PSYCHOLOGICAL DISTRESS OVER 12 MONTHS POST-DIAGNOSIS IN A NATIONAL EARLY INFLAMMATORY ARTHRITIS COHORT

BackgroundIn inflammatory arthritis patients, the concomitant decline of their mental wellbeing is an increasing concern[1,2]. It is important to not only describe the trajectory of psychological distress in early disease stages, but also understand which clinical outcome measures are most associated with these changes.ObjectivesUsing data from the National Early Inflammatory Arthritis Audit (NEIAA), we assessed trends in psychological wellbeing over 12 months after initial diagnosis and mapped these against clinical outcomes to identify significant associations.MethodsNEIAA collects data from patients referred with suspected early inflammatory arthritis in rheumatology services in England and Wales. We used data provided by 20,472 patients eligible for follow-up (diagnosis of inflammatory arthritis) between May 1st, 2018, and April 1st, 2022. Data items included baseline demographics e.g., age and gender, and clinical variables e.g., rheumatic disease comorbidity index (RDCI), DAS28, and patient reported outcomes.Psychological distress was measured by the sum score of Patient Health Questionnaire Anxiety and Depression Screener (PHQ4ADS). Using mixed effects regression models, we analysed the co-variability of PHQ4ADS with demographic factors and clinical outcomes over 12 months. Time was included as a dummy-coded covariant.ResultsThe analysis included 36% of patients (7,378 out of 20,472) who completed the baseline patient outcome survey. In this cohort, PHQ4ADS scores decreased from a baseline average of 4.7 (CI: [4.6, 4.8]) to 2.62 (CI: [2.5, 2.8]) at 12 months post-diagnosis. The proportion of patients screening positive decreased from 50.0% (CI: [48.9, 51.1]) at baseline to 23.8% (CI: [21.8, 25.9]) at 12 months.At baseline, psychological distress correlated significantly with age, gender, ethnicity, RDCI, prior depression diagnosis, and baseline DAS28 (Figure 1). No significant correlations were found between psychological distress and working diagnosis, seropositivity, or the assessment being recorded after the start of the COVID-19 pandemic. Younger ages were nonlinearly associated with higher distress levels (coefficient per decade: -0.006;p<0.001;CI: [-0.009, -0.003]) (Figure 1a). Distress levels in females were higher than that of males (coefficient: 0.5;p<0.001;CI: [0.4, 0.7]) (Figure 1b). White patients reported lower PHQ4ADS scores compared to non-white patients (coefficient: -0.7;p<0.001;CI: [-1.0, -0.4]) (Figure 1c). Higher distress levels were also associated with higher RDCI (coefficient: 0.2;p<0.001;CI: [0.1, 0.3]) and prior diagnosis of depression (coefficient: 1.8;p<0.001;CI: [1.5, 2.2]) (Figure 1d, 1e). Furthermore, higher baseline DAS28 scores correlated with more severe psychological distress (coefficient: 0.8;p<0.001;CI: [0.7, 0.8]) (Figure 1f).By 12-months, psychological distress decreased significantly overall, which correlated significantly with ethnicity (coefficient: 0.8;p=0.005;CI: [0.3, 1.4]) and baseline DAS28 (coefficient: -0.5;p<0.001;CI: [-0.6, -0.4]). Compared to white patients, the reduction was significantly greater for non-white patients, but the level of distress was no longer different at 12 months (Figure 1c). While those with higher baseline DAS28 showed a greater reduction in psychological distress, the distress levels remained higher at 12 months (Figure 1f).Figure 1.Changes in psychological distress correlated with age, gender, ethnicity, RDCI, prior depression diagnosis, and baseline DAS28.[Figure omitted. See PDF]ConclusionIn this early inflammatory arthritis cohort, mental health burden was high. Age, gender, ethnicity, RDCI, prior depression diagnosis and baseline DAS28 significantly correlated with psychological distress at baseline. Supporting mental health should be a focus of clinical care for this population and it may be beneficial to use an approach that is culturally valid for non-white patients and accounts for multimorbidity.References[1]Euesden, J, et al. Psychosomatic medicine 79.6 (2017): 638.[2]Lwin, MN, et al. Rheumatology and therapy 7.3 (2020): 457-471.AcknowledgementsThe authors would like to thank the Healthcare Quality Improvement Partnership (HQIP) as the commisioner of NEIAA, British Society for Rheumatology as the audit providers, Net Solving as the audit platform developers, and the Wellcome Trust (ST12406) for funding to support L.Z..Disclosure of InterestsLucy Zhao: None declared, James Galloway Speakers bureau: Has received honoraria from AbbVie Celgene, Chugai, Gillead, Janssen, Eli Lilly, Pfizer, Roche, and UCB, Jo Ledingham: None declared, Sarah Gallagher: None declared, Neena Garnavos: None declared, Paul Amlani-Hatcher: None declared, Nicky Wilson: None declared, Lewis Carpenter Consultant of: Statistical consultancy for Pfizer, Kirsty Bannister: None declared, Sam Norton Speakers bureau: Has received honoraria from Janssen and Pfizer.

Anxiety and depression among epilepsy patients in low-risk areas for COVID-19 in the northern part of Guizhou Province, China, during the COVID-19 pandemic

BackgroundThis study was aimed to investigate whether patients with epilepsy (PWE) have higher depression and anxiety levels than the normal population in low-risk areas for coronavirus disease 2019 (COVID-19) in the northern part of Guizhou Province, China, during the COVID-19 epidemic, to evaluate their knowledge on COVID-19, and to analyze related factors for the psychological distress of PWE at this special time.MethodsThe survey was conducted online from February 28, 2020 to March 7, 2020 via a questionnaire. PWE from the outpatient clinic of epilepsy of the Affiliated Hospital of Zunyi Medical University, and healthy people matched for age and sex, participated in this study. Mental health was assessed via a generalized anxiety self-rating scale (GAD-7) and the self-rating depression scale (PHQ-9). The knowledge of COVID-19 in both groups was investigated.ResultsThere were no significant differences in the general demographics between the PWE and healthy control groups. The scores of PHQ-9 (P < 0.01) and GAD-7 (P < 0.001) were higher in the PWE group than in the healthy group. There was a significant difference in the proportions of respondents with different severities of depression and anxiety, between the two groups, which revealed significantly higher degree of depression and anxiety in PWE than in healthy people (P = 0, P = 0). Overwhelming awareness and stressful concerns for the pandemic and female patients with epilepsy were key factors that affect the level of anxiety and depression in PWE. Further, the PWE had less accurate knowledge of COVID-19 than healthy people (P < 0.001). There was no statistically significant difference between the two groups in the knowledge of virus transmission route, incubation period, susceptible population, transmission speed, clinical characteristics, and isolation measures on COVID-19 (P > 0.05). PWE knew less about some of the prevention and control measures of COVID-19 than healthy people.ConclusionsDuring the COVID-19 epidemic, excessive attention to the epidemic and the female sex are factors associated with anxiety and depression in PWE, even in low-risk areas.

Mental Health and Coping Strategies among University Staff during the COVID-19 Pandemic: A Cross–Sectional Analysis from Saudi Arabia

This study examined psychological health and coping strategies among faculty and staff at a Saudi Arabian university. A web-based self-administered survey was used to assess probable anxiety, depression, post-traumatic stress disorder (PTSD), and coping strategies by using the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Impact of Event Scale-Revised (IES-R), and Brief-COPE scale, respectively. Of 502 participants (mean age 36.04 ± 10.32 years, male: 66.3%), 24.1% (GAD-7 ≥ 10) had probable anxiety. Anxiety score was significantly higher in females (p < 0.001), those with a history of COVID-19 infection (p = 0.036), and participants with less work experience (p = 0.019). Approximately 40% of participants met the criteria of probable depression, with females (p < 0.001) and participants with less experience having more depressive symptoms. Around one-fourth (27.7%) of study participants indicated probable PTSD (score ≥ 33), with higher symptoms in females (p <0.001), less experienced staff (p < 0.001), and academic staff (p = 0.006). Correlation analysis indicated a significant positive correlation between anxiety and depression (r = 0.844, p < 0.001), anxiety and PTSD (r = 0.650, p < 0.001), and depression and PTSD (r = 0.676, p < 0.001). Active coping, religious/spiritual coping, and acceptance were common coping strategies, while substance use was the least adopted coping method among the study participants. This study indicated a high prevalence of probable psychological ailments among university staff.

IS THERE HIGHER RISK OF FATIGUE, DEPRESSION, ANXIETY AND STRESS AFTER COVID-19 IN PATIENTS WITH IMMUNE-MEDIATED RHEUMATIC DISEASES? DATA FROM THE REUMACOV BRASIL COHORT

BackgroundSome individuals may have persistent symptoms after COVID-19, a new condition known as long COVID-19. However, these complaints can be misunderstood with disease activity in patients with immune-mediated rheumatic diseases (IMRD), especially fatigue and mental distress.ObjectivesTo evaluate fatigue, depression, anxiety, and stress in IMRD patients after 6 months of COVID-19, compared with IMRD patients without COVID-19.MethodsThe ReumaCoV Brasil is a longitudinal study designed to follow-up IMRD patients for 6 months after COVID-19 diagnosis (cases) compared with IMRD patients no COVID-19 (controls). Clinical data, such as age, sex, comorbidities, as well as disease activity measurements and current treatment regarding IMRD, and COVID-19 outcomes were evaluated in all patients. The FACIT questionnaire (Functional Assessment of Chronic Illness Therapy) and the DASS 21 (Depression, Anxiety and Stress Scale - 21 Items) were applied at 6 months after COVID in both groups.ResultsA total of 606 IMRD patients were included, of whom 322 (53.1%) cases and 284 (46.9%) controls. Most patients were female (85.3%) with mean age 46.1 (13.0) years old. Specific disease activity were similar between cases and controls. There was a significant difference between FACIT scores and 3 domains of DASS-21 comparing cases and controls (Figure 1). The factors associated with FACIT were female gender, diabetes, obesity, no comorbidities, COVID manifestations (skin, joint pain, asthenia, diarrhea, and dyspnea), and chronic oral corticosteroid use. DASS-21 Depression was associated with these same factors. Female gender, COVID manifestations as skin, joint pain, asthenia, cough, dyspnea, and chronic oral corticosteroid use were associated with DASS-21-Anxiety. DASS-21 Stress was associated with female gender, asthenia, diarrhea, dyspnea, cough, chronic oral corticosteroid use, and hospitalization. Table 1 shows the variables that remained in the models after the univariate logistic analysis. A weak correlation between disease activity and FACIT was observed in rheumatoid arthritis (p=0.010;r2 = 0.035) and ankylosing spondylitis patients (p=0.010;r2 = 0.129). No other correlations were observed between the scores results and disease activity (patient's global assessment - PGA), medications or specific IMRD.ConclusionFatigue and mental changes such as depression, anxiety, and stress, occurred more frequently in IMRD patients who had COVID-19 than in those who did not have COVID-19, especially in women, regardless of disease activity score. Fatigue was more related to female gender, diabetes, obesity, and current joint pain. Mental impairment was more associated with severity of COVID-19, including respiratory and non-respiratory symptoms.Figure 1.Comparison between cases and controls of FACIT and DASS-21 depression, anxiety, and stress scoresFACIT (Functional Assessment of Chronic Illness Therapy);DASS-21 (Depression, Anxiety and Stress Scale - 21 Items):Table 1.Final model using binary Logistic Regression analysis to evaluate the preditive factors associated with FACIT and DASS-21 scoresFACIT Score ≤ 37 x score > 37§DASS-21-DEPRESSION Score ≤ 6 (normal/mild) x score > 6 (moderate/severeDASS-21-ANXIETY Score ≤ 5 (normal/mild) x score > 5 (moderate/severe)DASS-21-STRESS Score ≤ 9 (normal/mild) x score > 9 (moderate/severeVariableP-valueOR (CI 95%)VariableP-valueOR (CI 95%)VariableP-valueOR (CI 95%)VariableP-valueOR (CI 95%)Female0.151.83 (1.12-2.98)No comorbidities0.0290.66 (0.46-0.95)Joint pain0.0022.44 (1.39-4.26)Female0.0122.31 (1.20-4.46)Diabetes0.0062.35 (1.28-4.32)Joint pain**0.0012.58 (1.57-4.22)Dyspnea0.0013.61 (2.11-6.19)Dyspnea0.0013.69 (2.09-6.51)Dyspneia0.0012.00 (1.23-3.26)Dyspnea0.0012.82 (1.79-4.44)Oral CE0.0141.55 (1.09-2.21)Joint pain0.0052.20 (1.41-3.43)Oral CE0.0481.41 (1.00-1.99)§Lower scores mean worse fatigue;CE: corticosteroid;OR: odds ratio;CI: confiance intervalAcknowledgementsReumaCoV Brasil researchers, Brazilian Rheumatology Society and National Council for Scientific and Technological Deve opment.Disclosure of InterestsNone Declared.

The Relationships between University Students' Physical Activity Needs, Involvement, Flow Experience and Sustainable Well-Being in the Post-Pandemic Era

As the global sustainable development agenda advances, having a healthy lifestyle has become an important part of the common pursuit. Physical activity needs and experiences are becoming increasingly diverse, yet there is a paucity of research on issues associated with university students' physical activity needs, and their perceptions of their physical activity needs and sustainable well-being are not yet fully understood. Therefore, this study combines Self-Determination Theory with the existence, relatedness, and growth (ERG) Theory of Needs to explore the mediating effects of different variables on the relationship between university students' physical activity needs and sustainable well-being. A total of 900 Chinese university students were invited through an online survey to participate in this study, and the collected data were validated with a structural equation model. According to the results of the study, it was found that the level of involvement and flow experience in university students' sports activities have a mediating effect on the relationship between needs and sustainable well-being. Therefore, educators can enhance the level of sustainable well-being by stimulating university students' physical activity needs and improving their level of involvement and participation experience.

Identifying the Influencing Factors of Depressive Symptoms among Nurses in China by Machine Learning: A Multicentre Cross-Sectional Study

Background. Nurses' high workload can result in depressive symptoms. However, the research has underexplored the internal and external variables, such as organisational support, career identity, and burnout, which may predict depressive symptoms among Chinese nurses via machine learning (ML). Aim. To predict nurses' depressive symptoms and identify the relevant factors by machine learning (ML) algorithms. Methods. A self-administered smartphone questionnaire was delivered to nurses to evaluate their depressive symptoms;1,431 questionnaires and 28 internal and external features were collected. In the training set, the use of maximum relevance minimum redundancy ranked the features' importance. Five ML algorithms were used to establish models to identify nurses' depressive symptoms using different feature subsets, and the area under the curve (AUC) determined the optimal feature subset. Demographic characteristics were added to the optimal feature subset to establish the combined models. Each model's performance was evaluated using the test set. Results. The prevalence rate of depressive symptoms among Chinese nurses was 31.86%. The optimal feature subset comprised of sleep disturbance, chronic fatigue, physical fatigue, exhaustion, and perceived organisation support. The five models based on the optimal feature subset had good prediction performance on the test set (AUC: 0.871–0.895 and accuracy: 0.798–0.815). After adding the significant demographic characteristics, the performance of the five combined models slightly improved;the AUC and accuracy increased to 0.904 and 0.826 on the test set, respectively. The logistic regression analysis results showed the best and most stable performance while the univariate analysis results showed that external and internal personal features (AUC: 0.739–0.841) were more effective than demographic characteristics (AUC: 0.572–0.588) for predicting nurses' depressive symptoms. Conclusions. ML could effectively predict nurses' depressive symptoms. Interventions to manage physical fatigue, sleep disorders, burnout, and organisational support may prevent depressive symptoms.

Keep Calm and Go Out: Urban Nature Exposure, Mental Health, and Perceived Value during the COVID-19 Lockdown

The COVID-19 pandemic has highlighted the importance of incorporating nature-based solutions in urban design, in order to create sustainable and resilient cities. Inspired by these events, the present study aims at exploring the mental health benefits of nature exposure during the outbreak. Secondarily, we investigate changes in use patterns towards urban green spaces (UGS) and urban blue spaces (UBS) and whether extreme conditions, such as these of a lockdown, can lead to an increase in people's appreciation of urban nature. Through an online survey, we observed that the pandemic resulted in a decrease in the frequency of visitation to UGS/UBS (p < 0.001). Significant differences were found for exercise (p < 0.001) and socialization (p < 0.05) as main drivers for visiting urban nature pre- and post-lockdown. Accordingly, visitation rates for forests (p < 0.05), playgrounds (p < 0.001), and the sea (p < 0.001) differed significantly when comparing the two periods. In people's perception, UGS/UBS are important for the urban fabric (89%). Our structural equation model indicated that nature exposure had a beneficial effect on participants' mental health (p < 0.001). Pathways that explain the relationship between nature exposure and post- lockdown value were nature relatedness, motivation, and perceived importance of UGS/UBS. No mediation could be extracted for nature exposure and mental health. Our findings show the positive association between nature exposure and mental health improvement, especially in times of crisis, as well as a shift in the "value domain” towards urban nature.

Screening adolescents for psychosocial concerns

Psychosocial issues are cen-'tral to the care of adolescent patients. Pediatricians routinely discuss substance use, sexual health, and accident prevention with adolescents and are likely to see specific mental health concerns in about 20% of their patients. In light of rising suicide rates and the likely consequences of COVID-19, depression is an increasingly common concern. With limited access to mental health clinicians, individual pediatricians must manage patients' mental health needs by enhancing their own skills, collocating mental health personnel in their practices, and building trusted referral networks. Because psychosocial screening is now an expected part of pediatric primary care,1 this article focuses on screening adolescent patients, including choice of tools and follow-up of positive results.

Differences in Perceived Stress and Depression among Weight (Dis)Satisfied Midwestern College Students during COVID-19

Background: Stress and depression are common mental health concerns among college students. Factors related to weight status and stigma are associated with poor mental health outcomes. We sought to describe the prevalence of weight dissatisfaction in relation to stress and depression among college students (n = 551). Methods: A cross-sectional study was conducted via a convenient sample between December 2020 and February 2021. Mean differences in the Perceived Stress Scale-10 scores and Center for Epidemiologic Studies Depression Scale scores were examined using a one-way analysis of variance. Associations between stress, depression, and weight dissatisfaction were measured by logistic regression. Results: Weight dissatisfied (75.1%) students had significantly higher mean depression scores compared to weight satisfied. The weight dissatisfied students were 1.05 times more likely to be depressed compared to those who were weight satisfied. Significant mean differences in stress and/or depression were found for weight dissatisfied students by gender, race, parental status, marital status, residence, and U.S. citizenship. Weight dissatisfaction was higher than that reported in the literature, possibly due to the influence of social isolation during the COVID-19 pandemic. Conclusions: Strategies to reduce the prevalence of weight dissatisfaction for improved mental health should be explored, particularly efforts to reduce weight stigmatization and expand access to mental health care. [ FROM AUTHOR] Copyright of COVID is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

COVID-19 AND ADVERSE MENTAL HEALTH OUTCOMES IN PATIENTS WITH RHEUMATOID ARTHRITIS

BackgroundThe COVID-19 outbreak is known to increase the fear level of most patients with chronic diseases. Patients with rheumatoid arthritis (RA) are very vulnerable to environmental stress. During this pandemic, the psychological pressure may be further increased due to the perplexing nature of information about the risk of infection in RA patients.ObjectivesThe objective of this study was to determine the impact of the COVID-19 pandemic on the mental health of RA patients and to investigate associated factors.MethodsThis is a cross-sectional study of 190 patients with RA who met the ACR/EULAR 2010 criteria. For each patient, we collected sociodemographic, clinical, and biological data. Depression and anxiety were assessed by the Hospital Anxiety and Depression scale (HADs) and disease activity by the DAS-28 score.ResultsThe average age of our patients was 55 years with a female predominance (86.3%). The average duration of the disease was 8 years. The mean DAS 28 score was 4.1 ±1.03. The disease was deforming in 52.9% of cases. All of us patients were on disease-modifying therapy, 87.1% were on methotrexate and 12.9% were on biotherapy. Sixty patients (31.57%) had contracted SARS-CoV-2.During the pandemic, depression was present in 38.4% of patients. It was mild in 33.1% of cases, moderate in 4.1%, and severe in 1.2% with a mean HADs depression score of 4.4 ± 3.1. This score was significantly higher in patients with a history of SARS-COV-2 infection in a family member (p=0,002), comorbidities (p<0.001), joint deformities (p=0.008), and high disease activity (p<0.001). Anxiety was present in 55.6% of patients. It was mild in 32.6% of cases, moderate in 20.6%, and severe in 2.4% of cases with a mean HADs anxiety of 6.4 ± 3.9. The presence of anxiety was correlated with fear of COVID-19, higher disease activity, the presence of comorbidities, and the presence of deformities (p<0.001 for all cases). This score was also significantly higher in the illiterate (p<0.001) and unemployed patients (p=0.001).ConclusionIn our study, depression and anxiety were frequent in RA patients during the COVID-19 pandemic. These psychological disorders were more common in patients with active and disabling RA associated with comorbidities. As the pandemic continues, more patients are susceptible to experience anxiety and depression. Therefore, rheumatologists must remain vigilant to these psychological alterations and provide the necessary support.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

TESTING A NEW FATIGUE CHECKLIST IN SLE PATIENTS FOR EVERYDAY CLINICAL PRACTICE - AN INTERIM ANALYSIS

BackgroundFatigue is a difficult subject for both physicians and patients. It is barely addressed during consultations and can therefore burden patient-physician-relations. To improve communication regarding fatigue, we developed a checklist that includes suggestions for evaluating possible causes for fatigue. In this analysis, we describe our study population and report first results 3 and 6 months after using the checklist.ObjectivesThe aims of our study are to validate the use of our newly developed fatigue checklist and to demonstrate that addressing fatigue in daily clinical practice and offering possible interventions can improve fatigue.MethodsWe recruited n=110 SLE patients with fatigue from our university hospital-based lupus reference centre in Duesseldorf. Fatigue was measured using the FSS (Fatigue Severity Scale). Our checklist included signs of depression and anxiety using the PHQ-4 (Patient Health Questionnaire), BMI (body mass index), physical activity, anemia, hypothyroidism and vitamin D deficiency. For each applicable cause, we listed possible interventions for free selection by the treating physician, such as replacement therapy (vitamin D, vitamin B12, iron, folic acid, erythropoietin), physical activity programs and psychosomatic consultations that were discussed with the patients. We re-evaluated our patients after 3 (T1) and 6 months (T2).ResultsBaseline characteristics of patients are summarized in Table 1.Table 1.BMI=body mass index, TSH=thyroidea stimulating hormone, PHQ4=patient health questionnaire (cut-off >3 points), HAQ=health assessment questionnaire, IMET= Index for measuring restrictions on social participation (higher scores point towards more restrictions on social participation), FSS=fatigue severity scale (≥4 points equal severe fatigue)N = 110n (%)Mean (SD)Age (years)49.0 (12.34)Female sex99.0 (90.0)BMI (kg/m2)25.9 (5.55)Disease duration (years)19.1 (10.05)TSH (µIU/ml)1.5 (1.05)25-OH-Vitamin D (ng/ml)39.5 (15.35)Haemoglobin (g/dl)13.0 (1.64)Sports activities>4h/week6.0 (5.5)2-4h/week18.0 (16.4)1-2h/week16.0 (14.5)<1h/week28.0 (25.5)No sport42.0 (38.2)Depression (PHQ4 score)2.3 (1.63)Anxiety (PHQ4 score)2.0 (1.71)Functional status (HAQ score)0.8 (0.49)Participation (IMET score)2.8 (2.31)Fatigue (FSS score)5.3 (1.35)After 3 and 6 months, we re-evaluated 83 patients and saw a significant reduction in fatigue measured by the FSS score (T1: mean difference estimate 0.367 and p-value <0.001;T2: mean difference estimate 0.305;p-value <0.005).Figure 1.Comparing FSS-Scores from T0, T1 and T2[Figure omitted. See PDF]ConclusionThe preliminary analysis of our study shows for the first time that incorporation of a checklist procedure into the management of patients with fatigue may improve short-term outcome after 3 and 6 months of observation. The improvement of symptoms documented in our study occurred even though the suggested exercise program and psychosomatic counseling sessions were not available for use during the current observation period because of the COVID-19 pandemic. At present, the mechanisms behind the observed effect remain unclear. Our ongoing analysis will clarify whether an additional effect on fatigue will occur after all suggested interventions resulting from the use of the checklist have been executed. Finally, it will demonstrate whether the incorporation of our checklist into routine clinical practice is capable to reduce fatigue over a prolonged time period.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Connection, desperation and disillusionment: Exploring student wellbeing at a university in South Africa during the COVID-19 pandemic

University students' mental health and wellbeing has been a global public health issue of increasing concern in recent years, with a growing body of empirical evidence suggesting university students are a 'very high-risk population' for mental disorders and psychological distress. Pre-existing mental health challenges among university students have consequently been compounded by the global COVID-19 pandemic. A sample of 20 students registered in the education faculty at a large urban university in South Africa participated in a Photovoice study. The research required them to capture three photos or images of their experiences of wellbeing during the pandemic. The findings showed that students experienced mental health concerns and disillusionment with higher education. Their wellbeing was associated with a sense of connection with themselves, their peers and the campus space, and the cultivation of resilience.

Impact of the COVID-19 pandemic on the well-being of the stranded seafarers

PurposeThis study examines the impact of the COVID-19 pandemic on the well-being and mental health of the seafarers who had to overstay on ships after their contracts expired, identifies topics that affect their mental distress and recommends measures to overcome these.Design/methodology/approachFour research questions about the impacts on the seafarers before and during the COVID-19 pandemic were raised. A literature review and a questionnaire survey were conducted to find answers. Ship officers were asked to assess and fill in the questionnaires for the stranded seafarers onboard in order to collect sufficient samples rapidly for this study.FindingsDespite the guidelines provided by the shipping companies being adequate to protect the seafarers from COVID-19, their mental distress levels have been worsened under the pandemic. The crew change crisis causes anxiety and negatively impacts on their working performance;however, the repatriation expectation of the stranded seafarers is of the highest concern. Three topics were identified as having impacts on the mental health of the stranded seafarers: crew change crisis, low vaccination rate and the lack of key worker recognition. While international stakeholders are advocating for support in these issues, the shipping companies and the seafarers need to do their parts to exacerbate the mental distress, and to survive and thrive beyond the pandemic.Originality/valueThe findings of this study will help the shipping companies to navigate the challenges and the seafarers to overcome issues caused by the COVID-19 pandemic.

THE ASSOCIATION OF GRIEF WITH MENTAL HEALTH AND THE ROLE OF LONELINESS DURING THE COVID-19 PANDEMIC

In this study, we aimed to gauge the effects of the process of bereavement on mental health in the context of the COVID-19 pandemic and to explore the mediating role of loneliness on the relationship between grief and mental health alterations by surveying a representative sample of 2000 Spanish adults interviewed by phone during the pandemic (February-March 2021). There has also been an increase in death rates from other causes during the pandemic, sometimes attributed to treatment for other life-threatening diseases being postponed or health care visits being avoided to prevent infection (Stroebe & Schut, 2021). By contrast, a group of bereaved (10 % after natural death and 50% after death due to unnatural causes) experience intense grief that persists longer than what would normally be expected (Djelantik et al., 2020), characterized by an enduring and overwhelming sense of yearning or preoccupation with the deceased and significant emotional suffering that causes functional impairment in daily life. Some authors have stated that researchers studying mental health in relation to the pandemic should include grief as a potential contributory factor (Bertuccio & Runion, 2020).

Prevalence a prediktory sebevražednosti mezi studenty ošetřovatelství v Indonésii

Úvod: Studenti ošetřovatelství jsou během pandemie covidu-19 zranitelnou populací, protože zažívají vyšší úroveň stresu a problémů s duševním zdravím než studenti mimo zdravotní péči, což je vystavuje vyššímu riziku sebevražedného chování. Cíl: Prozkoumat sebevražednost mezi studenty ošetřovatelství a posoudit souvislost mezi nezávislými proměnnými a sebevražedností. Metody: Tato průřezová studie zahrnovala 670 studentů ošetřovatelství z 5 indonéských univerzit, kteří byli vybráni metodou postupného vzorkování. Vlastní validované nástroje se skládaly z 8 sekcí: sociodemografický dotazník, RSES k posouzení sebe- úcty, BHS k posouzení beznaděje, UCLA-3 k posouzení osamělosti, GSES k posouzení sebeúčinnosti, PHQ-9 k posouzení deprese, CD-RISC-10 k posouzení odolnosti a SBQ-R k posouzení sebevražednosti. K identifikaci významných prediktorů sebevražednosti byla použita binární logistická regrese. Výsledky: Prevalence sebevražednosti mezi studenty ošetřovatelství byla 22,8 %. Se sebevražedností byly významně spojeny následující faktory (p < 0,05): nízká odolnost (AOR = 2,044;95 %CI: 1,309-3,192), osamělost (AOR = 1,609;95 %CI: 1,040-2,492), beznaděj (AOR = 48,48 95 %CI: 2,356-8,398) a deprese (AOR = 9,413;95 %CI: 5,795-15,288). Závěr: Tato zjištění poskytují důkaz, že odolnost, osamělost, beznaděj a deprese jsou rizikovými faktory sebevražednosti mezi studenty ošetřovatelství. Tento výsledek lze použít jako základ pro rozvoj vhodných strategií prevence sebevražd.Alternate :Introduction: Nursing students are a vulnerable population during the COVID-19 pandemic because they experience a higher level of stress and mental health problems than the non-healthcare student population, putting them at a higher risk for suicidal behaviour. Aim: To explore suicidality among nursing students and assess the association between independent variables and suicidality. Methods: This cross-sectional study involved 670 nursing students from 5 Indonesian universities who were recruited using consecutive sampling. Self-administered validated instruments consisted of 8 sections: sociodemographic questionnaire, RSES to assess self-esteem, BHS to assess hopelessness, UCLA-3 to assess loneliness, GSES to assess self-efficacy, PHQ-9 to assess depression, CD-RISC-10 to assess resilience, and SBQ-R to assess suicidality. Binary logistic regression was employed to identify significant predictors of suicidality. Results: Suicidality prevalence among nursing students was 22.8%. The following factors were significantly associated with suicidality (p < 0.05): low resilience (AOR = 2.044;95%CI: 1.309-3.192), loneliness (AOR = 1.609;95%CI: 1.040-2.492), hopelessness (AOR = 4.448;95%CI: 2.356-8.398), and depression (AOR = 9.413;95%CI: 5.795-15.288). Conclusions: These findings provide evidence that resilience, loneliness, hopelessness, and depression are risk factors for suicidality among nursing students. This outcome can be used as a basis to develop appropriate suicide prevention strategies.

Psychosocial impact of COVID-19 2 years after outbreak on mental health of medical workers in Iran

BackgroundThe COVID-19 pandemic had a substantial influence on the mental health of healthcare workers. This study investigated general health status, the prevalence, and the severity of depressive spectrum and anxiety-related disorders. It evaluated the association between various factors and depression, anxiety, and stress among healthcare workers in the Khatam-Alanbia Hospital in Iran, after 2 years since the corona virus disease 2019 (COVID-19) pandemic.ResultsIn this online cross-sectional study, 409 participants were selected and given a questionnaire about demographic, personal, and clinical characteristics as well as stressors related to COVID-19. The participants completed the General Health Questionnaire (GHQ-28) and the 42-item Depression, Anxiety, and Stress Scale (DASS-42) to report depression, anxiety, and stress/tension levels. We found that the overall incidence of depression, anxiety and stress among health care workers during the COVID-19 pandemic was 44.25%, 50.62%, and 43.76%, respectively. Participants with severe to very severe depression, anxiety and stress accounted for 19.2%, 26.6%, and 18.2% of the sample, respectively. Being female was associated with higher odds of depression, anxiety, and stress.ConclusionsTwo years after the COVID-19 outbreak, health workers are still showing a significant level of depression, anxiety, stress, and remarkable signs of psychological distress. The situation of a health care worker is worrying. The long-term psychological implications of infectious diseases should not be ignored. Mental health services could play an essential role in rehabilitation.

Best practices for prescribing medication

Anxiety and depression were relatively common in children and adolescents before the COVID-19 pandemic1;not surprisingly, study findings suggest that these conditions' prevalence has increased.2 Typical support systems for children and adolescents-friends, family, school, and extracurricular activities-look much different during the current pandemic. There are many misconceptions about psychotropic medications and stigmas because of mental health problems in general. National organizations such as the American Academy of Pediatrics and the American Association of Child and Adolescent Psychiatry have developed resources to help pediatricians feel more comfortable with offering mental health care, and groups such as The REACH Institute offer postgraduate training programs that provide education and ongoing support.

Mental Health Disparities Among Cisgender, Transgender, and Gender Nonconforming College Students in the United States

Many researchers attribute factors of identity, acculturation, sexual orientation, and substance use and other maladaptive behaviors as potential risk factors associated with increased mental illnesses reported by college students (Castillo & Schwartz, 2013;Wyatt & Oswalt, 2013). [...]the COVID-19 pandemic has further exacerbated mental health problems in college students (Lopez Steinmetz et al., 2021;Son et al., 2020), with 71% experiencing more stress, anxiety, problems with concentration, and worry about a loved one's health as well as their own (Son et al., 2020). Approximately 75% of first-year college students with any mental illness do not seek help (Bruffaerts et al, 2019). [...]there is a growing need to address possible factors contributing to reduced help seeking and to identify vulnerable groups in college populations (Castillo & Schwartz, 2013). Men's decreased treatment utilization may be in part due to shame, stigma, and parental and peer norms toward seeking out mental health services (Seehuus et al, 2021). Given the impact that gender-related stressors play in the rise of mental illness in college students, this study aims to bridge the gap in mental health clinicians' and researchers' understanding of how diverse gender identities influence mental health-related outcomes and mental illness. [...]this study addresses two research questions: (1) Do gender differences (i.e., between cisgender men, cisgender women, and TGNC individuals) exist among college students in the prevalence of mental illness, utilization of psychological services, and mental health-related outcomes (i.e., psychological distress, stress, resilience, overall health, and loneliness)? (2) Do mental health-related variables differentially predict mental illness diagnoses among college students? METHOD Participants and Data Collection The ACHA (2020) National College Health Assessment-Ill Fall 2020 (NCHA-III) is a survey that gathers information regarding students' health.

Relationship between social support and employment anxiety among art education students: Self-efficacy as a mediator

We investigated the effect of social support on employment anxiety among 217 art education college students in China and assessed the mediating role of self-efficacy in this relationship. The results showed that social support was significantly negatively correlated with employment anxiety. In addition, self-efficacy mediated the relationship between social support and employment anxiety. Our findings enhance understanding of the relationships between social support, employment anxiety, and self-efficacy among students in the context of higher education in China. The results also provide practical insights for educators to prevent students' employment anxiety. Directions for future research are suggested.

Medical Students' Empathy During the COVID-19 Pandemic: A crosssectional study

Several authors have underlined the negative consequences of the COVID-19 pandemic on mental health in several populations, including medical students, such as increases in anxiety, depression and burnout symptoms. Furthermore, previous studies showed that anxiety and depressive symptoms are positively associated with affective empathy and negatively associated with cognitive empathy. Given the adverse pandemic effects highlighted by several authors, the present study sought to determine whether medical students' empathy has been potentially impacted, with higher affective empathy and lower cognitive empathy score in the pandemic cohort compared to pre-pandemic cohorts. Medical students (n = 395) were recruited during the COVID-19 pandemic and completed the Interpersonal Reactivity Index (IRI) and the Basic Empathy Scale (BES). This cohort was then compared with two pre-pandemic cohorts (one used the BES [n = 1168], and the other used the IRI [n = 342]). Similar results were found on both scales: the pandemic cohort displayed significantly higher scores in affective empathy and personal distress (affective empathy domain) and, surprisingly, significant higher scores in cognitive empathy, fantasy, and perspective-taking (cognitive empathy domains). As stressed by previous studies, we posited that the higher scores in affective empathy, personal distress, and fantasy might indicate emotional difficulties. The paper concludes with the identification of empathy components that should be promoted in the curriculum of medical students.