Corona doubt and scepticism: repression and denial as psychological defence mechanisms to process distress?

After more than a year of pandemic, SARS-CoV-2 (Severe acute respiratory syndrome coronavirus type 2) remains a relevant health care and society issue. Movements doubting the dangerousness or the existence of the virus have emerged and became a challenge to social cohesion. About 3487 individuals (434 Corona doubters and 3053 non-doubters) have participated in an online survey (predominat age group: 35-45 years). Particularly, COVID-19-related anxiety, generalized anxiety (Generalizied Anxiety Disorder Screener, GAD-7), depression (Patient Health Questionnaire, PHQ-2) and functional/adherent safety behaviour were assessed. COVID-19 doubters describe less functional safety behaviour. Fear of the virus is evident, similar to non-doubters. Generalized anxiety and depression were significantly higher in doubters. Repression and denial as psychological defence mechanisms could be the unconscious psychological strategy for coping with the distress variables. The results point out that public strategies may only be successful in managing opinions and beliefs if they address fears and worries.

COVID-19-Related Fear, Risk Perception, and Safety Behavior in Individuals with Diabetes.

(1) The aim of the study is to assess the psychological burden of individuals with diabetes during the COVID-19 pandemic in comparison to matched controls. (2) Over the course of eight weeks, 9 April to 3 June 2020, 253 individuals with diabetes and 253 matched controls, using Propensity Score Matching (PSM), participated in this cross-sectional study. Participants completed an anonymous survey including demographics, depressive symptoms (PHQ-2), generalized anxiety (GAD-7), COVID-19-related fear, risk perception, and safety behavior. (3) While patients with diabetes expected their risk of infection similar to controls, they reported a higher probability of the occurrence of symptoms, severe course, and dying of COVID-19. Patients with diabetes showed no elevated generalized anxiety or depressive symptoms. However, they reported higher COVID-19-related fear and more adherent and dysfunctional safety behavior compared to controls. (4) From a public health view, it seems encouraging that despite the somatic risk condition, generalized anxiety and depression are not higher in patients with diabetes than in controls. Patients with diabetes report higher COVID-19-related fear, increased risk perception, and behavioral changes. This suggests that individuals with diabetes, as a significant risk group of severe COVID-19, show an adequate perception and functional reaction to the current pandemic.

Increased COVID-19-related fear and subjective risk perception regarding COVID-19 affects behavior in individuals with internal high-risk diseases.

Since December 2019, the coronavirus disease-2019 (COVID-19) has been keeping the world in suspense. Proven risk factors for a severe course of COVID-19 are common diseases like diabetes, hypertension, cardiovascular or respiratory disorders. Until today, little is known about the psychological burden of individuals suffering from these high-risk diseases regard to COVID-19. The aim of the study was to define the impact of the coronavirus pandemic on behavior and mental health in individuals at high risk for developing a severe COVID-19 course. Items assessed generalized anxiety (GAD-7), COVID-19-related fear, adherent/dysfunctional safety behavior, and the subjective risk perception of regarding symptoms, having a severe course and dying because of COVID-19. Data were compared between participants with the high risk diseases and individuals without any of those diseases. 16,983 respondents completed the study. Generalized anxiety, COVID-19-related fear, adherent/dysfunctional safety behavior and subjective risk perception were elevated in participants with high-risk diseases. The increased COVID-19-related fear as a functional concern is a conclusion on the increased risk of a severe course. The functionality of the fear is reflected in people's increased need for security and includes an increase in both adherent and dysfunctional safety behavior that underlines the need for psychological support strategies.

Mental Health Burden of German Cancer Patients before and after the Outbreak of COVID-19: Predictors of Mental Health Impairment.

The aim of this study was to analyze individual changes in cancer patients' mental health before and after the COVID-19 outbreak, and to explore predictors of mental health impairment. Over a two-week period (16-30 March 2020), 150 cancer patients in Germany participated in this study. Validated instruments assessed demographic and medical data, depression and anxiety symptoms (PHQ-2, GAD-2), distress (DT), and health status (EQ-5D-3L). All instruments were adapted to measure the individual mental health before the COVID-19 outbreak. COVID-19-related fear, trust in governmental actions to face COVID-19, and the subjective level of information regarding COVID-19 were measured. Cancer patients showed a significant increase in depression and anxiety symptoms and distress, while health status deteriorated since the COVID-19 outbreak. Increased depression and generalized anxiety symptoms were predicted by COVID-19-related fear. Trust in governmental actions to face COVID-19 and COVID-19-related fear predicted increases in distress. Higher subjective levels of information predicted less increasing anxiety symptoms and distress. Present data suggests that cancer patients experienced a significant increase in mental health burden since the COVID-19 outbreak. Observed predictors of mental health impairment and protective factors should be addressed, and appropriate interventions established, to maintain mental health of cancer patients during the pandemic.

Differences and similarities between the impact of the first and the second COVID-19-lockdown on mental health and safety behaviour in Germany.

BACKGROUND: Governmental restrictions of daily life are key elements in reducing the transmission of COVID-19, but they have also put a strain on people's mental health. Preventive policies differ all over the world as well as over different periods of time, and depend mostly on current infection rates. In Germany, there were two periods of restraint of varying severity, during which the government used different combinations of containment and mitigation measures to protect risk groups and to lower the number of hospitalizations. METHODS: In two online studies, we aimed to determine differences and similarities in COVID-19-related fear, generalized anxiety, depression and distress levels, as well as in the adherence to safety behaviour between the first lockdown in March and April and the second lockdown in November. RESULTS: This study showed continued high psychological burden and even increased levels of depression symptoms, as well as less safety behaviour in the second phase of restrictions. CONCLUSIONS: The results hint at a prolonged negative impact on people's mental health and their safety behaviour despite lesser restrictions in the second lockdown, which may be interpreted as pandemic fatigue and hence strengthens the argument for a low-threshold access to psychological care.

[Change in psychological burden during the COVID-19 pandemic in Germany: fears, individual behavior, and the relevance of information and trust in governmental institutions]. / Veränderung der psychischen Belastung in der COVID-19-Pandemie in Deutschland: Ängste, individuelles Verhalten und die Relevanz von Information sowie Vertrauen in Behörden.

BACKGROUND: The potential impact of the COVID-19 pandemic on mental health was evident early on. The extent of the effects, especially cumulative over the long period of the pandemic, has not yet been fully investigated for Germany. OBJECTIVES: The aim of the study was to determine psychological burden as well as COVID-19-related experience and behavior patterns and to show how they changed during the different phases of the pandemic in Germany. MATERIALS AND METHODS: The Germany-wide online-based cross-sectional study (03/10-07/27/2020) included 22,961 people (convenience sample). Generalized anxiety (GAD-7), depression (PHQ-2), and psychological distress (DT) were collected, as well as COVID-19-related experiences and behavior patterns: COVID-19-related fear, trust in governmental actions, subjective level of information, adherent safety behavior, and personal risk assessment for infection/severe course of illness. The pandemic was retrospectively divided into five phases (initial, crisis, lockdown, reorientation, and new normality). RESULTS: Compared to pre-COVID-19 reference values, GAD­7, PHQ­2, and DT levels were significantly elevated and persistent throughout the different phases of the pandemic. COVID-19-related fear, information level, trust, safety behavior, and the risk assessment for infection/severe course of illness showed, after initial strong increase, a strong decrease to partly below the initial value. Exceptions were constant risk assessments of having a severe course of illness or dying of it. CONCLUSIONS: The increased levels of psychological burden, which have persisted throughout all phases of the pandemic, illustrate the need for sustainable support services. Declining values over the duration of the pandemic in terms of trust in governmental actions and the feeling of being well informed underline the need for more targeted education.

Psychosocial emergency care in times of COVID-19: the Essen University Hospital concept for corona-infected patients, their relatives, and medical staff.

Due to the SARS CoV-2-virus (COVID-19), anxiety, distress, and insecurity occur more frequently. In particular, infected individuals, their relatives, and medical staff face an increased risk of high psychological distress as a result of the ongoing pandemic. Thus, structured psychosocial emergency concepts are needed. The University hospital of Essen has taken up this challenge by creating the PEC concept to reduce psychosocial long-term consequences for infected patients, relatives, and medical staff at the university hospital. The concept includes professional medical as well as psychological support to convey constructive coping strategies and the provision of adequate tools such as the low-threshold online training program (CoPE It), which is accessible via the webpage www.cope-corona.de .

Phenotyping mental health: Age, community size, and depression differently modulate COVID-19-related fear and generalized anxiety.

INTRODUCTION: When the first COVID-19 infections were reported in Germany, fear and anxiety spread faster than the pandemic itself. While moderate amounts of fear of a COVID-19 infection may be functional, generalized anxiety and the potentially resulting distress and psychopathology may possibly be detrimental to people's health. Authorities need to avoid a countrywide panic, on the one hand, but foster a realistic awareness of the actual threat, on the other hand. OBJECTIVES: The current cross-sectional study aimed to investigate psychological reactions in response to the real or perceived infection threats. In particular, the analysis should reveal whether COVID-19-related fear and generalized anxiety in times of COVID-19 have distinct correlates. METHODS: A nationwide study was conducted from March 10th to May 4th 2020 in Germany (n = 15,308; 10,824 women, 4433 men, 51 other). Generalized anxiety was assessed using the GAD-7, while COVID-19-related fear was measured using a self-generated item. Both outcome variables were entered into linear regression models. Demographic information, depressive symptoms, trust in governmental interventions, subjective level of information regarding COVID-19 and media use were used to predict generalized anxiety and COVID-19-related fear. RESULTS: The data revealed distinct correlates of COVID-19-related fear and generalized anxiety. Although COVID-19-related fear and generalized anxiety had overlapping predictors, such as neuroticism, they most prominently differed in age distribution and direction of an urban-rural disparity: generalized anxiety decreases with age, but COVID-19-related fear is most pronounced in elderly participants. Generalized anxiety is also more prevalent in rural communities, but COVID-19-related fear is elevated in metropoles. Furthermore, the presence of a risk disease increases COVID-19-related fear, but not generalized anxiety. CONCLUSION: These results suggest that COVID-19-related fear is often justified considering the individual risk of infection or complication due to infection. Some of the characteristics that predict COVID-19-related fear leave generalized anxiety unaffected or show divergent predictive directions. The present findings hint toward two related, but discriminant constructs.

Severely increased generalized anxiety, but not COVID-19-related fear in individuals with mental illnesses: A population based cross-sectional study in Germany.

The COVID-19 pandemic affected individuals, governments, and health care centers all around the globe. Social isolation obligation, restricted working shifts, and curfews posed unprecedented challenges for the population. Social isolation, boredom, and financial problems have been shown to stress peoples' mental health in previous comparable pandemics and even in regular situations. Individuals with a mental illness may particularly be at risk due to an already instable mental health status. While research mainly focused on the pandemic's impact on somatic health care and risk group patients, psychological obstacles caused by legal restrictions and their impact on already mentally affected individuals have been discussed, but so far only scarcely been investigated in a large sample. For this study, 12,028 people completed an online-survey during that time in Germany, when the COVID-19 outbreak gained momentum with a surge in cases and death rates as well as a lockdown of the public life. Generalized anxiety (GAD-7), depression (PHQ-2), distress (distress thermometer) and COVID-19-specific items, especially COVID-19-related fear, were assessed in healthy individuals, patients suffering from mental illnesses, and in patients with chronic somatic diseases, known to be at risk for an unfavorable course of COVID-19. Results show that the COVID-19-pandemic significantly worsens psychometric scores throughout the population - individuals with already heightened levels, like people with mental illnesses now reach concerning levels. Surprisingly, even though generalized anxiety, depressive symptoms, and perceived distress are elevated in individuals with mental illness, these individuals seem to be less affected by explicit COVID-19-related fear, than the general population or individuals with chronic somatic diseases. This study thus objectively quantifies the psychological impact of COVID-19 in a large sample and provides evidence for not only the public, but also critically affected individuals with a mental illness.

Mental Health Burden of the COVID-19 Outbreak in Germany: Predictors of Mental Health Impairment.

INTRODUCTION: COVID-19 is causing an enormous psychological burden for most people. This study aims to assess individual changes in mental health and health status before and after the COVID-19 outbreak, and to explore potential predictors of change. METHODS: A cross-sectional study in Germany (n = 15 037) were conducted. Demographics, depression and anxiety symptoms (PHQ-2, GAD-2), distress (DT), and health status (EQ-5D-3L) were assessed. Additionally, all instruments used were adapted to measure the participants' mental health and health status before the COVID-19 outbreak. COVID-19-related fear, trust in governmental actions to face COVID-19, and the subjective level of information about COVID-19 were examined. RESULTS: Overall, the participants showed a significant increase in depression and anxiety symptoms, and distress, while health status deteriorated since the COVID-19 outbreak. Impairment in mental health was predicted by COVID-19-related fear. Pre-existing mental illness predicted an increase in depression symptoms and a deterioration in health status. Trust in governmental actions and the subjective level of information predicted less increase in psychological burden. CONCLUSIONS: Our data revealed that there have been changes in mental health and health status at an individual level since the outbreak of COVID-19. In order to maintain mental health, the observed predictors should be addressed.

COVID-19-Related Fear and Health-Related Safety Behavior in Oncological Patients.

OBJECTIVE: This study aimed to assess cancer patients' psychological burden during the COVID-19 pandemic by investigating distress (distress-thermometer), health status (EQ-5D-3L), general anxiety (GAD-7), COVID-19-related fear and associated behavioral changes and comparing these to matched healthy controls, using propensity score matching (PSM). METHODS: During the first days of the COVID-19 pandemic in Germany, March 16 to 30, 2020, 150 actually treated cancer patients and 150 matched healthy controls participated in this study. Participants completed an anonymous online survey assessing health status, distress, general anxiety, COVID-19-related fear and behavioral changes (i.e., adherent safety behavior and dysfunctional safety behavior). RESULTS: Cancer patients showed no elevated level of distress, U = 10,657.5, p = 0.428, general anxiety U = 10,015.5, p = 0.099, or COVID-19-related fear compared to healthy controls, U = 10,948, p = 0.680. Both groups showed elevated COVID-19-related fear. Cancer patients reported more adherent safety behavior, such as washing hands more often or avoiding public places, U = 8,285, p < 0.001, d = 0.468. They also reported more dysfunctional safety behavior such as buying larger quantities of basic food, compared to healthy controls U = 9,599, p = 0.029, d = 0.256. Adherent safety behavior could be significantly explained by cancer diagnosis, increased COVID-19-related fear and subjective level of information about COVID-19, R 2 = 0.215, F(3) = 27.026, p < 0.001. CONCLUSION: This suggests that cancer patients are more likely to utilize adherent safety behavior. Cancer patients reported comparable levels of distress and anxiety compared to healthy controls. Still, the COVID-19 pandemic is associated with elevated COVID-19-related fear. Therefore, specific interventions are needed to prevent anxiety and improve mental health during the COVID-19 pandemic.

Sleep disturbances, fear, and generalized anxiety during the COVID-19 shut down phase in Germany: relation to infection rates, deaths, and German stock index DAX.

BACKGROUND: The COVID-19 pandemic impacts the whole world. So far, nothing is known about the course of psychological disturbances, such as fear, anxiety, and sleep disturbances of this pandemic over time in Europe. METHODS: Aim of this web-based survey was to assess the mental health burden of the German public over a period of 50 days after the COVID-19 outbreak. 16,245 individuals responded regarding sleep disturbances, COVID-19-fear, and generalized anxiety disorder (GAD-7). Data were put in relation to infection rates, number of deaths and the German stock index. RESULTS: The specific fear increased rapidly in concordance with infection numbers. However, no relation to the number of deaths was found, COVID-19-fear developed reversed to the stock index. Initially, 13.5% of the respondents reported a reduced sleep quality, and 7.2% a moderate generalized anxiety; proceeding simultaneously with high peaks. Finally, more than twice as many respondents showed psychological burdens. CONCLUSION: The COVID-19-fear decreased within six weeks to the level before the shutdown, indicating a habituation to the threatening situation. However, generalized anxiety remained elevated over time. Sleep disturbances, generalized anxiety as well as economical stock alterations develop in advance to infectiological trends which demands consequent and comprehensible information policies.

Psychological burden of healthcare professionals in Germany during the acute phase of the COVID-19 pandemic: differences and similarities in the international context.

BACKGROUND: Healthcare professionals (HPs) are the key figures to keep up the healthcare system during the COVID-19 pandemic and thus are one of the most vulnerable groups in this. To this point, the extent of this psychological burden, especially in Europe and Germany, remains unclear. This is the first study investigating German HPs after the COVID-19 outbreak. METHODS: We performed an online-based cross-sectional study after the COVID-19 outbreak in Germany (10-31 March 2020). In total, 2224 HPs (physicians n = 492, nursing staff n = 1511, paramedics n = 221) and 10 639 non-healthcare professionals (nHPs) were assessed including generalized anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-2), current health status (EQ-5D-3L), COVID-19-related fear, subjective level of information regarding COVID-19. RESULTS: HPs showed less generalized anxiety, depression and COVID-19-related fear and higher health status and subjective level of information regarding COVID-19 than the nHPs. Within the HP groups, nursing staff were the most psychologically burdened. Subjective levels of information regarding COVID-19 correlated negatively with generalized anxiety levels across all groups. Among HPs, nursing staff showed the highest and paramedics the lowest generalized anxiety levels. CONCLUSIONS: In the context of COVID-19, German HPs seem to be less psychological burdened than nHPs, and also less burdened compared with existing international data.

Increased generalized anxiety, depression and distress during the COVID-19 pandemic: a cross-sectional study in Germany.

BACKGROUND: Since the first cases of the novel coronavirus disease SARS-CoV-2 were reported in December 2019 in China, the virus has spread in most countries. The aim of the present study was to assess initial data on the mental health burden of the German public during the COVID-19 pandemic. METHODS: A cross-sectional study was conducted in Germany and collected complete datasets from 15 704 German residents aged 18 years and over. Besides demographics, generalized anxiety (GAD-7), depression (PHQ-2) and psychological distress (DT) were assessed. Furthermore, COVID-19-related fear, trust in governmental actions to face COVID-19 and the subjective level of information regarding COVID-19 were covered. RESULTS: Significantly increased symptoms were highly prevalent in all dimensions: generalized anxiety (44.9%), depression (14.3%), psychological distress (65.2%) and COVID-19-related fear (59%). Females and younger people reported higher mental burden. Trust in governmental actions to face COVID-19 and the subjective level of information regarding COVID-19 are negatively associated with mental health burden. However, the subjective level of information regarding COVID-19 is positively associated with increased COVID-19-related fear. CONCLUSIONS: The provision of appropriate psychological interventions for those in need and the provision of transparency and comprehensible information are crucial during the current pandemic.

Not all world leaders use Twitter in response to the COVID-19 pandemic: impact of the way of Angela Merkel on psychological distress, behaviour and risk perception.

At a time of growing governmental restrictions and 'physical distancing' in order to decelerate the spread of COVID-19, psychological challenges are increasing. Social media plays an important role in maintaining social contact as well as exerting political influence. World leaders use it not only to keep citizens informed but also to boost morale and manage people's fears. However, some leaders do not follow this approach; an example is the German Chancellor. In a large online survey, we aimed to determine levels of COVID-19 fear, generalized anxiety, depression, safety behaviour, trust in government and risk perception in Germany. A total of 12 244 respondents participated during the period of restraint and the public shutdown in March 2020. Concurrent with the German Chancellor's speech, a reduction of anxiety and depression was noticeable in the German population. It appears that, in addition to using social media platforms like Twitter, different-and sometimes more conservative-channels for providing information can also be effective.

Different Correlates of COVID-19-Related Adherent and Dysfunctional Safety Behavior.

Introduction: Safety behaviors are key elements in reducing the spread of the COVID-19 virus, but have also assumed excessive proportions in form of panic buying groceries. This raises the question whether these behaviors are independent or related to each other. Adherent safety behavior including increased hygiene and physical distancing appears inherently adherent and prosocial, while dysfunctional safety behavior such as panic buying most probably emerges from other motives and contextual variables. Methods: Data from 15,308 participants collected from March 10 to May 4, 2020, during the COVID-19 acute period in Germany, was analyzed to assess whether adherent and dysfunctional safety behavior are predicted by the same or divergent variables. Two multiple regression models are presented including various sociodemographic, trait, attitudinal, and COVID-19-specific variables as predictors. Results: Some variables similarly predict both, adherent and dysfunctional safety behavior. Yet, adherent safety behavior is stronger predicted by COVID-19-related fear than generalized anxiety, while a trend toward a reverse pattern emerged for dysfunctional safety behavior. Adherent safety behavior was also related to higher trust in governmental actions to face COVID-19, subjective level of information, as well as use of public media and TV to remain informed on COVID-19. Higher age was related to dysfunctional, but not adherent safety behavior. Respondents living in rural communities report more adherent safety behavior than urban dwellers. Discussion: Divergent psychological variables underlie adherent and dysfunctional safety behavior. This hints toward a theoretical separation with practical relevance in behavioral engineering and public health campaigning.

Increased Anaplastic Lymphoma Kinase Activity Induces a Poorly Differentiated Thyroid Carcinoma in Mice.

Background: Radioiodine refractory dedifferentiated thyroid cancer is a major clinical challenge. Anaplastic lymphoma kinase (ALK) mutations with increased ALK activity, especially fusion genes, have been suggested to promote thyroid carcinogenesis, leading to development of poorly differentiated thyroid carcinoma (PDTC) and anaplastic thyroid carcinoma. To determine the oncogenic potential of increased ALK activity in thyroid carcinogenesis in vivo, we studied mice with thyrocyte-specific expression of a constitutively active ALK mutant. Methods: Mice carrying a Cre-activated allele of a constitutively active ALK mutant (F1174L) were crossed with mice expressing tamoxifen-inducible Cre recombinase (CreERT2) under the control of the thyroglobulin (Tg) gene promoter to achieve thyrocyte-specific expression of the ALK mutant (ALKF1174L mice). Survival, thyroid hormone serum concentration, and tumor development were recorded. Thyroids and lungs were studied histologically. To maintain euthyroidism despite dedifferentiation of the thyroid, a cohort was substituted with levothyroxine (LT4) through drinking water. Results: ALKF1174L mice developed massively enlarged thyroids, which showed an early loss of normal follicular architecture 12 weeks after tamoxifen injection. A significant decrease in Tg and Nkx-2.1 expression as well as impaired thyroid hormone synthesis confirmed dedifferentiation. Histologically, the mice developed a carcinoma resembling human PDTC with a predominantly trabecular/solid growth pattern and an increased mitotic rate. The tumors showed extrathyroidal extension into the surrounding strap muscles and developed lung metastases. Median survival of ALKF1174L mice was significantly reduced to five months after tamoxifen injection. Reduced Tg expression and loss of follicular structure led to hypothyroidism with elevated thyrotropin (TSH). To test whether TSH stimulation played a role in thyroid carcinogenesis, we kept ALKF1174L mice euthyroid by LT4 substitution. These mice developed PDTC with identical histological features compared with hypothyroid mice, demonstrating that PDTC development was due to increased ALK activity and not dependent on TSH stimulation. Conclusion: Expression of a constitutively activated ALK mutant in thyroids of mice leads to development of metastasizing thyroid cancer resembling human PDTC. These results demonstrate in vivo that increased ALK activity is a driver mechanism in thyroid carcinogenesis.