Psychometric Properties of a Spanish Version of the Fear of COVID-19 Scale in General Population of Lima, Peru.

The current pandemic of the novel coronavirus COVID-19 has increased the anxiety and fear experienced by many. The main objective of this study was to analyze the psychometric properties of the Spanish-translated version of the Fear of COVID-19 Scale (FCV-19S) using a sample of population in Peru. This is a cross-sectional instrumental study. Data were collected by a convenience sampling method, resulting in a total of 832 participants, and the collection took place over 1 week, April 17-23, 2020. The original version of the FCV-19S was translated from English into Spanish. The results support a bifactor model consisting of one general factor and two specific factors-one of emotional fear reactions and another of somatic expressions of fear of COVID-19 (CFI = 0.988, RMSEA = 0.075). Invariance between healthcare workers and age groups was reached (ΔCFI < 0.01), but the invariance between men and women was not met (ΔCFI = 0.02). Convergent validity was found with depressive, anxious, and posttraumatic stress symptoms. The general factor of the fear of COVID-19 and two specific factors had an optimal level of internal consistency (ω > 0.89 and α > 0.83). The study found the Spanish-translated version of the FCV-19S has good psychometric properties and presents evidence of validity and reliability.

Mental Health in COVID-2019 Survivors from a General Hospital in Peru: Sociodemographic, Clinical, and Inflammatory Variable Associations.

The current coronavirus disease-2019 (COVID-19) pandemic constitutes a significant public health problem worldwide, as well as mental health problems. This study aimed to evaluate the mental health of COVID-19 survivors, considering their sociodemographic, clinical, and immune variables. A cross-sectional and correlational study was conducted on 318 COVID-19 survivors from one hospital in Peru. Through telephone interviews, evaluation of the presence of depressive symptoms using the Patient Health Questionnaire-9, anxiety symptoms through the Generalized Anxiety Disorder-7, somatic symptoms through Patient Health Questionnaire-15, and posttraumatic stress disorder (PTSD) symptoms through Impact of Event Scale-Revised was carried out. Poisson regression analyses were performed with their adjusted variances to calculate the prevalence ratio (PR) with their 95% confidence interval. All regression models were adjusted (PRa) for follow-up time. A significant proportion of patients have depressive (30.9%), anxious (31.1%), somatic (35.2%), and PTSD (29.5%) symptoms. The variables associated with a higher frequency of clinically relevant mental symptoms were female sex, self-perception of greater COVID-19 severity, presence of persistent COVID-19 symptoms, loss of a family member due to COVID-19, and prior psychiatric diagnosis or treatment. In addition, the neutrophil-to-lymphocyte ratio was significantly higher in patients with clinically relevant symptoms of depression. COVID-19 survivors showed a high prevalence of negative mental symptoms. Our findings help to identify patients who are vulnerable and require psychiatric care.

One-year follow-up of depression, anxiety, and quality of life of Peruvian patients who survived COVID-19.

PURPOSE: To assess health-related quality of life (HRQoL) and its associated factors in patients who survived COVID-19 and to assess a prospective evaluation of the prevalence and severity of their depression and anxiety symptoms. METHODS: We followed up a sample of hospitalized patients who survived COVID-19 at 3 and 12 months after discharge. We assessed HRQoL (Euroqol-5D-5L) through telephone interviews. Any problem in any dimension of Euroqol-5D-5L was considered as low HRQoL. The depression and anxiety symptoms were measured using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 tools, respectively. We estimated the adjusted prevalence ratios (aPR) to low HRQoL using Poisson regression and the changes on their depression and anxiety symptoms during the follow-up. RESULTS: We included 119 patients with a mean follow-up time of 363.6 days. 74% of the participants had low HRQoL at one year after hospital discharge and were associated with being ≥ 41 years old (aPR: 1.95), having a previous history of psychiatric diagnoses before COVID-19 infection (aPR: 1.47), having any COVID-19 symptom during the follow-up at one year (aPR: 1.84), and having a family member who had died from COVID-19 during the first wave (aPR: 1.24). In addition, the clinically relevant depression symptoms were frequent, and they increased from 3 (14.3%) to 12 months (18.5%). CONCLUSION: One year after COVID-19 hospitalization discharge, patients had low HRQoL, and their depression symptoms increased. These findings acknowledge the need to provide services that adequately address mental health sequels and HRQoL to reduce the burden of the COVID-19.

Factors associated with suicidal ideation among medical students during the initial phase of the COVID-19 pandemic in Peru: A multicenter study.

We aimed to describe the prevalence and factors associated with suicidal ideation in a sample of 1238 medical students from different medical schools in Peru based on question 9 of the Patient Health Questionnaire (PHQ-9). Our results revealed that 17.9% of the participants had suicidal ideation. Furthermore, using logistic regression, we found that not practicing any religion, the presence of clinically significant depression, and the presence of clinically significant anxiety were statistically related to the presence of suicidal ideation. Our results indicate that suicidal ideation was highly prevalent in the sample of medical students studied.

An explanatory model of depressive symptoms from anxiety, post-traumatic stress, somatic symptoms, and symptom perception: the potential role of inflammatory markers in hospitalized COVID-19 patients.

BACKGROUND: The context of the COVID-19 pandemic has harmed the mental health of the population, increasing the incidence of mental health problems such as depression, especially in those who have had COVID-19. Our study puts forward an explanatory model of depressive symptoms based on subjective psychological factors in those hospitalized for COVID-19 with and without biological markers (i.e., inflammatory markers). Therefore, we aim to evaluate the hypotheses proposed in the model to predict the presence of depressive symptoms. METHOD: We conducted a cross-sectional study, using a simple random sampling. Data from 277 hospitalized patients with COVID-19 in Lima-Peru, were collected to assess mental health variables (i.e., depressive, anxiety, post-traumatic stress, and somatic symptoms), self-perception of COVID-19 related symptoms, and neutrophil/lymphocyte ratio (NLR) such as inflammatory marker. We performed a structural equation modeling analysis to evaluate a predictive model of depressive symptoms. RESULTS: The results showed a prevalence of depressive symptoms (11.2%), anxiety symptoms (7.9%), somatic symptoms (2.2%), and symptoms of post-traumatic stress (6.1%) in the overall sample. No association was found between the prevalence of these mental health problems among individuals with and without severe inflammatory response. The mental health indicators with the highest prevalence were sleep problems (48%), low energy (47.7%), nervousness (48.77%), worry (47.7%), irritability (43.7%) and back pain (52%) in the overall sample. The model proposed to explain depressive symptoms was able to explain more than 83.7% of the variance and presented good goodness-of-fit indices. Also, a different performance between the proposed model was found between those with and without severe inflammatory response. This difference was mainly found in the relationship between anxiety and post-traumatic stress symptoms, and between the perception of COVID-19 related symptoms and somatic symptoms. CONCLUSIONS: Results demonstrated that our model of mental health variables may explain depressive symptoms in hospitalized patients of COVID-19 from a third-level hospital in Peru. In the model, perception of symptoms influences somatic symptoms, which impact both anxiety symptoms and symptoms of post-traumatic stress. Thus, anxiety symptoms could directly influence depressive symptoms or through symptoms of post-traumatic stress. Our findings could be useful to decision-makers for the prevention of depression, used to inform the creation of screening tools (i.e., perception of symptoms, somatic and anxiety symptoms) to identify vulnerable patients to depression.

Factors Associated with Mental Health Outcomes in Hospital Workers during the COVID-19 Pandemic: A Mixed-Methods Study.

BACKGROUND: We investigated some of the factors associated with depression, perceived stress, and anxiety in clinical and nonclinical healthcare workers of two hospitals. METHODS: A mixed-methods approach was used. The sample included clinical (physicians, nurses, and others) and nonclinical (security and cleaning staff) healthcare workers of two tertiary hospitals in Peru. Participants completed an online self-survey. In the qualitative analysis, data were subjected to thematic analysis. RESULTS: We analyzed data from 613 participants, of which 8.6%, 9.0%, and 78.2% had moderate-to-severe anxiety, depression, and perceived stress, respectively. Having a previous mental health problem, being concerned about losing one's job, having at least two COVID-19 symptoms in the preceding two weeks, and being afraid of infecting family members increased the prevalence of experiencing moderate-to-severe depression and anxiety. The qualitative analysis allowed us to identify five recurring factors that caused a negative impact on workers' lives during the pandemic: emotional distress linked to hospital experiences of suffering and death, modification of routines, fear of COVID-19, exacerbation of mental disorders, and physical problems associated with emotional distress. CONCLUSIONS: Clinical and nonclinical healthcare workers in Peru have experienced depression, anxiety, and stress during the COVID-19 pandemic. Future research and interventions are necessary to improve psychological support for hospital workers.

Development of a Framework for the Implementation of Synchronous Digital Mental Health: Realist Synthesis of Systematic Reviews.

BACKGROUND: The use of technologies has served to reduce gaps in access to treatment, and digital health interventions show promise in the care of mental health problems. However, to understand what and how these interventions work, it is imperative to document the aspects related to their challenging implementation. OBJECTIVE: The aim of this study was to determine what evidence is available for synchronous digital mental health implementation and to develop a framework, informed by a realist review, to explain what makes digital mental health interventions work for people with mental health problems. METHODS: The SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) framework was used to develop the following review question: What makes digital mental health interventions with a synchronous component work on people with mental health problems, including depression, anxiety, or stress, based on implementation, economic, quantitative, qualitative, and mixed methods studies? The MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases were searched from January 1, 2015, to September 2020 with no language restriction. A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) was used to assess the risk of bias and Confidence in Evidence from Reviews of Qualitative Research (CERQual) was used to assess the confidence in cumulative evidence. Realist synthesis analysis allowed for developing a framework on the implementation of synchronous digital mental health using a grounded-theory approach with an emergent approach. RESULTS: A total of 21 systematic reviews were included in the study. Among these, 90% (n=19) presented a critically low confidence level as assessed with AMSTAR-2. The realist synthesis allowed for the development of three hypotheses to identify the context and mechanisms in which these interventions achieve these outcomes: (1) these interventions reach populations otherwise unable to have access because they do not require the physical presence of the therapist nor the patient, thereby tackling geographic barriers posed by in-person therapy; (2) these interventions reach populations otherwise unable to have access because they can be successfully delivered by nonspecialists, which makes them more cost-effective to implement in health services; and (3) these interventions are acceptable and show good results in satisfaction because they require less need of disclosure and provide more privacy, comfortability, and participation, enabling the establishment of rapport with the therapist. CONCLUSIONS: We developed a framework with three hypotheses that explain what makes digital mental health interventions with a synchronous component work on people with mental health problems. Each hypothesis represents essential outcomes in the implementation process. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020203811; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020203811. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.12688/f1000research.27150.2.

Depression, post-traumatic stress, anxiety, and fear of COVID-19 in the general population and health-care workers: prevalence, relationship, and explicative model in Peru.

BACKGROUND: This study has two aims. First, determine the fit of the fear model to COVID-19, anxiety, and post-traumatic stress in the general population and health-care workers. Second, determine which model best explains the relationship between depression and the triad of fear, anxiety, and post-traumatic stress in both groups. METHOD: A cross-sectional study was conducted using self-reported questionnaires for anxiety, fear of COVID-19, depression, and post-traumatic stress. Information was collected from adults living in Lima, the capital and the most populous city in Peru. The explanatory models were evaluated using a structural equation model. RESULTS: A total of 830 participants were included, including general population (n = 640) and health-care workers (n = 190). A high overall prevalence of depressive symptoms (16%), anxiety (11.7%), and post-traumatic stress (14.9%) were identified. A higher prevalence of depressive, anxious, or stress symptoms was identified in the general population (28.6%) compared to health-care workers (17.9%). The triad model of fear of COVID-19, anxiety, and stress presented adequate goodness-of-fit indices for both groups. A model was identified that manages to explain depressive symptoms in more than 70% of the general population and health-care workers, based on the variables of the triad (CFI = 0.94; TLI = 0.94; RMSEA = 0.06; SRMR = 0.06). In the general population post-traumatic stress mediated the relationship between anxiety and depression (ß = 0.12; 95%CI = 0.06 to 0.18) which was significant, but the indirect effect of post-traumatic stress was not significant in health care workers (ß = 0.03; 95%CI = - 0.11 to 0.19). LIMITATIONS: The prevalence estimates relied on self-reported information. Other variables of interest, such as intolerance to uncertainty or income level, could not be evaluated. CONCLUSIONS: Our study proposes and tests one model that explains more than 70% of depressive symptoms. This explanatory model can be used in health contexts and populations to determine how emotional factors can affect depressive symptoms.

Factors Associated with Distress Among Medical Staff During the Initial Phase of the COVID-19 Pandemic in Peru.

The current COVID-19 pandemic affects the mental health of medical staff. Our objective was to evaluate the factors that are associated with the distress of physicians in two general hospitals in Lima, Peru. A cross-sectional correlational survey study was carried out. Physicians completed The Impact of Event Scale-Revised-22 (IES-R), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). A total of 310 physicians completed the survey, 36.5% of whom reported distress symptoms. Higher levels of distress were reached by women, by those with a prior psychiatric diagnosis, by those who considered that the hospital does not provide adequate personal protective equipment, and by those who perceived stigma from family members. Multiple regression analysis showed that there is a correlation between distress symptoms and anxiety symptoms, (B = 0.509), depressive symptoms (B = 0.305), the total hours/week worked in the Emergency Department (B=-0.142), and the stigma perception (B = 0.096). Early intervention programs must be developed to support medical staff members exposed to severe distress situations such as the current viral pandemic.

Factors associated with mental health in Peruvian medical students during the COVID-19 pandemic: a multicentre quantitative study.

OBJECTIVE: To assess the mental health status and associated factors of Peruvian medical students during the COVID-19 pandemic. METHODS: Descriptive, multicentre, correlational study that used the "Patient Health Questionnaire-9 (PHQ-9)", the "Generalized Anxiety Disorder-7 (GAD-7)" and the "Impact of Event Scale-Revised (IES-R)" questionnaires to evaluate mental health problems. RESULTS: A total of 1,238 students from 8 Peruvian medical schools participated in the study. Of these, 68.5% were women, and the mean age was 21.4 years. Depressive symptoms were found in 74% of the participants, anxiety symptoms in 57% and distress symptoms in 65%. The variables associated with the development of symptoms of moderate-severe depression, anxiety and distress were: not having family economic stability, being in the first years of medical training, being female, and fearing that their medical training would be delayed and impaired. CONCLUSIONS: In a sample of medical students surveyed during the COVID-19 pandemic, mental health problems were common. The factors associated with mental health reported in this study could be useful in identifying vulnerable medical students who require timely psychosocial support and/or psychiatric care.

Rheumatology and psychiatry: allies in times of COVID-19.

The COVID-19 (coronavirus disease 2019) pandemic has had a significant global impact. Physical, emotional, and psychological health, particularly its specific mental health area, has been affected. Patients with rheumatic diseases are more likely to be concerned about COVID-19 than the public in general. Depression and anxiety are the symptoms most commonly reported by these patients. Therefore, now more than ever before, rheumatologists and psychiatrists should work together to improve the care of rheumatic disease patients, identifying the symptoms that uniquely reflect mental health problems, so the patients' quality of life can be substantially improved.

Psychometric properties of the Spanish version of the fear of COVID-19 scale in Peruvian medical students.

The Coronavirus Disease 2019 (COVID-19) pandemic continues to produce significant emotional consequences at the individual, community, societal, and global levels. This study describes the psychometric properties of the Spanish version of the Fear of COVID-19 Scale (FCV-19S) in Peruvian medical students. Data were collected by a convenience sampling method, resulting in a total of 1238 medical students from different medical schools in Peru. Our analyses suggest that a two-factor model explains the underlying two-dimensional structure of the FCV-19S. The results indicated that the Spanish version of the FCV-19S scale was found to have adequate psychometric properties.

Depresión psicótica y síndrome de Cotard en una paciente con enfermedad de Graves-Basedow: reporte de un caso

Resumen La presentación de trastornos afectivos y psicosis en el contexto de hipertiroidismo es muy rara. Exponemos el caso de una paciente de 65años quien presentó un miedo intenso a la enfermedad por el nuevo coronavirus (COVID-19), ánimo deprimido, ansioso, delirios nihilistas, de culpa, somáticos y apatía. Se le diagnosticó de un trastorno depresivo mayor con psicosis el cual desarrolló un síndrome de Cotard además de tener una enfermedad de Graves-Basedow. El tratamiento consistió en venlafaxina 150mg/día, quetiapina 50mg/día, tiamazol 30mg/día y propranolol 60mg/día. Luego de 2 semanas de tratamiento la paciente mejoró y fue dada de alta. El artículo se complementa con una revisión de la literatura en torno a la asociación entre síntomas mentales, síndrome de Cotard e hipertiroidismo. The presentation of affective disorders and psychosis in the context of hyperthyroidism is very rare. We present the case of a 65-year-old patient who presented an intense fear of the new coronavirus disease (COVID-19), depressed mood, anxious, nihilistic delusions, guilt, somatic and apathy. He was diagnosed with a major depressive disorder with psychosis which developed Cotard's syndrome in addition to having Graves-Basedow disease. Treatment consisted of venlafaxine 150mg/day, quetiapine 50mg/day, thiamazole 30mg/day, and propranolol 60mg/day. After two weeks of treatment, the patient improved and was discharged. The article is complemented with a literature review on the association between mental symptoms, Cotard's syndrome and hyperthyroidism.

Consideraciones sobre la salud mental en la pandemia de COVID-19.

Since December 2019, 414,179 cases of people with coronavirus disease 2019 (COVID-19) have been reported. As a result of the rapid increase in confirmed cases and deaths, population and health personnel, have experienced psychological problems, such as anxiety, depression, and stress. Although scientific information on COVID-19 is constantly increasing, it mainly focuses on genetic, epidemiological aspects, and public health measures, leaving aside possible effects on mental health. In order to summarize the current evidence, we present a narrative review of the effects of the COVID-19 pandemic on mental health. So far, the presence of anxiety, depression, and stress has been reported mostly in general population. Nonetheless, mental health issues have also been reported in health care workers, especially among female professionals, nurses, and those who work directly with suspected or confirmed cases of COVID-19. In efforts to reduce the spread of the disease, attention should be paid to the diagnosis and treatment of mental health issues. We believe that addressing them adequately will empower Peru to contain and eradicate COVID-19.

Desde diciembre de 2019 se han reportado 414 179 casos de personas con la enfermedad por coronavirus (COVID-19). Como resultado del rápido incremento de casos confirmados y muertes, la población general y el personal de salud experimentaron problemas psicológicos, como ansiedad, depresión y estrés. Si bien la información científica sobre la COVID-19 se incrementa constantemente, esta se centra en los aspectos genéticos y epidemiológicos del virus y en las medidas de salud pública, dejando de lado los posibles efectos en la salud mental. Con la finalidad de resumir la evidencia actual, presentamos una revisión narrativa de los efectos de la pandemia de COVID-19 sobre la salud mental. Hasta el momento, se ha informado la presencia de ansiedad, depresión y reacción al estrés en la población general. Además, en el personal de salud también se han encontrado problemas de salud mental, especialmente en las profesionales mujeres, el personal de enfermeria y aquellos que trabajan directamente con casos sospechosos o confirmados de COVID-19. En los esfuerzos realizados para disminuir la propagación de la enfermedad, se debe prestar atención al diagnóstico y tratamiento de los problemas de salud mental. Creemos que abordarlos adecuadamente empoderará al Perú en la contención y erradicación de la COVID-19.

Consideraciones sobre la salud mental en la pandemia de COVID-19

RESUMEN Desde diciembre de 2019 se han reportado 414 179 casos de personas con la enfermedad por coronavirus (COVID-19). Como resultado del rápido incremento de casos confirmados y muertes, la población general y el personal de salud experimentaron problemas psicológicos, como ansiedad, depresión y estrés. Si bien la información científica sobre la COVID-19 se incrementa constantemente, esta se centra en los aspectos genéticos y epidemiológicos del virus y en las medidas de salud pública, dejando de lado los posibles efectos en la salud mental. Con la finalidad de resumir la evidencia actual, presentamos una revisión narrativa de los efectos de la pandemia de COVID-19 sobre la salud mental. Hasta el momento, se ha informado la presencia de ansiedad, depresión y reacción al estrés en la población general. Además, en el personal de salud también se han encontrado problemas de salud mental, especialmente en las profesionales mujeres, el personal de enfermeria y aquellos que trabajan directamente con casos sospechosos o confirmados de COVID-19. En los esfuerzos realizados para disminuir la propagación de la enfermedad, se debe prestar atención al diagnóstico y tratamiento de los problemas de salud mental. Creemos que abordarlos adecuadamente empoderará al Perú en la contención y erradicación de la COVID-19. ABSTRACT Since December 2019, 414,179 cases of people with coronavirus disease 2019 (COVID-19) have been reported. As a result of the rapid increase in confirmed cases and deaths, population and health personnel, have experienced psychological problems, such as anxiety, depression, and stress. Although scientific information on COVID-19 is constantly increasing, it mainly focuses on genetic, epidemiological aspects, and public health measures, leaving aside possible effects on mental health. In order to summarize the current evidence, we present a narrative review of the effects of the COVID-19 pandemic on mental health. So far, the presence of anxiety, depression, and stress has been reported mostly in general population. Nonetheless, mental health issues have also been reported in health care workers, especially among female professionals, nurses, and those who work directly with suspected or confirmed cases of COVID-19. In efforts to reduce the spread of the disease, attention should be paid to the diagnosis and treatment of mental health issues. We believe that addressing them adequately will empower Peru to contain and eradicate COVID-19.

Psychometric Properties of a Spanish Version of the Fear of COVID-19 Scale in General Population of Lima, Peru

The current pandemic of the novel coronavirus COVID-19 has increased the anxiety and fear experienced by many. The main objective of this study was to analyze the psychometric properties of the Spanish-translated version of the Fear of COVID-19 Scale (FCV-19S) using a sample of population in Peru. This is a cross-sectional instrumental study. Data were collected by a convenience sampling method, resulting in a total of 832 participants, and the collection took place over 1 week, April 17–23, 2020. The original version of the FCV-19S was translated from English into Spanish. The results support a bifactor model consisting of one general factor and two specific factors—one of emotional fear reactions and another of somatic expressions of fear of COVID-19 (CFI = 0.988, RMSEA = 0.075). Invariance between healthcare workers and age groups was reached (ΔCFI < 0.01), but the invariance between men and women was not met (ΔCFI = 0.02). Convergent validity was found with depressive, anxious, and posttraumatic stress symptoms. The general factor of the fear of COVID-19 and two specific factors had an optimal level of internal consistency (ω > 0.89 and α > 0.83). The study found the Spanish-translated version of the FCV-19S has good psychometric properties and presents evidence of validity and reliability.