Health and wellbeing of staff working at higher education institutions globally during the post-COVID-19 pandemic period: Evidence from a cross-sectional study (preprint)

Background The ongoing global crisis of Higher Education (HE) institutions during the post-COVID-19 pandemic period has increased the likelihood of enduring psychological stressors for staff. This study aimed to identify factors associated with job insecurity, burnout, psychological distress and coping amongst staff working at HE institutions globally.Methods An anonymous cross-sectional study was conducted in 2023 with staff at HE institutions across 16 countries. Job insecurity was measured using the Job Insecurity Scale (JIS), burnout using the Perceived Burnout measure question, psychological distress using the Kessler Psychological Distress Scale (K10), and coping using the Brief Resilient Coping Scale. Multivariable logistic regression with a stepwise variable selection method was used to identify associations.Results A total of 2,353 staff participated; the mean age (± SD) was 43(± 10) years and 61% were females. Most staff (85%) did not feel job insecurity, one-third (29%) perceived burnout in their jobs, more than two-thirds (73%) experienced moderate to very high levels of psychological distress, and more than half (58%) exhibited medium to high resilient coping. Perceived job insecurity was associated with staff working in research [Adjusted Odds Ratio 1.37 (95% Confidence Intervals 1.04–1.81)] and part-time, having an academic appointment [2.45 (1.78–3.27)], perceived burnout and moderate to very high level of psychological distress. Perceived burnout was associated with being female [1.35 (1.12–1.63)], having a leadership appointment [1.30 (1.05–1.61)], perceived job insecurity, and moderate to very high levels of psychological distress. Staff with administrative roles [1.26 (1.04–1.52)], mental health issues [2.73 (1.79–4.15)], perceived job insecurity, and perceived burnout were associated with moderate to very high levels of psychological distress. Staff who perceived their mental health as good to excellent [3.36 (2.69–4.19)] were more likely to have medium to high resilient coping.Conclusions Factors identified in this study should be considered in reviewing and updating current support strategies for staff at HE institutions across all countries to reduce stress and burnout and improve wellbeing.

Tobacco retailer density and smoking behaviour: how are exposure and outcome measures classified? A Systematic Review (preprint)

Introduction: To date only a limited number of reviews have focused on how exposure and outcome measures are defined in the existing literature on associations between tobacco retailer density (‘density’) and smoking behaviour (‘smoking’). Therefore this systematic review classified and summarised how both density and smoking variables are operationalised in the existing literature, and provides several methodological recommendations for future density and smoking research. Methods: Two literature searches between March and April 2018 and April 2022 were conducted across 10 databases. Inclusion and exclusion criteria were developed and keyword database searches were undertaken. Studies were imported into Covidence. Cross-sectional studies that met the inclusion criteria were extracted and a quality assessment was undertaken. Studies were categorised according to the density measure used, and smoking was re-categorised using a modified classification tool. Results: Large heterogeneity was found in the operationalisation of both measures in the 47 studies included for analysis. Density was most commonly measured directly from geocoded locations using circular buffers at various distances (n = 14). After smoking was reclassified using a smoking classification tool, past-month smoking was the most common smoking type reported (n = 26). Conclusions: It is recommended that density is measured through length-distance and travel time using the street network and weighted (e.g. by the size of an area), or by using Kernel Density Estimates as these methods provide a more accurate measure of geographical to tobacco and e-cigarette retailer density. The consistent application of a smoking measures classification tool, such as the one developed for this systematic review, would enable better comparisons between studies. Future research should measure exposure and outcome measures in a way that makes them comparable with other studies. Implications This systematic review provides a strong case for improving data collection and analysis methodologies in studies assessing tobacco retailer density and smoking behaviour to ensure that both exposure and outcome measures are clearly defined and captured. As large heterogeneity was found in the operationalisation of both density and smoking behaviour measures in the studies included for analysis, there is a need for future studies to capture, measure and classify exposure measures accurately, and to define outcome measures in a manner that makes them comparable with other studies.

Psychological Distress among Bangladeshi Dental Students during the COVID-19 Pandemic (preprint)

Background: Psychological sufferings are observed among dental students during their academic years, which had been intensified during the COVID-19 pandemic. Objectives: This study assessed the levels and identified factors associated with psychological distress, fear and coping experienced by dental undergraduate students in Bangladesh. Methods: A cross sectional online survey was conducted during October-November, 2021. The Kessler Psychological Distress Scale (K-10), Fear of COVID-19 Scale (FCV-19S) and Brief Resilient Coping Scale (BRCS) were used in order to assess psychological distress, fear and coping strategies respectively. Results: A total of 327 students participated; the majority (72%) were 19-23 years old and females (75%). One in five participants were infected with COVID-19 and 15% reported contact with COVID-19 cases. Negative financial impact (AOR 3.72, 95%CIs 1.28-10.8), recent or past COVID-19 infection, contact with COVID-19 cases were associated with higher levels of psychological distress; but being a 3rd year student (0.14, 0.04-0.55) and being satisfied about current social life (0.11, 0.03-0.33) were associated with lower levels of psychological distress. Being a 3rd year (0.17, 0.08-0.39) and a 4th year student (0.29, 0.12-0.71) were associated with lower levels of fear. Health care service use and feeling positive about life were associated with medium to high resilience coping. Conclusions: This study iden-tified dental students in Bangladesh who were at higher risk of psychological distress, fear and coping during the ongoing pandemic. Development of mental health support system within dental institution should be considered in addition to the academic and clinical teaching.

Psychological Distress, Fear, and Coping Strategies among Citizens and Residents in Saudi Arabia During the COVID-19 Pandemic (preprint)

Background: COVID-19 caused the worst international public health crisis, accompanied by major global economic downturns, mass-scale job losses, which impacted on the psychosocial wellbeing of the worldwide population. This study examined factors associated with psychosocial distress, fear of COVID-19 and coping strategies amongst the general population in Saudi Arabia. Methods: : A cross-sectional study was conducted using an anonymous online questionnaire. Multivariate logistic regressions were used; Adjusted Odds Ratio (AOR) with 95% Confidence Intervals (CIs) was reported. Results: : Among 803 participants, 70 %(n=556), were females and the median age was 27 years; 35% (n=278), were frontline or essential service workers; 24% (n=195), reported comorbid conditions including mental health illness. Factors associated with moderate to high levels of psychological distress were: youth (18 - 29 years) (AOR 3.35, 95% CIs 2.06 - 5.44), females (2.59, 1.60 - 4.19), non-Saudi nationals (2.17, 1.11 - 4.26), change in employment (2.9, 1.73 - 4.87), negative financial impact (2.14, 1.29-3.56), having comorbidities (2.67, 1.47 - 4.87), and current smoking (2.87, 1.55 - 5.33). Being ex-smokers (3.72, 1.14 - 12.14) and change in employment (3.42, 1.91 - 6.11) were associated with higher levels of fear of COVID-19. People whose financial situation was impacted and who had contact with known/suspected cases (1.63, 1.12-2.38) had low medium to high resilient coping. Conclusions: : People in Saudi Arabia were at a higher risk of psychosocial distress and fear along with low resilience during the COVID-19 pandemic, warranting urgent attention from healthcare providers and policymakers, to provide specific mental health support strategies for their wellbeing currently and to avoid a post-pandemic mental health crisis.

COVID-19: Factors Associated with Psychol­­­ogical Distress, Fear, and Coping Strategies among Community Members Across 17 Countries (preprint)

Background: The current pandemic of COVID-19 impacted the psychological wellbeing of populations globally. Objectives: We aimed to examine the extent and identify associated factors of psychological distress, fear of COVID-19, and coping.Methods: We conducted a cross-sectional study across 17 countries during Jun-2020 to Jan-2021. Levels of psychological distress (Kessler Psychological Distress Scale), fear of COVID-19 (Fear of COVID-19 Scale), and coping (Brief Resilient Coping Scale) were assessed. Results: A total of 8,559 people participated; mean age (±SD) was 33(±13) years, 64% were females and 40% self-identified as frontline workers. More than two-thirds (69%) experienced moderate-to-very high levels of psychological distress, which was 46% in Thailand and 91% in Egypt. A quarter (24%) had high levels of fear of COVID-19, which was as low as 9% in Libya and as high as 38% in Bangladesh. More than half (57%) exhibited medium to high resilient coping; the lowest prevalence (3%) was reported in Australia and the highest (72%) in Syria. Being female (AOR 1.31 [95% CIs 1.09-1.57]), perceived distress due to change of employment status (1.56 [1.29-1.90]), comorbidity with mental health conditions (3.02 [1.20-7.60]) were associated with higher levels of psychological distress and fear. Doctors had higher psychological distress (1.43 [1.04-1.97]), but low levels of fear of COVID-19 (0.55 [0.41-0.76]); nurses had medium to high resilient coping (1.30 [1.03-1.65]). Conclusions: The extent of psychological distress, fear of COVID and coping varied by country; however, some groups were more vulnerable than others. There is an urgent need to prioritise health and well-being of these people through well-designed intervention that may need to be tailored to meet country specific requirements.

COVID-19: Psychol­­­ogical Distress, Fear, and Coping Strategies Among Community Members Across 17 Countries (preprint)

Background: The current pandemic of COVID-19 impacted the psychological wellbeing of populations globally. Our study aimed to examine the extent and associated factors to psychological distress, the level of fear of COVID-19, and coping strategies amongst a diverse range of community people in multi-country settings.Methods: A cross-sectional study across 17 countries was conducted. Psychological distress (based on the Kessler Psychological Distress Scale) was categorized into low and moderate to very high, fear of COVID-19 (based on the Fear of COVID-19 Scale) was categorized into low and high, and coping (based on the Brief Resilient Coping Scale) was categorized into low and medium to high. For country-wise comparisons, we selected the reference country based on the lowest prevalence of each outcome and examined the status for other countries. Multivariate analyses were conducted to adjust potential confounders including in-country variations; adjusted odds ratio (AOR) and 95% confidence intervals (CIs) were reported.Findings: A total of 8559 people participated in this study. Mean age (±SD) was 33 (±13) years and two-thirds (64%) were females. More than one-third (40%) self-identified as frontline or essential service workers. More than two-thirds (69%) experienced moderate to very high levels of psychological distress, which was 46% in Thailand and 91% in Egypt. A quarter (24%) had high levels of fear of COVID-19, which was as low as 9% in Libya and as high as 38% in Bangladesh. More than half (57%) exhibited medium to high resilient coping; the lowest prevalence (3%) was reported in Australia and the highest (72%) in Syria. Being female (AOR 1.31 [95% CIs 1.09-1.57]), perceived distress due to change of employment status (AOR 1.56 [1.29-1.90]), being affected by the change of financial situation, comorbidity with mental health conditions (AOR 3.02 [1.20-7.60]), unsure contact with COVID-19 patient, and use of healthcare services in the last six months were associated with moderate to very high levels of psychological distress. Doctors had higher psychological distress (AOR 1.43 [1.04-1.97]), but low levels of fear of COVID-19 (AOR 0.55 [0.41-0.76]); nurses had medium to high resilient coping (AOR 1.30 [1.03-1.65]). Participants from 10 countries (Hong Kong, Oman, Libya, Kuwait, Saudi Arabia, UAE, Jordan, Syria, Palestine and Egypt) demonstrated significantly higher psychological stress compared to the participants from Thailand. Participants from four countries (Oman, Indonesia, Hong Kong and Pakistan) exhibited higher levels of fear of COVID-19 compared to those from Libya. Participants from 12 countries (Jordan, Egypt, Saudi Arabia, Kuwait, Hong Kong, UAE, Palestine, Thailand, Oman, Nepal, Indonesia and Syria) demonstrated statistically significant medium to high resilience coping compared to those from Australia.Interpretation: Females and people with existing mental health issues were the most vulnerable groups of populations for adverse psychological impact of COVID-19 pandemic across 17 countries. While these two groups had ongoing challenges in a COVID-free world, the pandemic worsened their wellbeing. There is an urgent need to prioritise their needs. Adequate medical and social support along with specific health promotion policies should be considered within the strategic response to the ongoing pandemic and future crises.Funding Information: None.Declaration of Interests: We declare no competing interests.Ethics Approval Statement: Ethics approval was obtained from the Human Research Ethics Committee from each participating country. The survey was voluntary in nature and it was clarified in the PLIS, so that participants got the opportunity to have informed decision to participate in the study. Privacy and confidentiality of the collected data were maintained. All responses were anonymous and there was no information about the identity of the participants.

Factors associated with psychological distress, fear and coping strategies during the COVID-19 pandemic in Australia (preprint)

Background: The COVID-19 pandemic disrupted the personal, professional and social life of Australians with some people more impacted than others. Objectives: This study aimed to identify factors associated with psychological distress, fear and coping strategies during the COVID-19 pandemic in Australia. Methods: : A cross-sectional online survey was conducted among residents in Australia, including patients, frontline health and other essential service workers, and community members during June 2020. Psychological distress was assessed using the Kessler Psychological Distress Scale (K10); level of fear was assessed using the Fear of COVID-19 Scale (FCV-19S); and coping strategies were assessed using the Brief Resilient Coping Scale (BRCS). Logistic regression was used to identify factors associated with the extent of psychological distress, level of fear and coping strategies while adjusting for potential confounders. Results: : Among 587 participants, the majority (391, 73.2%) were 30-59 years old and female (363, 61.8%). More than half (349, 59.5%) were born outside Australia and two-third (418, 71.5%) completed at least a Bachelor’s degree. The majority (401, 71.5%) had a source of income, 243 (42.3%) self-identified as a frontline worker, and 335 (58.9%) reported financial impact due to COVID-19. Comorbidities such as pre-existing mental health conditions (AOR 3.13, 95% CIs 1.12-8.75), increased smoking (8.66, 1.08-69.1) and alcohol drinking (2.39, 1.05-5.47) over the last four weeks, high levels of fear (2.93, 1.83-4.67) and being female (1.74, 1.15-2.65) were associated with higher levels of psychological distress. Perceived distress due to change of employment status (4.14, 1.39-12.4), alcohol drinking (3.64, 1.54-8.58), providing care to known or suspected cases (3.64, 1.54-8.58), being female (1.56, 1.00-2.45), being 30-59 years old (2.29, 1.21-4.35) and having medium to high levels of psychological distress (2.90, 1.82-5.62) were associated with a higher level of fear; while healthcare service use in the last four weeks was associated with medium to high resilience. Conclusions: : This study identified individuals who were at higher risk of distress and fear during the COVID-19 pandemic specifically in the State of Victoria, Australia. Specific interventions to support the mental wellbeing of these individuals should be considered in addition to the existing resources within primary healthcare settings.

Association between symptoms and severity of disease in hospitalised novel coronavirus (COVID-19) patients: A systemic review and meta-analysis (preprint)

Background Symptoms of the novel coronavirus disease (COVD-19) are well known, although asymptomatic cases were also reported due to this rapidly evolving viral disease. However, there has been limited research with inconsistent findings on symptoms of COVID-19 and diseases severity. We aimed to evaluate the association between symptoms and severity of disease in confirmed COVID-19 cases by performing a meta-analysis.Methods We conducted a systematic review by searching four online databases (Medline, Web of Science, EMBASE and Cochrane library) of published studies that included symptoms of COVID-19 cases and severity of the disease between 01-Jan-2020 and 20-Apr-2020. PRISMA and MOOSE guidelines were followed, and only articles published in English were selected. We performed meta-analysis using Mantel-Haenszel random-effects model. Degree of heterogeneity among studies and quality of the selected studies were evaluated.Results Out of 153 articles identified, a total of seven articles, including 3,168 participants, met the inclusion criteria and were included. The median age of the patients was 49 years, 1818 (57.38%) were males, and 574 (18.11%) reported severe conditions. Fever was the most commonly reported symptom in the reported COVID-19 confirmed cases (87.89%, 95% CI: 83.22–81.39%), which was followed by cough, myalgia or fatigue, and less proportionally dyspnea and headache. Dyspnea was the only symptom, which was associated with severity of COVID-19 (OR 2.38, 95% CI: 1.83–3.10).Conclusions Dyspnoea was found to be associated with severity of COVID-19. People with existing respiratory illnesses, such as chronic obstructive pulmonary diseases need to be careful about the onset of such symptom and should seek medical attention.