wuhan and Shanghai, China.

Background: Nurses at the frontline of caring for COVID-19 patients might experience mental health challenges and supportive coping strategies are needed to reduce their stress and burnout. The aim of this study was to identify stressors and burnout among frontline nurses caring for COVID-19 patients in Wuhan and Shanghai and to explore perceived effective morale support strategies. Method: A cross-sectional survey was conducted in March 2020 among 110 nurses from Zhongshan Hospital, Shanghai, who were deployed at COVID-19 units in Wuhan and Shanghai. A COVID-19 questionnaire was adapted from the previous developed "psychological impacts of SARS" questionnaire and included stressors (31 items), coping strategies (17 items), and effective support measures (16 items). Burnout was measured with the Maslach Burnout Inventory. Results: Totally, 107 (97%) nurses responded. Participants mean age was 30.28 years and 90.7% were females. Homesickness was most frequently reported as a stressor (96.3%). Seven of the 17 items related to coping strategies were undertaken by all participants. Burnout was observed in the emotional exhaustion and depersonalization subscales, with 78.5 and 92.5% of participants presenting mild levels of burnout, respectively. However, 52 (48.6%) participants experienced a severe lack of personal accomplishment. Participants with longer working hours in COVID-19 quarantine units presented higher emotional exhaustion (OR = 2.72, 95% CI 0.02-5.42; p = 0.049) and depersonalization (OR = 1.14, 95% CI 0.10-2.19; p = 0.033). Participants with younger age experienced higher emotional exhaustion (OR = 2.96, 95% CI 0.11-5.82; p = 0.042) and less personal accomplishment (OR = 3.80, 95% CI 0.47-7.13; p = 0.033). Conclusions: Nurses in this study experienced considerable stress and the most frequently reported stressors were related to families. Nurses who were younger and those working longer shift-time tended to present higher burnout levels. Psychological support strategies need to be organized and implemented to improve mental health among nurses during the COVID-19 pandemic.

Perceived Stress among Iranians during COVID-19 Pandemic; Stressors and Coping Mechanisms: A Mixed-methods Approach.

OBJECTIVE: New coronavirus (COVID-19) pandemic socioeconomically affected the world. In this study, we measured the perceived stress in response to the COVID-19 pandemic among Iranians to determine the groups at both extremes of the spectrum followed by identifying the stressors and coping mechanisms. METHODS: This study was a mixed-methods study. We distributed a web-based 10-item perceived stress scale (PSS-10), to measure perceived stress score (PSS), through social networks from March 12 to 23, 2020. Then, we interviewed 42 students, 31 homemakers, 27 healthcare providers, and 21 male participants to identify the sources of stress and coping mechanisms. RESULTS: Finally, 13,454 participants completed the questionnaires. The median and interquartile range (IQR) of the participants' PSS was 21 (15-25). Students, homemakers, and healthcare workers (HCWs) showed a higher median (IQR) of PSS compared to other groups (23 [18 to 27], 22 [16 to 26], and 19 [14 to 24], respectively). Male participants showed a lower median (IQR) PSS (17 [12 to 23]). Content analysis of 121 participants' answers showed that the most common stressors were school-related issues mentioned by students, family-related issues mentioned by homemakers, and COVID-19-related issues mentioned by healthcare providers. Male participants' coping mechanisms were mostly related to the perception of their abilities to cope with the current crisis. CONCLUSION: Our participants clinically showed a moderate level of PSS. The main stressors among students, homemakers, and HCWs were related to their principal role in this period, and male participants' coping mechanisms were inspired by the self-image retrieved from the social perspectives.

Stress and Anxiety among Healthcare Workers Associated with COVID-19 Pandemic in Russia.

BACKGROUND: Mental health of medical workers treating patients with COVID-19 is an issue of increasing concern worldwide. The available data on stress and anxiety symptoms among healthcare workers during the COVID-19 are relatively limited and have not been evaluated in Russia yet. SUBJECTS AND METHODS: The cross-sectional anonymous survey included 1,090 healthcare workers. Stress and anxiety symptoms were assessed using Stress and Anxiety to Viral Epidemics - 9 (SAVE-9) and Generalized Anxiety Disorder - 7 (GAD-7) scales. Logistic regression, Kaiser-Meyer-Olkin two component factor model, Cronbach's alpha and ROC-analysis were performed to determine the influence of different variables, internal structure and consistency, sensitivity and specificity of SAVE-9 compared with GAD-7. RESULTS: The median scores on the GAD-7 and SAVE-9 were 5 and 14, respectively. 535 (49.1%) respondents had moderate and 239 (21.9%) had severe anxiety according to SAVE-9. 134 participants (12.3%) had severe anxiety, 144 (13.2%) had moderate according to GAD-7. The component model revealed two-factor structure of SAVE-9: "anxiety and somatic concern" and "social stress". Female gender (OR - 0.98, p=0.04) and younger age (OR - 0.65, p=0.04) were associated with higher level of anxiety according to regression model. The total score of SAVE-9 with a high degree of confidence predicted the GAD-7 value in comparative ROC analysis. CONCLUSIONS: Healthcare workers in Russia reported high rates of stress and anxiety. The Russian version of the SAVE-9 displayed a good ratio of sensitivity to specificity compared with GAD-7 and can be recommended as a screening instrument for detection of stress and anxiety in healthcare workers.

Mental Health Outcomes of Adults with Comorbidity and Chronic Diseases during the COVID-19 Pandemic: A Matched Case-Control Study.

BACKGROUND: Individuals with certain pre-existing chronic health conditions have been identified as a high-risk group for fatalities of COVID-19. Therefore, it is likely that individuals with chronic diseases may worry during this pandemic to the detriment of their mental health. This study compares the mental health of Bangladeshi adults affected by chronic disease to a healthy, matched control group during the COVID-19 pandemic. SUBJECTS AND METHODS: A matched case-control analysis was performed with data collected from 395 respondents with chronic diseases and 395 controls matched for age, gender, and residence. Inclusion criteria for cases were respondents who self-reported having asthma, cardiovascular disease symptoms and/or diabetes. Respondents were recruited using an online survey, which included the DASS-21 measure to assess symptoms of stress, anxiety, and depression. Chi-square test, t-test, Fisher's exact test and a conditional logistic regression were performed to examine associations among variables. RESULTS: The prevalence of anxiety symptoms and depression symptoms and the level of stress were significantly higher among cases (59%; 71.6%; 73.7%, respectively) than among controls (25.6%; 31.1%; 43.3%, respectively). Chi-square and t-test showed significant associations and differences between having chronic diseases and mental health outcomes. A conditional logistic regression showed that respondents with asthma, diabetes, cardiovascular disease symptoms, or any combination of these diseases had higher odds of exhibiting symptoms of stress, anxiety, and depression than healthy individuals. CONCLUSION: These results underscore a subpopulation vulnerable to mental health consequences during this pandemic and indicate the need for additional mental health resources to be available to those with chronic diseases.

Prevalence of and Risk Factors Associated With Mental Health Symptoms Among the General Population in China During the Coronavirus Disease 2019 Pandemic.

Importance: People exposed to coronavirus disease 2019 (COVID-19) and a series of imperative containment measures could be psychologically stressed, yet the burden of and factors associated with mental health symptoms remain unclear. Objective: To investigate the prevalence of and risk factors associated with mental health symptoms in the general population in China during the COVID-19 pandemic. Design, Setting, and Participants: This large-sample, cross-sectional, population-based, online survey study was conducted from February 28, 2020, to March 11, 2020. It involved all 34 province-level regions in China and included participants aged 18 years and older. Data analysis was performed from March to May 2020. Main Outcomes and Measures: The prevalence of symptoms of depression, anxiety, insomnia, and acute stress among the general population in China during the COVID-19 pandemic was evaluated using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Insomnia Severity Index, and Acute Stress Disorder Scale. Logistic regression analyses were used to explore demographic and COVID-19-related risk factors. Results: Of 71 227 individuals who clicked on the survey link, 56 932 submitted the questionnaires, for a participation rate of 79.9%. After excluding the invalid questionnaires, 56 679 participants (mean [SD] age, 35.97 [8.22] years; 27 149 men [47.9%]) were included in the study; 39 468 respondents (69.6%) were aged 18 to 39 years. During the COVID-19 pandemic, the rates of mental health symptoms among the survey respondents were 27.9% (95% CI, 27.5%-28.2%) for depression, 31.6% (95% CI, 31.2%-32.0%) for anxiety, 29.2% (95% CI, 28.8%-29.6%) for insomnia, and 24.4% (95% CI, 24.0%-24.7%) for acute stress. Participants with confirmed or suspected COVID-19 and their family members or friends had a high risk for symptoms of depression (adjusted odds ratios [ORs], 3.27 [95% CI, 1.84-5.80] for patients; 1.53 [95% CI, 1.26-1.85] for family or friends), anxiety (adjusted ORs, 2.48 [95% CI, 1.43-4.31] for patients; 1.53 [95% CI, 1.27-1.84] for family or friends), insomnia (adjusted ORs, 3.06 [95% CI, 1.73-5.43] for patients; 1.62 [95% CI, 1.35-1.96] for family or friends), and acute stress (adjusted ORs, 3.50 [95% CI, 2.02-6.07] for patients; 1.77 [95% CI, 1.46-2.15] for family or friends). Moreover, people with occupational exposure risks and residents in Hubei province had increased odds of symptoms of depression (adjusted ORs, 1.96 [95% CI, 1.77-2.17] for occupational exposure; 1.42 [95% CI, 1.19-1.68] for Hubei residence), anxiety (adjusted ORs, 1.93 [95% CI, 1.75-2.13] for occupational exposure; 1.54 [95% CI, 1.30-1.82] for Hubei residence), insomnia (adjusted ORs, 1.60 [95% CI, 1.45-1.77] for occupational exposure; 1.20 [95% CI, 1.01-1.42] for Hubei residence), and acute stress (adjusted ORs, 1.98 [95% CI, 1.79-2.20] for occupational exposure; 1.49 [95% CI, 1.25-1.79] for Hubei residence). Both centralized quarantine (adjusted ORs, 1.33 [95% CI, 1.10-1.61] for depression; 1.46 [95% CI, 1.22-1.75] for anxiety; 1.63 [95% CI, 1.36-1.95] for insomnia; 1.46 [95% CI, 1.21-1.77] for acute stress) and home quarantine (adjusted ORs, 1.30 [95% CI, 1.25-1.36] for depression; 1.28 [95% CI, 1.23-1.34] for anxiety; 1.24 [95% CI, 1.19-1.30] for insomnia; 1.29 [95% CI, 1.24-1.35] for acute stress) were associated with the 4 negative mental health outcomes. Being at work was associated with lower risks of depression (adjusted OR, 0.85 [95% CI, 0.79-0.91]), anxiety (adjusted OR, 0.92 [95% CI, 0.86-0.99]), and insomnia (adjusted OR, 0.87 [95% CI, 0.81-0.94]). Conclusions and Relevance: The results of this survey indicate that mental health symptoms may have been common during the COVID-19 outbreak among the general population in China, especially among infected individuals, people with suspected infection, and people who might have contact with patients with COVID-19. Some measures, such as quarantine and delays in returning to work, were also associated with mental health among the public. These findings identify populations at risk for mental health problems during the COVID-19 pandemic and may help in implementing mental health intervention policies in other countries and regions.

Is COVID-19 Associated With Posttraumatic Stress Disorder?

OBJECTIVE: To assess the prevalence of and risk factors for posttraumatic stress disorder (PTSD) in patients with COVID-19. METHODS: We conducted a cohort study between March and May 2020 at the Lille University Hospital (France), including all patients with laboratory-confirmed COVID-19. Psychological distress symptoms were measured 3 weeks after onset of COVID-19 symptoms using the Impact of Event Scale-6 items (IES-6). The evaluation of PTSD symptoms using the PTSD Checklist for DSM-5 (PCL-5) took place 1 month later. Bivariate analyses were performed to analyze the relationship between PCL-5 scores and the demographic and health variables. The significant variables were then introduced into a multivariable linear regression analysis to establish their relative contributions to the severity of PTSD symptoms. RESULTS: 180 patients were included in this study, and 138 patients completed the 2 evaluations. Among the 180 patients, 70.4% patients required hospitalization, and 30.7% were admitted to the intensive care unit. The prevalence of PTSD was 6.5%, and the predictive factors of PTSD included psychological distress at the onset of the illness and a stay in an intensive care unit. CONCLUSIONS: The prevalence of PTSD in patients with COVID-19 is not as high as that reported among patients during previous epidemics. Initial psychological responses were predictive of a PTSD diagnosis, even though most patients showing acute psychological distress (33.5% of the sample) improved in the following weeks. PTSD symptoms also increased following a stay in an intensive care unit. Future studies should assess the long-term consequences of COVID-19 on patients' mental health.

Association of COVID-19 Pandemic with undergraduate Medical Students' Perceived Stress and Coping.

PURPOSE: The COVID-19 pandemic poses a major challenge for medical students' learning and has become a potential stressor, with a profound influence on their psychological well-being. We aimed to determine the effect of the current pandemic on undergraduate medical students' learning. We also explored the association of their stress level with coping strategies, educational, and psychological variables. MATERIALS AND METHODS: This is a cross-sectional design study, and participants were the 1st to 5th year medical students. A self-administered questionnaire (18 items) and a well-known Kessler 10 Psychological Distress questionnaire (10 items) were used to collect the data related to perceived stress with an association of educational, psychological, and coping variables. RESULTS: The prevalence of overall stress was significantly higher (χ 2= 16.3; P=0.000) in female medical students, ie, (40%) as compared to the male students (16.6%), and was highest (48.8%) during the 3rd medical year. It was also noted that the most effective strategy, embraced by students to cope with the severe stress, was "indulging in religious activities" (OR= 1.08; P=0.81). Furthermore, 22.3% of students had perceived severe stress as they did not prefer online learning. Similarly, those students who have not believed or refused the online learning or disagree in "there is pleasure in the study due to COVID" they have significantly higher stress (χ 2=39.7; P=0.000) 21.5% mild, 17.8% of moderate, and 21.2% severe. CONCLUSION: We found that the COVID-19 pandemic has induced stress and changes in medical students' educational attitudes and strategies. The results exhibited that the predominance of stress is higher in females than males, and also more stress was perceived by the students during their transitional year, ie, 3rd medical year (from pre-clinical to clinical) and also the respondents who regularly did religious meditation were at lower levels of stress. COVID-19's influence on medical education and students' well-being will be felt at an extended level, which necessitates an appropriate plan for preparedness.

[Survey of the effect of the SARS-CoV-2 outbreak on the job training members with high exercise intensity: Analysis of the factors causing infection spread and the effectiveness of the prevention measures].

OBJECTIVES: Immediately before the state of emergency was declared, there was an outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among special training participants with severe physical stress. For promoting the optimization of infection prevention measures by identifying acts and situations with high risk of infection, we conducted a survey and analysis to understand the detailed process of infection spread in these cases. METHODS: A structured interview was conducted for the special training participants on their health status, changes in symptoms, training methods, and behavior history in their private lives. Additionally, a patrol of the training facility was carried out to understand the training environment, and antibody tests were conducted on the close contacts for more accurately grasping the spread of infection, by identifying subclinical infected persons. RESULTS: Within 10 days of COVID-19 onset in the first patient, 15 of the 19 original training participants developed symptoms, and 14 patients tested positive for RT-PCR. PCR tests were also performed on four patients who did not develop the disease - two were positive and negative, each. The two negatives turned positive on a later antibody test, suggesting that there was an asymptomatic infection. In addition, all five patients who participated in the training for only a day developed symptoms and tested positive for PCR in a few days. Of the 64 people who underwent testing for antibodies as close contacts, all but one who was living together with a patient were negative on antibody testing. CONCLUSIONS: The onset of COVID-19 occurred after the start of practice-based training continuously; therefore, the practice-based training was thought to be the main cause of the transmission. We speculate that the main factors behind the rapid spread of infection are as follows: during practice-based training, increased ventilation made it difficult to wear a mask; repeated loud vocalizations at close range; and the training pair was not fixed. Physical training without shouting and desk work, however, did not possess the risk of COVID-19, and avoiding certain situations at high risk of respiratory infections may have significantly reduced SARS-CoV-2 transmission. If personnel become infected with SARS-CoV-2, emergency measures should be devised by identifying patients and close contacts and facilitating the investigation of their behavioral history. Furthermore, evaluating and improving the effectiveness of infection control measures is necessary by ascertaining potentially infected persons by performing PCR tests, antigen tests, antibody tests, etc. in combination.

Mental health considerations for children & adolescents in COVID-19 Pandemic.

Children are not indifferent to the significant psychological impact of the COVID-19 Pandemic. They experience fears, uncertainties, substantial changes to their routines, physical and social isolation alongside high level of parental stress. Understanding their emotions and responses is essential to properly address their needs during this pandemic. In this article, we highlight children's vulnerability, provide an overview of common symptoms of distress in different age groups, and summarize the interventions and resources available to promote child mental health and wellbeing during these challenging times. We advocate that prioritizing mental health including child & adolescent mental health is an essential component of any universal, community led response to COVID-19 Pandemic.

Assessing the Impact of COVID-19 on the Mental Health of Healthcare Workers in Three Metropolitan Cities of Pakistan.

PURPOSE: The COVID-19 (coronavirus disease-2019) has been associated with psychological distress during its rapid rise period in Pakistan. The present study aimed to assess the mental health of healthcare workers (HCWs) in the three metropolitan cities of Pakistan. METHODS: A cross-sectional, web-based study was conducted in 276 HCWs from April 10, 2020, to June 5, 2020. Depression, anxiety, and stress scale (DASS-21) were used for the mental health assessment of the HCWs. Multivariable logistic regression analysis (MLRA) was performed to measure the association between the demographics and the occurrence of depression, anxiety, and stress (DAS). RESULTS: The frequency of DAS in the HCWs was 10.1%, 25.4%, and 7.3%, respectively. The MLRA showed that the depression in HCWs was significantly associated with the profession (P<0.001). The anxiety in HCWs was significantly associated with their age (P=0.005), profession (P<0.05), and residence (P<0.05). The stress in HCWs was significantly associated with their age (P<0.05). LIMITATION: This study was conducted in the early phase of the COVID-19 pandemic, when the number of COVID-19 cases was on the rise in Pakistan and it only represents a definite period (April to June 2020). CONCLUSION: The symptoms of DAS are present in the HCWs of Pakistan and to manage the psychological health of HCWs, there is a need for the initiation of psychological well-being programs.

Burnout and Sources of Stress Among Health Care Risk Managers and Patient Safety Personnel During the COVID-19 Pandemic: A Pilot Study.

OBJECTIVE: This study investigates burnout and sources of stress related to the coronavirus disease 2019 (COVID-19) pandemic among a group of health care risk managers/patient safety practitioners. METHODS: An online survey was used, including the Oldenburg Burnout Inventory (OLBI) and 1 open-ended question: Since the start of the COVID-19 pandemic, what work or non-work-related issues have been causing you the most stress? RESULTS: A total of 31 participants completed the OLBI; 27 answered the open-ended question. Over 70% of participants qualified as burned out. A thematic analysis was used to analyze stressors. Key themes included impacts of social distancing, changing duties and workload, real and potential impacts of the virus (eg, fear of infection for self or others), and financial concerns (personal and organizational). Less common themes included untrustworthy and constantly changing guidance, feeling abused by persons in power, and positive comments about the experience of working during the pandemic. CONCLUSION: Burnout and pandemic-related stress may be very common in the health care risk management and patient safety workforce. Additional research is required to more robustly estimate the prevalence of burnout in this population. Meanwhile, the sources of stress identified here may aid health care organizations in taking immediate action to protect this vital workforce.

Stress and COVID-19 related behaviours: The mediating role of delay discounting.

We examined stress as a predictor of behaviours related to Coronavirus Disease-2019 (COVID-19) through its effects on delay discounting. Adults (N = 3686) completed an online survey with a behavioural measure of delay discounting and questions regarding stress, physical distancing, and stockpiling of food and supplies. Stress was weakly, but positively, correlated with delay discounting (p < 0.01). Delay discounting was positively correlated with stockpiling (p < 0.01); and discounting was negatively correlated with physical distancing (p < 0.01). Mediation models indicated that discounting was a significant mediator of the relationship between stress and physical distancing (-0.003) and stockpiling (0.003); bootstrap 95% CIs (-0.006, -0.001) and (0.001, 0.005), respectively. After accounting for its indirect effects through discounting, stress continued to have a direct effect on these outcomes. This study indicates that delay discounting partially mediates the link between stress and behaviours related to COVID-19. Results suggest that interventions reducing stress and/or delay discounting may be profitable for increasing infection prevention and reducing stockpiling.

Association between perceived stress and depression among medical students during the outbreak of COVID-19: The mediating role of insomnia.

BACKGROUND: The purpose of this study was to explore the association between perceived stress and depression among medical students and the mediating role of insomnia in this relationship during the COVID-19 pandemic in China. METHODS: A cross-sectional survey was conducted from March to April 2020 in medical university. Levels of perceived stress, insomnia and depression were measured using Perceived Stress Scale (PSS), Insomnia Severity Index (ISI) and Patient Health Questionnaire 9 (PHQ-9). The descriptive analyses of the demographic characteristics and correlation analyses of the three variables were calculated. The significance of the mediation effect was obtained using a bootstrap approach with SPSS PROCESS macro. RESULTS: The mean age of medical students was 21.46 years (SD=2.50). Of these medical students, 10,185 (34.3%) were male and 19,478 (65.7%) were female. Perceived stress was significantly associated with depression (ß=0.513, P < 0.001). Insomnia mediated the association between perceived stress and depression (ß=0.513, P < 0.001). The results of the non-parametric bootstrapping method confirmed the significance of the indirect effect of perceived stress through insomnia (95% bootstrap CI =0.137, 0.149). The indirect effect of insomnia accounted for 44.13% of the total variance in depression. CONCLUSIONS: These findings contribute to a better understanding of the interactive mechanisms underlying perceived stress and depression, and elucidating the mediating effects of insomnia on the association. This research provides a useful theoretical and methodological approach for prevention of depression in medical students. Findings from this study indicated that it may be effective to reduce depression among medical students by improving sleep quality and easing perceived stress.

Parental stress during COVID-19: A brief report on the role of distance education and family resources in an Italian sample.

Since the COVID-19 outbreak, school closures have affected over 1.5 billion children worldwide. Many countries implemented a rapid transition to distance education (DE), but the effects of such transition on family life remain largely underexplored. The current study used a cross-sectional, correlational survey design to explore the role of DE and family resources (parenting self-efficacy and family functioning) in perceived stress among Italian parents of first-grade children (N = 89). Results of hierarchical multiple regression indicated that, after controlling for stressful events experienced during school closure, parents' difficulty to manage children's DE was positively linked to levels of stress. However, this association became nonsignificant after adding family resources to the model, with more parental self-efficacy and good family functioning predicting less perceived stress. The findings underscore the importance of supporting positive resources within the family environment to reduce DE-related parental stress in the context of the ongoing COVID-19 pandemic.

Prevalence of depression, anxiety and stress in china during COVID-19 pandemic: A systematic review with meta-analysis.

BACKGROUND: The novel coronavirus disease which is believed to have initially originated in Wuhan city of China at the end of 2019 was declared as pandemic by March 2020 by WHO. This pandemic significantly impacted the mental health of communities around the globe. This project draws data from available research to quantify COVID-19 mental health issues and its prevalence in China during the early period of the COVID-19 crisis. It is believed that this pooling of data will give fair estimate of the effects of the COVID-19 pandemic on mental health. METHODS: We conducted this study in accordance with PRISMA guidelines 2009. The protocol for this review is registered and published in PROSPERO (CRD42020182893). The databases used were Pubmed, Medline, Google scholar and Scopus. The studies were extracted according to pre-defined eligibility criteria and risk of bias assessment was conducted. The Meta-analysis was done using OpenMeta [analyst]. RESULTS: Total of 62382 participants in nineteen studies fulfilled the eligibility criteria. Stress was the most prevalent (48.1%) mental health consequence of Covid-19 pandemic, followed by depression (26.9%) and anxiety (21.8%). After performing subgroup analysis, prevalence of depression and anxiety in both females and frontline health care workers were high as compared to the prevalence in general Chinese population. CONCLUSION: The prevalence of depression and anxiety is moderately high whereas pooled prevalence of stress was found to be very high in Chinese people during this Covid-19 crisis.

Posttraumatic Stress Disorder and Persistent Somatic Symptoms During the COVID-19 Pandemic: The Role of Sense of Threat.

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.

Association of GSTM1 and GSTT1 gene polymorphisms with COVID-19 susceptibility and its outcome.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has become a global health issue and develops into a broad range of illnesses from asymptomatic to fatal respiratory diseases. SARS-CoV-2 infection is associated with oxidative stress that triggers cytokine production, inflammation, and other pathophysiological processes. Glutathione-S-transferase (GST) is an important enzyme that catalyzes the conjugation of glutathione (GSH) with electrophiles to protect the cell from oxidative damage and participates in the antioxidant defense mechanism in the lungs. Thus, in this study, we investigated the role of GSTM1 and GSTT1 gene polymorphism with COVID-19 susceptibility, as well as its outcome. The study included 269 RT-PCR confirmed COVID-19 patients with mild (n = 149) and severe (n = 120) conditions. All subjects were genotyped for GSTM1 and GSTT1 by multiplex polymerase chain reaction (mPCR) followed by statistical analysis. The frequency of GSTM1-/- , GSTT1-/- and GSTM1-/- /GSTT1-/- was higher in severe COVID-19 patients as compared to mild patients but we did not observe a significant association. In the Cox hazard model, death was significantly 2.28-fold higher in patients with the GSTT1-/- genotype (p = 0.047). In combination, patients having GSTM1+/+ and GSTT1-/- genotypes showed a poor survival rate (p = 0.02). Our results suggested that COVID-19 patients with the GSTT1-/- genotype showed higher mortality.

Impact of the COVID-19 pandemic on migraine in Japan: a multicentre cross-sectional study.

OBJECTIVES: To assess the impacts of social situation changes due to the coronavirus disease 2019 (COVID-19) pandemic on headache-related disability and other symptoms in patients with migraine in Japan. METHODS: We conducted a multicentre, cross-sectional study including 659 outpatients with migraine diagnosed by headache specialists. The participants were asked about the impacts of the first wave of the COVID-19 pandemic on headache-related disability, headache days, headache intensity, stress, physical activity, hospital access and their work and home lives. For headache-related disability, the total Migraine Disability Assessment (MIDAS) score and part A and B scores were analysed. Multivariate stepwise linear regression analysis was performed to identify the clinical predictors of changes in the total MIDAS score before and during the COVID-19 pandemic. Logistic regression analysis was performed to determine the factors related to new-onset headache during the COVID-19 pandemic. RESULTS: Finally, 606 migraine patients (73 M/533 F; age, 45.2 ± 12.0 years) were included in the study, excluding those with incomplete data. Increased stress, substantial concern about COVID-19 and negative impacts of the first wave of the COVID-19 pandemic on daily life were reported in 56.8 %, 55.1 and 45.0 % of the participants, respectively. The total MIDAS and A and B scores did not significantly change after the first wave of the COVID-19 pandemic. New-onset headache, which was observed in 95 patients (15.7 %), was associated with younger age and worsened mood and sleep in the logistic regression analysis. The multivariate stepwise linear regression analysis of changes in the total MIDAS score before and during the first wave of COVID-19 pandemic identified worsened sleep, increased acute medication use, increased stress, medication shortages, comorbidities, the absence of an aura and new-onset headache were determinants of an increased total MIDAS score during the first wave of the COVID-19 pandemic. CONCLUSIONS: In this multicentre study, clinical factors relevant to headache-related disability, such as new-onset headache, stress and sleep disturbances, were identified, highlighting the importance of symptom management in migraine patients during the first wave of the COVID-19 pandemic.

COVID-19 fear and compliance in preventive measures precautions in workers during the COVID-19 pandemic.

OBJECTIVE: The aim of the study is to identify the relationship between the fear of COVID-19 and the preventive measures of healthcare workers and service sector employees during the covid-19 pandemic. METHODS: The present study is a descriptive type of research. The study's sample group consisted of 735 people and included healthcare workers (n = 426) and service sector employees (n = 309). In this study, sociodemographic characteristics, employment in the healthcare or service sector, having a relative with COVID-19, losing any relative due to COVID-19 and taking preventive measures were taken as independent variables. The dependent variable was the score from the Fear of COVID-19 Scale (FCV-19S). RESULTS: The FCV-19S median value was 14 for the service sector and 17 for the healthcare sector. While no difference was found between occupational groups and the FCV-19S score in the service sector, there was a significant correlation between occupational groups and the FCV-19S score in the healthcare sector. The FCV-19S median value of midwives was 21, and it was higher than those of other occupational groups were. The mean FCV-19S scores of those who thought they had COVID-19 symptoms due to stress or panic were higher among the healthcare workers. CONCLUSION: The healthcare workers need more support in fear management than those engaged in service sector employees, and it is recommended that raising the awareness of service sector employees in terms of compliance with preventive measures should be prioritized.